Iran Red Cres Med J.2012;14(8).in press
The Effect of Gender, Age, and Nationality on the Personal Space Preferences
in Children’s Hospitals among Iranian and German Children and Adolescents
Sanaz Litkouhi 1, Masoud Geramipour 2, Sachli Litkouhi1
1
2
Department of Architecture, Payam Noor University, Tehran, IR Iran
Allameh Tabatabaii University of Tehran, Tehran, IR Iran
Abstract
Background: Patients in the therapeutic environment worry about their health and therapy; they are away from their usual social
activities, and these entire put a great deal of stress on them, and delay their therapy by affecting their immune system and
reducing their spiritual power.
Objectives: The present study seeks to investigate the effect of gender, age, and nationality of children on their personal space
preferences during hospital stay in children’s hospitals the dependent variable, i.e., personal space preference, was measured in
hospital rooms with or without a barrier to separate children’s beds. (Barriers could be curtains or walls).
Patients and Methods: The research method was descriptive survey research, and the participants included 120 Iranian children
staying at Tehran children’s hospitals and 104 German children staying at Stuttgart’s children hospitals, who were chosen
through stratified random sampling.(in all wards except infectious wards) The data was gathered through self report
questionnaires and analyzed conducting categorical methods of Logic Log Linear Analysis and Logistic Regression methods
using the SPSS software.
Results: The results show that Iranian children, contrary to German children, prefer a space without any barrier, and that girls
prefer closed spaces more than boys. Regarding the age, it was revealed that children and adolescents have nearly similar
preferences. Finally, remarkable differences were found among groups with regard to their desired kind of barrier.
Conclusions: Preferring a space without a barrier, which provides more chances for social interaction among individuals, shows
that the majority of children prefer to have social interactions and contacts in the hospital that is in line with the results of similar
studies. Last preference (separating the beds with curtains) was not generally favored by the respondents, which is in line with the
results of similar studies in 2006.
Keywords: Demographic Statistics, Hospitals, Pediatric, Personal and Inter-personal Spaces
Article Type: Original Article
Article History
Received: 14 Mar 2011
Revised: 11 Sep 2011
Accepted: 17 Sep 2011
Please cite this paper:
Litkouhi S, Geramipour M, Litkouhi S. The Effect of
Gender, Age, and Nationality on the Personal Space
Preferences in Children’s Hospitals among Iranian
and German Children and Adolescents, Iran Red
Cres Med J. 2012:14(8):in press.
Corresponding Author
Sanaz Litkouhi, Department of Architecture, Payam Noor University, Tehran, IR Iran, Post Box: 16845-179, Tel-Fax: +982188710046, Mobile: +98-9122033813
Environment and Healing
1. Background
The current study is an attempt to examine
Patients in the therapeutic environment
the
worry about their health and therapy; they
demographic
are away from their usual social activities,
gender and age, as main criteria in spatial
and all of these put a great deal of stress on
planning of therapeutic environment of
them, and delay their therapy by affecting
hospitals, and also Iranian and German
their immune system and reducing their
nationalities to find cultural differences
spiritual power (1). Regarding children, this
regarding children’s spatial preferences.
causes a much bigger problem as they have
3. Patients and Methods
less compatibility with the environment, and
3.1. Review of the Literature
less ability to analyze the problems. So, to
Personal space means the limits within an
reduce these problems, we can facilitate the
individual’s surrounding environment which
child’s compatibility process with the
is determined by unseen boarders. One is
therapeutic environment , and reduce the
irritated by the presence of anybody in this
negative effects of the environment on their
particular
therapy
the
necessarily round in shape, and does not
environment according to his/her desire,
expand in the same extend from all its
This is economically beneficial for the
dimensions (3). Gafman proposed another
hospital as it reduces the period of the
definition for personal space, i.e., “the space
child’s hospital stay (2). With regard to the
around a person to which the entrance of
population pyramid of Iran and the fact that
another person is considered as violating
a great number of children and adolescents
her/his limits, which causes irritation, and
are hospitalized before beings adults, and
even abandonment”. One of the most
that the existing strategies in other countries,
remarkable views regarding personal space
due to cultural differences, cannot be
belongs to Hall, who describes it as
adopted exactly to be used in our country, it
proxemics when examining the relationship
seems that examining the effects of hospital
between humans and space in his book,
stay on children and adolescents, and also
called “The Hidden Dimension”. In his
optimizing
classification of spaces, personal space
process
the
by
present
designing
strategies
is
relationship
between
children’s
characteristics,
including
space.
This
space
is
not
absolutely necessary.
distance occurs in the second part, after the
2. Objectives
intimacy distance. In one of the chapters,
Environment and Healing
entitled “Distance in Men”, regarding the
psychological and social characteristics of
formless space, Hall notes that, “Not only do
people in different cultures and countries,
birds and mammals have a land that they
some
occupy and protect it against their own kind,
concentrated
but they also keep some fixed distances
personal distance. The results indicate that
among themselves. Hydger has classified
there are fundamental differences among
these distances as runaway distance, critical
cultures
distance, personal distance, and social
personal distance, the distances they keep,
distance. Humans also have similar ways to
the form of the territory, and their
keep distance from others. The runaway
interpretations of intimate behavior. Among
distance and the critical distance, except for
other effective indices we can refer to the
a few cases, have been deleted from human
perception of space, interpersonal behavior,
reactions. Yet, the personal and social
and the extend of individualism:
distance clearly do exist. Now the questions
Space: Dolphin has studied the use of space,
are: How many different distances between
as another aspect of human interaction, in
humans exist? And how do they distinguish
different cultures. The resultant hypothesis
one from the other?” According to Hall,
is that the use of space by an individual is a
humans consider space not as something
message, transferring a meaning to others
static based on the linear perspective of
around him/her. One’s perception of space
Renaissance, but something dynamic. He
and its use is directly related to his/her
maintains that an incorrect understanding of
culture, which is discussed in Dolphin’s
space can be due to two main factors: One is
article entitled “Personal space Variables in
that we always try to find one specific cause
Cultural
for any effect; the other factor is that we
Dolphin, culture is more than an individual’s
consider the beginning and end of human
hometown, and the age, gender, relationship,
limitations the same as his/her physical body
environment, and ethnic group are all
(4). One of the most important indices of
important
determining
interaction (6).
the
distance
between
of
which
on
have
the
regarding
the
Interactions”.
in
one’s
factors
specifically
affecting
application
According
of
to
communicative
individuals is their cultural characteristic (5).
3.2. Interpersonal Behavior: Immediacy and
In this regard, a number of inter-cultural
Expressiveness
studies have been carried out on the
Environment and Healing
In
discussing
cultural
influences
on
Europe such as Scandinavian countries,
subjective wellbeing, Triandis has proposed
Germany, England, Russia, and also Japan).
the concept of "Person-Environment Fit
The geographical differences include energy
"Having a personality which matches the
level, climate, and body metabolism. The
values of the overarching culture should
culture of cold areas is clearly work-
increase subjective wellbeing, while a
centered and “cold” regarding interpersonal
mismatch will decrease it (7). Another factor
relations, whereas the culture in warm areas
in determining the intimacy and distance
is relation-centered and “warm” (8).
between
individuals
3.3. Individualism
behavior.
Intimate
is
interpersonal
behaviors
transfer
One of the fundamental cultural differences
sociability, closeness, and readiness for
is the degree of individualism as opposed to
communication. They show willingness
collectivism.
against avoidance, and intimacy against
determines the way people live with each
abandonment. Some examples of intimate
other (alone, in a family, or in a tribe), their
behaviors are smiling, touching, eye contact,
values, and their relations. Western culture
close distance, and voice changes. Some
is an individualistic culture, whereas eastern
researchers consider these behaviors as
culture
“meaningful”. The cultures in which there is
relationship among people and between
a lot of interpersonal intimacy and closeness
people and nature. Those in favor of
are called” Contact Cultures”
individualism consider it as the basis of
because
This
cultural
emphasizes
dimension
homogeneity
and
people in these countries stand close to each
liberalism,
other, and usually touch each other. People
economical motivation, and a protective
in Less Contact Cultures stand within a
factor against cruelty. On the other hand,
distance from each other and occasionally
individualism
touch each other. It is interesting that
alienating people from each other, causing
Contact Cultures are usually in countries
loneliness, egoism, and proud. People in
with warm weather (e.g., Arabian countries,
individualistic cultures isolate from each
countries in Mediterranean zone such as
other whereas in collectivist cultures, they
France, Greece, Italy, Spain, East Europe) ,
have relations with each other, and as a
and Less Contact Cultures in countries with
result their work, entertainment, life, and
cold weather ( e.g., parts of the north of
rest all happen at a closer distance from each
democracy,
has
been
free
will,
criticized
and
for
Environment and Healing
other. (9). People in individualistic cultures
on children’s personal space. In this study,
smile more than people in collectivist
some differences were found between the
cultures. This can be due to the fact that
preferences of 3 and 5-7 years old children
individualistic people consider themselves
with regard to personal space. It was also
responsible for their own relations and
revealed that girls, in comparison with boys,
happiness, whereas in collectivist cultures
stand closer to each other (14). In a study,
people consider accepting norms as the most
regarding the effect of class organization on
important value, and the individual or
personal space preferences of students,
interpersonal happiness as the secondary
Brody and Zimmerman concluded that the
value (10). In the other hand individualists
class organization has an effect on personal
frequently think of self-reliance as being
space preferences of students, and that
able to pursue their own goals while for
children in open- area classes prefer closer
collectivitists self-reliance means not being
personal space than traditional classes (15).
a
(11).
Another part of the studies has concentrated
Industrialized nations such as United States,
on the privacy in therapeutic environment,
England,… are regarded as individualistic
the debate over the role of privacy in patient
while developing regions such as Africa,
well-being and particularly in the context of
Chine, typically have traditional values and
the architecture of the patient room, has a
are collectivistic (12). Another part of
long history within the history of the
studies regarding personal space include
hospital (16). As privacy and personal
those
specific
control lighting levels, spatial props, view,
environments. For example, a study on the
and so on believed to influence patient
university and high school environments
outcomes (16). Privacy (in hospital) is an
reveals the effect of gender and age on
umbrella condition or state consisting of the
personal space in these environments.
sum total of five interrelated dimensions:
Tennis and Dabbs indicated that university
auditory privacy (sound), visual privacy
students as compared to high school students
(sight),
tend to have more personal space (13). Other
privacy (personal space) and olfactory
studies show that males prefer larger
privacy (smell) (17). In the other hand
personal space than females. Lomranz and
cognitive and spatial control is highest when
his team studied the effect of gender and age
the patient and family are in space of their
burden
on
one's
concentrating
in-group
on
tactile
privacy
(touch),spatial
Environment and Healing
own, undisturbed by outsiders, and where
aged between 12 to 14, about physical
persons unfamiliar to the patient and family
designing and visual characteristics of
do not share the same zone of personal space
hospitals. They also studied the adolescents’
(18).
preferences regarding the existence of
Geden and Begeman who studied the
solitary, hospital space, entertainments and
personal space preferences during hospital
leisure activities, public spaces, and visiting
stay. This study reveals some differences
hours. The study indicated that in hospitals,
personal space preferences of hospitalized
the sense of personal control is in danger,
adults. Here, the preferred personal space in
but through designing we can help patients
interacting with nurses, doctors, and family
to specify their personal boarders, and feel
members and the effect of gender and age on
that they a private space. This is specifically
personal space preferences has been studied.
important for adolescents considering their
The results show that the personal distance
specific characteristics regarding their age.
of patients from their family members is
In this study, the adolescents were required
smaller than the distance from doctors and
to indicate the items which they considered
nurses, and that the age and gender variables
important in having privacy in hospital; 96%
normalize this relationship (19).
of the adolescents mentioned having private
Another research indicates that children
bath, 89% having single room, and the
naturally tend to establish social relations,
possibility of closing the door of the room,
and that forming peer groups, especially for
which indicate their need for privacy and
adolescents in the hospital, is of utmost
solitude. Studies show that this sense
importance (20). The NAWCH study, done
extremely changes in adolescents from the
in 2001, concludes that it is absolutely
age of 11 to 13. 82% of adolescents
crucial to pay attention to the social needs of
preferred to wear comfortable clothes which
adolescent
the
covered all their body. Even some of them
appropriate design of the hospital to promote
liked to bring their own pajamas to the
social
hospital, which all indicate that adolescents
patients,
interactions
emphasizing
of
children
and
adolescents.
tend to have privacy and control, and a sense
Another remarkable research in this case has
of
been done by Devlin and Blumberg,
Regarding
studying the views of 54 boys and 46 girls,
adolescents are shy, and do not like the short
individuality
their
in
their
sexual
peer
group.
characteristics,
Environment and Healing
clothes of the hospital which are open in the
also their lack of ability in responding to
back, and aggravate these negative feelings.
questions orally, the answers of graphic-
Strategies, such as pulling curtains around
based questionnaires have more reliability
the beds to provide privacy, were only
than other kind of questionnaires.
accepted by 28% of adolescents (1).
The face validity and content validity of the
3.4. Methodology
questionnaire used in the interview were
The present study is a descriptive- analytic
confirmed by child psychology experts
(non- experimental) research regarding the
before
method of data gathering. It is also a
Considering the limitation of doing the
demographic
Moreover,
research in all cities of Iran and Germany,
considering the purpose of the research, this
the research population is delimited to the
study is an applied research. Measurement
children hospitals in Tehran and Stuttgart.
Instrument: To obtain children’s viewpoints
The sample was selected from different
and
wards
research.
preferences
based
on
research
its
of
implementation.
children
hospitals
Sample:
(except
objectives, a questionnaire for children was
infectious wards). The sample under study
constructed. The questionnaire was easy
included 106 girls (47.3%) and 118 boys
enough to understand and to answer by
(52.7%). the sample included 120 (53.6%)
children especially for sick children because
Iranian
of
children’s
their
special
conditions.
This
children,
hospitalized
hospitals
of
in
Tehran,
the
and
questionnaire were developed in two Iranian
104(46.4%) German children hospitalized in
and Deutsch language formats for sick
the hospitals of Stuttgart. The sample size
children with 2 major questions about
estimated based on Cochran formulae with
barriers and type of them(curtain, wall or
accepting error magnitude of 0.1. Stratified
nothing) and demographic characteristics of
random sampling was applied to select the
the children(gender, age group, nationality).
children in which at first the city partitioned
There
in
into four geographical direction (North,
constructing questionnaire due to children’s
South, West and East) and then about %70
characteristics: The first was limiting the
of the hospitals randomly selected from each
number of questions and the second one was
direction and at last in each hospital children
designing questionnaire graphically. Due to
were randomly and proportionally selected
children’s problems in imagining space and
based on sample size Also, the sample
were
some
considerations
Environment and Healing
included 135 (60.3%) children aged 6 to 11,
dependent variable at two levels, with
and 89 (39.7) adolescents aged 12 to 16.The
barrier and without barrier, collapsed, and
data was gathered in 2006-7.
the effect of independent variables on it
4. Results
were examined using Logistic Regression.
In order to investigate the effect of gender,
The results of the Logit Log Linear
nationality, and age group, as independent
Analysis, to investigate the corresponding
variables, on the space preferences during
relationship
between
hospital stay, the dependent variable was
variables of
gender, nationality, and age
studied from two approaches. First, to
group, and space preferences (wall, curtain,
examine the exact kind of the barrier (wall
or without a barrier) as indicated in Table 1
or curtain) or without a barrier, Logit Log
a model with an appropriate Goodness of fit.
the
independent
Linear Analysis was carried out. Then, the
Table 1: Parameter estimates of Logit Log Linear
Curtain Choosing
Wall Choosing
No barrier
Choosing
Curtain, 6-11
Curtain, 12-16
Wall, 6-11
Wall, 12-16
No barrier, 6-11
No barrier, 12-16
Curtain, Iranian
Curtain, German
Wall, Iranian
Wall, German
No barrier, Iranian
No barrier, German
Curtain, Girls
Curtain, Boys
Wall, Girls
Wall, Boys
No barrier, Girls
No barrier, Boys
Estimate
-1.054
-.611
0(A)
Standard Error
.359
.429
Z
-2.933
-1.425
Significance level
.003
.154
.564
0(A)
-.949
0(A)
0(A)
0(A)
-.684
0(A)
-.980
0(A)
0(A)
0(A)
1.037
0(A)
.226
0(A)
0(A)
0(A)
.341
1.653
.098
.449
-2.113
.035
.318
-2.151
.031
.452
-2.166
.030
.316
3.280
.001
.448
.503
.615
Environment and Healing
Thus, other competent models could not
what is expected. We can conclude that
overshadow the present model considering
using a wall, compared with other choices,
the ease of interpretation and goodness of fit
is not desirable for separating children aged
of the data (χ2 (8) = 9/23, P = 0/321).
6 to 11. The probability of choosing a
The results of Table 1 indicate that, in
curtain by Iranian children, compared to the
general, the probability of choosing a curtain
same choice by German children, is
or a space without a barrier is significantly
significantly less than expected (B = -0/98,
less than what is expected (B = -1/05, P <
P < 0/05). Moreover, the probability of such
0/01), whereas the probability of choosing a
a choice, compared with choosing a wall, by
wall or a space without a barrier does not
Iranian and German children is less. Thus,
have significant difference (B = -0/61, P >
Iranian children prefer curtains less than
0/05). Therefore, on the whole, without
German
considering the mentioned demographic
choosing a curtain by girls is significantly
characteristics, it is revealed that curtain is
more than boys (B = 1/04, P < 0/01), but
less favored by children. The probability of
there is no difference between boys and girls
choosing curtain by children aged 6 to 11,
in choosing wall (B = 0/448, P > 0/05).
does not have any significant difference with
Neither is there any difference between boys
the probability of the same choice with
and girls in choosing wall or an open space.
children aged 12 to 16 (B = 0/61, P > 0/05).
Thus, if we have to use curtains, it is better
This means that age groups cannot have any
to use it for separating girls.
effect on choosing curtains. The probability
Also as showed in Table 2 , the Backward
of choosing a wall by children aged 6 to
Ward Logistic Regression analysis, used for
11,compared with the probability of the
studying the relationships of the independent
same choice by children aged 12 to 16, is
variables of nationality, age group, and
significantly less than what is expected (B =
gender, with spatial preferences (both with
-0/95, P < 0/05). Also, the probability of
or without a barrier), at two stages, provided
such a choice, regarding a space without a
a fit model.
barrier, by the two age groups is less than
children.
The
probability
of
Environment and Healing
Table 2: Parameter estimates of Logistic Regression analysis
Model parameters
Nationality (Iranian)
Age Group (6-11)
Gender (Girl)
Constant
Nationality(Iranian)
Gender (Girl)
Constant
Standard
Estimates Error
First Stage
-.733
.285
.101
.294
.820
.283
-.269
.303
Second Stage
-.716
.281
.809
.281
-.211
.252
Wald
statistics
Significant
DF Level
EXP
(B)
6.599
.118
8.414
.786
1
1
1
1
.010
.731
.004
.375
.480
1.106
2.270
.764
6.503
8.307
.702
1
1
1
.011
.004
.402
.489
2.245
.810
Also the results of Hosmer and Lemeshow
choosing a space with a barrier by
Test indicate the appropriate fitness of the
49%.Moreover, girls prefer spaces with
2
observed data to the expected data (χ (2) =
barrier more than boys, that is, and being a
0/790, P = 0/674).
girl increases the chance of choosing a space
As indicated in Table 2 the results of the
with a barrier by 2/24%. Finally, lack of any
parameter estimates for the final stage of the
relationship between age groups and their
Logistic Regression model reveal that there
preferences show that is no difference
is a statistically significant relationship
between the preferences of children and
between the two variables of nationality (B
adolescents.
= -0/72, P < 0/05) and gender (B = 0/81, P <
5. Discussion
0/01)
space
Reviewing the views of the children and
preferences (i.e., with barrier or without
adolescents indicate that, regarding their
barrier). The age group variable did not
private space in hospitals, they prefer a
show any significant relationship at the first
space without a barrier, a wall, and a curtain
stage of Logistic Regression analysis, and
respectively. Totally wall was not preferred
exited from the model (B = 0/10, P > 0/05).
by children and in most situations they were
These relations mean that Iranian children
indifferent in choosing wall as barrier.
prefer open spaces, without a barrier, more
Preferring a space without a barrier, which
than German children. This preference is
provides more chances for social interaction
vice versa for German children, that is,
among individuals, shows that the majority
being an Iranian reduces the chance of
of children prefer to have social interactions
,
and
two
dimensional
Environment and Healing
and contacts in the hospital, which is in line
well as spaces for establishing social
with the results of the similar research. For
interactions. In another research done in
example, Platt based on a similar study,
2006,
notes that children naturally tend to establish
systems, i.e., open and separated rooms,
social communication, and the research done
were studied. The advantages of separated
in 1993 indicates that it is very important for
room were quietness, more comfortable
adolescents to form peer groups in the
sleep, more comfortable stay of parents,
hospital. Also, the research done by
having private bath and TV, and the
NAWCH
disadvantage
in
2001
emphasizes
the
regarding
hospital
was
the
wards,
lack
of
two
social
importance of social needs for adolescent
interactions. The last preference of the
patients.
into
respondents was having a curtain around the
children’s
patients’ bed. Girls more than boys preferred
This
consideration
has
in
been
taken
designing
hospitals.
to have curtains around their beds, which
Regarding the effects of nationality on the
seems to be logical with regard to cultural
children’s preferences, it can be concluded
issues.
that Iranian respondents preferred spaces
(separating the beds with curtains) was not
without
German
generally favored by the respondents, which
respondents and that boys preferred this
is in line with the results of similar studies
more than girls. This is also in line with the
of Delvin and Blumberg in 2006.
results of similar studies. Yet, there was no
Acknowledgements
difference between children and adolescents
None declared
in this regard. The second preference in the
Financial Disclosure
responses was to have a wall between the
None declared
patients, which was more favored by
Funding/Support
adolescents. This shows that adolescents
None declared.
a
barrier
more
that
tend to have privacy more than children.
Other similar researches done in 1980 and
2003 conclude that adolescents face a lot of
problems regarding privacy in hospitals, and
that ideal therapeutic environments are those
which have designed single-bed rooms as
However,
this
last
preference
Environment and Healing
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