Sachs, Naomi (2017-08). The Healthcare Garden Evaluation Toolkit: A Standardized Method for Evaluation, Research, and Design of Gardens in Healthcare Facilities. Doctoral Dissertation. Thesis uri icon


  • As healthcare organizations and designers accept, and even embrace, healing gardens and other natural spaces as modalities for promoting the health and well-being of patients, visitors, and staff, the spaces provided must be designed and programmed to best optimize user health outcomes. Valid, reliable research instruments can aid in the evaluation of existing spaces. They can also be used as guides and tools for future design and research. The Healthcare Garden Evaluation Toolkit (H-GET) is a set of four standardized instruments developed for use, individually or in combination, by researchers, designers, and healthcare providers to evaluate, design, and research gardens in general acute care hospitals. Evaluation is an important component of research on the designed environment, and is a critical part of evidence-based design. The more valid and reliable the instrument, the greater the likelihood that results will be credible and generalizable. To date, despite a clear need, there are no rigorously tested, validated instruments available for the evaluation of outdoor spaces in general acute care hospitals. The H-GET fills this need. This mixed methods study involved development and testing of the four H-GET instruments: (a) the Garden Assessment Tool for Evaluators; (b) Staff and Patient/Visitor Surveys; (c) Behavior Mapping protocol ; and (d) Stakeholder Interviews. All four instruments were tested at eight Pilot Test sites across the United States. Emphasis with data collection and analysis was on establishing instrument reliability and validity. Data from each instrument were analyzed, and data from the four instruments were triangulated to examine support for validity and to explore specific hypotheses about physical and programmatic factors that promote garden use and user satisfaction. Through H-GET pilot testing, a Healthcare Garden Evaluation Method (HGEM) emerged--a methodological process that the individual instruments facilitate in a rigorous, standardized, research-based format for future studies' design, protocol, data collection, data analysis, and dissemination of findings.

publication date

  • August 2017