Socio-Spatial Ward Design and Perceived Therapeutic Benefits of Outdoor Environments in Nigerian Psychiatric Hospitals

Abstract

While environmental psychology theories support the therapeutic potential of the outdoor environment in hospitals, studies are predominantly from Western cultures. Little is known about such associations in a socio-culturally and economically diverse setting. This study investigated the influence of patient characteristics and ward attributes on patients' perceptions of the therapeutic value of outdoor environments in four tertiary psychiatric hospitals in southeastern Nigeria. Using a quantitative cross-sectional design, data were collected from 123 inpatients with three validated tools and analyzed using quantile regression: the Inpatient Demographic and Admission Self-Report Questionnaire, the Socio-Spatial Ward Attribute Checklist, and the Perceived Influence of Ward Attributes on Outdoor Therapeutic Experience Scale. Quantile regression analysis revealed that specific ward attributes, including layout, dominant outdoor view, social density, outdoor access modality, and nursing station configuration, were significant and meaningful predictors of perceived therapeutic value. In contrast, patient characteristics such as age, length of stay, and history of admissions were non-significant predictors, while gender had a statistically significant but negligible practical influence. This reinforces the dominant role of spatial design in deriving therapeutic value from outdoor environments, but with nuanced interpretations. Findings contribute to an emerging discussion on privacy and restorativeness, highlighting social dynamics in shared psychiatric wards and a conditional preference for grey outdoor views. The study offers context-specific, evidence-based design guidance for low-resource mental health systems seeking to enhance autonomy, dignity, and recovery through socially and culturally relevant environmental interventions.