VISUAL ART AND HEALTH

perception “of” healthcare art

UPALI NANDA, PHD,

ASSOC. AIA, EDAC
VICE PRESIDENT, DIRECTOR
OF RESEARCH
AMERICAN ART
RESOURCES
ROLE OF ART
Integral Part of Architecture
& Design

Prominent point of focus

Not limited to “framed”

pictures on the wall.

With new media boundaries

between art and
architecture are becoming
fused
WHAT IS “ART”

Not my question to answer……

WHAT ART CAN
DO

POWER TO HEAL
• VISUAL IMAGES
POWER TO HARM
HAVE A DIRECT
IMPACT ON HEALTH
WHY DO WE IMPACT ON THE BOTTOM
CARE? LINE
AAR CASE STUDIES
• Patients who had a window view requested less
analgesics, and spent less time in the hospital
(Ulrich, 1984)12.

• Women in a labor and delivery unit had an

average 2.1 hours less of delivery time, and
requested less epidural, when visual art was
designed on a screen in the room (Staricoff,
2004)14.

• Patients made less front desk queries in an

Emergency Department waiting room after art
was installed (Nanda, in press).
IMPACT ON THE
BOTTOMLINE • PRN medication rates were significantly
AAR CASE STUDIES lower for psychiatric patients on days
when a realistic nature image was
placed in the patient lounge, projecting
an annual savings of approximately
$27,000 (Nanda et. al., 2011)
PAIN • Burn patients viewing a nature video with sound
PERCEPTION reported significantly less pain compared to the
control group with no video (Miller, 1992)2.

• Nature murals and nature video when shown to

patients before, after, and during a flexible
bronchoscopy significantly reduced pain (Diette et.
al., 2003)3.

• Nature images using prospect/refuge elements

were shown in a simulated hospital patient room
and resulted in lower sensory pain responses
(Vincent, et al., 2010)4.
 • Students working on a task in a simulated
ANGER & office environment reported less anger
when nature art was hung on the wall than
AGGRESSION compared to no art, abstract art, or mixed
art on the wall (Kweon, et al, 2008)9.

• PRN medication rates, prescribed as needed

for visible signs of aggression, were
significantly lower for psychiatric patients
on days when a realistic nature image was
hanging in the patient lounge (Nanda et. al.,
2011)10.

• Patients with dementia appeared to show

less aggressive agitated behavior after
incorporating large color images and a
nature sound track to a shower area (Whall
et. al., 1997)11.
STRESS & • Patients had a systolic BP levels 10-15 pts
lower while viewing non-arousing nature
ANXIETY images than while viewing arousing, and
aesthetically pleasing nature images (Coss,
Highly Vulnerable Contexts 1990)5.

• Stressed blood donors had lower pulse rates

and blood pressure when exposed to nature
video versus daytime TV (Ulrich, Simmons, &
Miles, 2003)8.

• Patients experienced less anxiety when

exposed to an image of a nature landscape
with high depth of field than compared to a
landscape image without depth of field, or
abstract art. Abstract art with rectilinear
forms worsened outcomes (Ulrich, 1993)6.
DIGGING DEEPER

Neuroscience study on the impact

of contours
– Curved contours preferred
– Sharp contours activate
Amygdala (fear center) to a
FEAR greater degree.
– Bar et al., 2008
 “I Think, I Reason”
THE PERCEPTUAL Aesthetic
Judgment
CONTEXT

“I Feel, I React”
Fight or
Flight
DANGEROUS
LEAP OF FAITH Nature: Good

Culture?
Context: Age/ Space?

Composition?
Color?
Abstract: Bad
Scale?
Location?
Line of Sight?

BIAS?
 EXISTING GUIDELINES FOR APPROPRIATE HEALTHCARE
GUIDELINES AND ART:
• Waterscapes:
DEBATES Calm or Non-turbulent Water
• Landscapes:
– Visual Depth or open foreground
– Trees with broad canopy
– Savannah Landscapes
– Verdant Vegetation
Evolutionary theory – Positive cultural artifacts (e.g. barns and older
houses)
Prospect and Refuge
Elements • Flowers
– Healthy and Fresh
– Familiar
– Gardens with open foreground
• Figurative
– Emotionally positive faces
– Diverse
– Leisurely
(Ulrich et al. 2003)
PERCEPTION
SHAPED BY
CONTEXT Highest Rated in Acute Care Patients

THEORY:
EVOLUTIONARY THEORY
EMOTIONAL CONGRUENCE
HEORY

RESEARCH PRIORITIES:
CHOOSING AN
APPROPRIATE
YARDSTICK
ADDRESSING RESEARCH
BIAS
Rated Low in Pediatrics, and in Long Term Care
PERCEPTION SHAPED • Experienced art viewers (experts)
BY EDUCATION – Preferred art that was intellectually challenging
(more emotionally provocative)
– Disagreed with the notion that art should
produce positive feelings in the general public
– Preferred more challenging styles (i.e. abstract
and representational images)
Winston and Cupchick (1992)

• Significant correlations were found between the

level of art education (or involvement with the arts)
and positive ratings for abstract or pop art
paintings.
– Increased exposure like increases ones understanding
of art.

© Kandinsky

Furnham and Walker (2001)

 • FORM VS. STYLE
PERCEPTION SHAPED
BY EDUCATION
Degree of realism is less important for art
students than non-art students
O’Hare (1976)

Psychology students describe paintings using

semantic features (content) over formal elements

The opposite holds true for art students—describing

things like style and artist intention Schmidt et al. (1989)

Experts rate the overall quality largely based on

originality whereas non-experts do not.
Hekkert and Van Wieringen (1996)
© Henry Membreno

Vincent Van Gogh

 • Eye tracking study with photo collages
(containing both abstract and figurative elements)
PERCEPTION SHAPED
BY EDUCATION – Non-experts: clustered around figurative
elements
– Experts: showed preference for graphic
composition and color contrast
Vogt (1999)

• Follow up study showed:

– Non-experts: preference for viewing human
features and familiar objects
– Experts: pictorial view mode- preference for
structural and abstract features
– Familiar objects were viewed less by expert
group

Vogt and Magnussen (2007)

Vincent Van Gogh

PERCEPTION • All “most wanted” * paintings included
SHAPED BY nature image with water and some
CULTURE figurative content (people or animals)
In a survey across more
than a dozen countries,
artists Komar and Melamid
found that people across
cultures prefer realistic
paintings that make them
happy and relaxed.

*with the exception of Holland

PERCEPTION SHAPED • East Asians preferred more context
BY CULTURE inclusiveness by having significantly
higher horizon lines than Westerners.

• East Asians were also more likely to

include contextual information at the
expense of the figure in the scene,
whereas Westerners were not.
Masuda (2008)

Vincent Van Gogh

 • ART PREFERENCE STUDY ACROSS
ART, CULTURE AND – USA (UTSA, SAN ANTONIO). 200 students.
EDUCATION STUDY – MEXICO (UNAM, MEXICO CITY). 200 students.
– SINGAPORE (NUS, SINGAPORE). 200 students.

DO PREFERENCES VARY BY • STUDENTS- DESIGN (Architecture) AND NON-

DESIGN (Psychology and Sociology)
EDUCATION
CULTURE
CONTEXT
EMOTIONAL RESPONSE/
SELECTION Dr. Ruzica Bozovic-Stamenovic Dr. Irina Solovyova Dr. Patricia Ortega Andeane
National University of University of Texas, San Universidad Nacional
Singapore Antonio Autonoma de Mexico
ART, CULTURE AND • SURVEY INSTRUMENT
EDUCATION STUDY • Set of 37 Images Selected
IMAGE CATEGORIES:
Based on Evidence Based
Guidelines
– Culture Counterparts
LANDSCAPES
– Abstract Contrasts
FLORALS
•Questions:
FIGURATIVES (HUMAN
FIGURES) • How does this picture make you feel?
CULTURAL ARTIFACTS – Much Better
– Better
ABSTRACTS – No Difference
– Worse
– Much Worse

• Would you put this picture in your room?

CAN EMPATHY –
–
Definitely
Probably
INFLUENCE –
–
Not Sure
Probably Not
PREFERENCE? – Definitely Not
PROJECTION………………..
Now, imagine yourself in a
hospital room.

You are alone and there is no

family or friends with you
at the moment.

You are waiting for the

doctor and on the wall in
front of you is a picture.

Please rate the following

images with this scenario
in mind.
CONTENT STYLE EVIDENCE-BASED

Savannah Realistic-Photographs Waterscapes

Waterscapes
Flowers Realistic- Paintings Landscapes
Figurative (group)
Figurative (couples) Stylized Positive Cultural Artifact
Figurative (women-solo)
Figurative (friends) Abstract Representational Flowers/Gardens
Positive Cultural Artifact
Abstract (pure) Abstract Figurative Art
Abstracted (with content)
 CULTURE
ANALYSIS (3)
Mexico,
REGRESSION (4 FACTOR) TO EXPLAIN Singapore,
Texas
VARIANCE IN THE OVERALL DATA

REGRESSION (2 FACTOR: CULTURE,

CONTEXT) TO COMPARE VARIANCE IN
THE FEELING AND SELECTION DATA FOR EDUCATION
EACH DISCIPLINE CONTEXT (2)
(2)
2 WAY ANOVA- CULT V. EDUCATION- TO Room FACTORS
Design
COMPARE THE EFFECT OF CULTURE V Hospital
Psych/Socio
EDU FOR EACH QUESTION.

2 WAY ANOVA- CONTEXT V. QUESTION-

COMPARE THE EFFECT OF CULTURE V
EDU FOR EACH GROUP
EMOTION
(2)
CORRELATION BETWEEN FEELING AND Feeling/
SELECTION RATINGS FOR SPECIFIC Selection
GROUPS OF IMAGES
 CULTURE
ANALYSIS 2ND LARGEST EFFECT
NO CONSISTENT TREND
4 FACTOR REGRESSION 34/37

ANALYSIS

CONTEXT FACTORS
EDUCATION
SMALLEST EFFECT
3RD LARGEST EFFECT NO CONSISTENT
NO CONSISTENT TREND TREND
28/37 21/37

EMOTION

LARGEST EFFECT,
FEELING > SELECTION

37/37
 IMAGE ART TITLE AND STYLE IMAGE DESCRIPTION RESPONSE SUMMARY- 4 FACTOR
ARTIST Culture Education Context Question

P01 A Sunday Representation Painting of a lush X X H>R F>S

Afternoon on al/ Stylized green picnic scene
the Island by with a background of
Seurat water and many
people. A period piece.
P02 Starry Night by Abstract Painting of a UNAM>NUS ND>D R>H F>S
Van Gogh Representation tumultuous night seen
al with bold brush
strokes
P03 Dahlia, Mexico Realistic Photograph of a Dahlia UNAM>NUS X H>R F>S
from Photograph flower- close-up with
Istockphoto bright green
background
P04 Vector Image Abstract Image of a single Asian NUS>UNAM, ND>D X F>S
from Representation woman with white UNAM>UTSA
Istockphoto al face sitting at a table in
room with a blue floor
P05 Xochimilco Realistic Photograph of Mexican UNAM>NUS X X F>S
Canals in Photograph boats on a river with
Mexico City by hanging trees
Clinker
P06 Convergence by Abstract/ Non- Abstract painting with UNAM>NUS, D>ND R>H F>S
Jackson Pollock representation chaotic, rectilinear UTSA>UNAM
al brush strokes using
dull/dark colors
 • OVERALL RATINGS WERE HIGHER
MEXICO
• ABSTRACT REPRESENTATIONAL
TWO FACTOR ANOVAS
FIGURATIVE ART RATED HIGHER
 • OVERALL RATINGS WERE LOWER
SINGAPORE
• EAST ASIAN CONTEXT RATED
TWO FACTOR ANOVAS
HIGHER

• FIGURATIVE ART WITH

CONTEXTUAL INFO RATED
HIGHER
DESIGN > NON- • ABSTRACT IMAGES
DESIGN • URBANSCAPES
TWO FACTOR ANOVAS
NON-DESIGN> • FIGURATIVE ART
DESIGN
TWO FACTOR ANOVAS
SOME
UNIVERSALS
AND THE ISSUE OF
FIGURATIVE ART
 KEY
OTHER EVIDENCE-BASED ABSTRACT ABSTRACT NON-
IMAGE REP REP

RANKINGS TOP RANKED IMAGES- DESIGN STUDENTS

ROOM FEELING HOSPITAL FEELING ROOM SELECTION HOSPITAL SELECTION
UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA
DESIGN VS. NON-DESIGN P10 P07 P10 P10 P07 P10 P10 P07 P10 P10 P07 P10
P19 P10 P19 P19 P10 P19 P37 P10 P32 P19 P10 P19
EBD VS, ABSTRACT P07 P19 P07 P07 P19 P27 P19 P37 P37 P27 P20 P27

TOP RANKED IMAGES- NONDESIGN STUDENTS

ROOM FEELING HOSPITAL FEELING ROOM SELECTION HOSPITAL SELECTION
UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA
P10 P07 P10 P19 P07 P10 P10 P07 P02 P10 P07 P10
P07 P10 P07 P10 P34 P27 P02 P10 P10 P07 P34 P27
P19 P19 P19 P07 P14 P19 P19 P19 P19 P27 P19

BOTTOM RANKED IMAGES- DESIGN STUDENTS

ROOM FEELING HOSPITAL FEELING ROOM SELECTION HOSPITAL SELECTION
UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA
P29 P29 P28 P11 P29 P13 P05 P05 P05 P11 P11 P28
P28 P11 P29 P29 P11 P28 P35 P36 P35 P29 P29 P11
P28 P15 P06 P13 P11 P33 P29 P26 P15 P13 P13

BOTTOM RANKED IMAGES- NONDESIGN STUDENTS

ROOM FEELING HOSPITAL FEELING ROOM SELECTION HOSPITAL SELECTION
UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA UNAM NUS UTSA
P25 P06 P28 P06 P11 P11 P36 P05 P26 P06 P11 P11
P28 P29 P04 P11 P06 P28 P30 P36 P30 P11 P06 P28
P28 P25 P29 P13 P33 P06 P05 P28 P05 P05
CORRELATION DESIGN ROOM HOSPITAL
STUDENTS
BETWEEN FEELING AND
ABSTRACT LOW HIGH
SELECTION RATINGS CORRELATION CORRELATION
ABSTRACT VS. EVIDENCE-
BASED EVIDENCE- LOW HIGH
BASED CORRELATION CORRELATION

NON-DESIGN ROOM HOSPITAL

STUDENTS
ABSTRACT HIGH LOW
CORRELATION CORRELATION

EVIDENCE- LOW HIGH

BASED CORRELATION CORRELATION

Least preferred Most preferred

 • Most preferred image, across cultures,
supports previous research
Conclusions • Issues of style, and composition,
influence cultural preferences

• Design students are more comfortable

with pure abstracts than non-design
students
• Non-design students are more
comfortable with images depicting
people
• Design students can adapt selections
based on context, and have a better
grasp on hypothetical contexts
 • Projection is an effective tool in design
Implications decision making- students can make a
distinction between personal selection and
what they would select for hospital rooms.
Empathy is key
• Emotional responses drive selection for
hospitals, selection is based on empathy

• Our educational and cultural background

biases our preferences, particularly in the case
of figurative art

• Preferences for art may vary across cultures,

and should be taken into account while
selecting art. The final stake-holder, the
patient, should be involved in art selection, as
they are in the rest of the design.
ART IN The greatest enemy of
HEALTHCARE knowledge is not ignorance,
it is the illusion of knowledge

FIRST DO NO HARM
QUESTIONS??????
UPALI.NANDA@AMERICANARTRESOURCES.COM