An Assessment of Healthcare Service Users’ Awareness Levels Regarding Green Hospital Practices: The Case of Adana Province

Abstract

Aim: This study aims to determine the awareness levels of healthcare service users regarding the concept and practices of green hospitals. Within the scope of the research, participants’ knowledge about green hospital practices, their consideration of such practices in choosing healthcare institutions, and whether their awareness levels significantly differ based on demographic characteristics were analyzed. The study seeks to evaluate the societal response to environmentally sustainable healthcare delivery. Method: The research was conducted in the province of Adana during the 2023–2024 period with 431 participants selected through convenience sampling. Data were collected via a questionnaire based on the “Green Hospital Design Scale” adapted into Turkish by Mansur and Korkmaz (2020). The data were analyzed using confirmatory factor analysis (CFA), descriptive statistics, and hypothesis testing. Results: While 59.9% of the participants consider green practices an important criterion in selecting healthcare institutions, only 21.6% are aware of the presence of green hospital implementations in their city. The highest mean scores were observed in the dimensions of indoor environmental quality and materials-resources, whereas water efficiency received the lowest scores. Statistically significant differences in awareness levels were found across certain dimensions based on gender, education level, and income. Conclusion: The study revealed that although healthcare service users demonstrate a certain level of awareness regarding green hospital practices, overall awareness remains insufficient. These findings underscore the need for community-based awareness-raising initiatives to advance environmental sustainability in healthcare services.

Keywords

• Green hospital
• environmental sustainability
• healthcare service user

Sağlık Hizmet Kullanıcılarının Yeşil Hastane Uygulamalarına Dair Farkındalık Düzeyinin Değerlendirilmesi: Adana İl Örneği

Öz

Amaç: Bu çalışma, sağlık hizmeti kullanıcılarının yeşil hastane kavramı ve uygulamalarına ilişkin farkındalık düzeylerini belirlemeyi amaçlamaktadır. Araştırma kapsamında, bireylerin yeşil hastane uygulamalarıyla ilgili bilgi düzeyleri, bu uygulamaları sağlık kurumu tercihinde dikkate alma durumları ve demografik özelliklerine göre farkındalık düzeylerinde anlamlı farklılıkların bulunup bulunmadığı analiz edilmiştir. Böylece, çevresel sürdürülebilirliği esas alan sağlık hizmet sunumunun toplum nezdindeki karşılığının değerlendirilmesi hedeflenmiştir. Yöntem: Araştırma, 2023-2024 döneminde Adana ilinde sağlık hizmeti alan bireyler üzerinde yürütülmüş ve kolayda örnekleme yöntemiyle belirlenen 431 katılımcıdan anket yoluyla veri toplanmıştır. Veri toplama aracı olarak, Mansur ve Korkmaz (2020) tarafından Türkçeye uyarlanan “Yeşil Hastane Tasarımı Ölçeği” kullanılmıştır. Veriler doğrulayıcı faktör analizi (DFA), tanımlayıcı istatistikler ve hipotez testleri ile analiz edilmiştir. Bulgular: Katılımcıların %59,9’u sağlık kurumu tercihlerinde yeşil uygulamaları önemli bir kriter olarak değerlendirmektedir; ancak yalnızca %21,6’sı yaşadığı ilde yeşil hastane uygulamalarının varlığından haberdardır. En yüksek ortalamalar iç çevre kalitesi ve materyal-kaynaklar boyutunda elde edilirken, en düşük puan su verimliliği boyutunda gözlemlenmiştir. Cinsiyet, eğitim ve gelir düzeyine göre bazı boyutlarda farkındalık düzeyleri anlamlı şekilde farklılık göstermektedir. Sonuç: Araştırma, sağlık hizmeti kullanıcılarının yeşil hastane uygulamalarına yönelik farkındalığının belirli açılardan gelişmiş olduğunu ancak genel düzeyde yetersiz kaldığını ortaya koymuştur. Bu durum, çevresel sürdürülebilirlik hedeflerine ulaşmak için toplum temelli bilinçlendirme çalışmalarının önemini göstermektedir.

Anahtar Kelimeler

• Yeşil hastane
• çevresel sürdürülebilirlik
• sağlık hizmeti kullanıcıları

References

1. ALKAABI, A., & ALJARADIN, M. (2023). Green Hospitals for the Future of Healthcare: A Review. Al-Kitab Journal for Pure Sciences. https://doi.org/10.32441/kjps.06.02.p4.
2. BREEAM. (2021). Healthcare: Building research establishment environmental assessment method. https://www.breeam.com/discover/technical-standards/healthcare/
3. CHAN, E. H. W., QIAN, Q. K., & LAM, P. T. I. (2016). The market for green building in developed Asian cities—The perspectives of building designers. Energy Policy, 37(8), 3061–3070. https://doi.org/10.1016/j.enpol.2009.03.057
4. DANGELICO, R. M., & VOCALELLI, D. (2017).Green Marketing: An analysis of definitions, strategy steps, and tools through a systematic review of the literature. Journal of Cleaner Production, 165, 1263–1279.
5. DEMİR, F., & SARP, N. (2020). Yeşil hastane uygulamalarının sağlık hizmet kalitesi ve maliyetleri üzerindeki etkisi: Kamu hastanelerinde bir araştırma. Sağlık ve Sosyal Refah Araştırmaları Dergisi, 2(1), 45–60.
6. ECKELMAN, M. J., & SHERMAN, J. D. (2018). Environmental impacts of the U.S. health care system and effects on public health. PLoS ONE, 13(6), e0200034. https://doi.org/10.1371/journal.pone.0200034
7. ELMUALIM, A., SHOCKLEY, D., VALLE, R., LUDLOW, G., & SHAH, S. (2010). Barriers and commitment of facilities management profession to the sustainability agenda. Building and Environment, 45(1), 58–64. https://doi.org/10.1016/j.buildenv.2009.03.001
8. GARG, N., & DEWAN, A. (2022). User perception of green hospitals: A study of patient satisfaction and environmental sustainability. Journal of Building Engineering, 45, 103507. https://doi.org/10.1016/j.jobe.2021.103507

9. GHAFFARIANHOSEINI, A., DAHLAN, N. D., BERARDI, U., GHAFFARIANHOSEINI, A., MAKAREMI, N., & GHAFFARİANHOSEINI, M. (2018). Sustainable energy performances of green buildings: A review of current theories, implementations and challenges. Renewable and Sustainable Energy Reviews, 25, 1–17. https://doi.org/10.1016/j.rser.2013.01.010
10. GIASUDDIN, M. (2024). Income, consumption patterns and environmental responsibility in health service preferences. Sustainable Production and Consumption, 38, 214–224. https://doi.org/10.1016/j.spc.2023.12.006
11. HAIR, J. F., BLACK, W. C., BABIN, B. J., & ANDERSON, R. E. (2019). Multivariate data analysis (8th ed.). Cengage Learning. https://www.cengage.com/c/multivariate-data-analysis-8e-hair
12. HERMAWAN, A., MAHALLI, M. A., & AMRINA, R. (2022). Implementation of green hospital in Indonesia: Barriers and recommendation. IOP Conference Series: Earth and Environmental Science, 1016, 012055. https://doi.org/10.1088/1755-1315/1016/1/012055
13. KAISER PERMANENTE. (2019). Environmental stewardship: Annual report. https://about.kaiserpermanente.org/
14. KARLINER, J., SLOTTERBACK, S., BOYD, R., ASHBY, B., & STEELE, K. (2019). Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. Health Care Without Harm & Arup. https://noharm-global.org/documents/health-care-climate-footprint-report
15. KATS, G. (2006). Greening America’s schools: Costs and benefits. Capital E Report. https://www.usgbc.org/sites/default/files/Greening_Americas_Schools.pdf
16. KLINE, R. B. (2016). Principles and practice of structural equation modeling (4th ed.). Guilford Press. https://www.guilford.com/books/Principles-and-Practice-of-Structural-Equation-Modeling/Rex
17. KOLLMUSS, A., & AGYEMAN, J. (2002). Mind the gap: Why do people act environmentally and what are the barriers to pro-environmental behavior? Environmental Education Research, 8(3), 239–260. https://doi.org/10.1080/13504620220145401
18. LEE, K., KIM, J., & PARK, H. (2023). Gender differences in environmental awareness and sustainable consumption behavior. Sustainability, 15(4), 2897. https://doi.org/10.3390/su15042897
19. LEE, P., HUANG, C., HUANG, M., & HSU, M. (2023). The Behavioral Intention of Hospitals to Promote Sustainable Development of Green Healthcare from the Perspective of Organizational Stakeholders during the COVID-19 Epidemic: A Case Study of Hospitals in Taiwan. Sustainability. https://doi.org/10.3390/su15054521.
20. MEYER, A. (2015). Does education increase pro-environmental behavior? Evidence from Europe. Ecological Economics, 116, 108–121. https://doi.org/10.1016/j.ecolecon.2015.04.018
21. ONG, B. L., & LEE, T. C. (2016). Organizing for sustainability: A study of green teams in healthcare. Journal of Healthcare Management, 61(3), 194–207.
22. SADATSAFAVI, H., WALEWSKI, J., & SHEPLEY, M. M. (2021). Indoor environmental quality and patient outcomes: A review of evidence in healthcare settings. Building and Environment, 191, 107570. https://doi.org/10.1016/j.buildenv.2021.107570
23. T.C. SAĞLIK BAKANLIĞI. (2021). Sağlık Tesisleri için Yeşil Rehber. Sağlık Yatırımları Genel Müdürlüğü. https://yhgm.saglik.gov.tr/
24. ULRICH, R. S., ZIMRING, C., ZHU, X., DUBOSE, J., SEO, H. B., CHOI, Y. S., QUAN, X., & JOSEPH, A. (2008). A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 1(3), 61–125. https://doi.org/10.1177/193758670800100306
25. ÜNVER, E., & KALAYCI, M. (2021). Sağlık hizmeti kullanıcılarının çevre dostu hastane uygulamalarına ilişkin farkındalık düzeyleri. Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi, 7(1), 52–68.
26. WATTS, N., AMANN, M., ARNELL, N., AYEB-KARLSSON, S., BELESOVA, K., BOYKOFF, M., … COSTELLO, A. (2023). The 2023 report of the Lancet Countdown on health and climate change: The imperative for a health-centred response. The Lancet, 402(10419), 2346–2394. https://doi.org/10.1016/S0140-6736(23)01859-7
27. WGBC – WORLD GREEN BUILDING COUNCIL. (2016). Health, wellbeing & productivity in hospitals: The impact of green design on staff & patient outcomes. https://www.worldgbc.org/news-media/health-wellbeing-productivity-hospitals
28. WHO – WORLD HEALTH ORGANIZATION. (2020). Safe management of wastes from health-care activities: A summary. https://www.who.int/publications/i/item/9789240005259
29. WHO. (2014). Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. World Health Organization. https://www.who.int/publications/i/item/9789241507691
30. WHO. (2020). Operational framework for building climate resilient health systems. World Health Organization. https://www.who.int/publications/i/item/WHO-CED-PHE-EPE-18.13
31. WOOD, L., WANG, C., ABDUL-RAHMAN, H., & ABDUL-NASIR, N. (2016). Green hospital design: integrating quality function deployment and end-user demands. Journal of Cleaner Production, 112, 903-913. https://doi.org/10.1016/J.JCLEPRO.2015.08.101.
32. YILMAZ, B., & YALÇINTAŞ, M. (2018). Yeşil hastane kavramı ve hasta tercihine etkisi: Şehir hastaneleri üzerine bir değerlendirme. Sağlık Akademisyenleri Dergisi, 5(2), 124–132.
33. ZAREI, E., DANESHKOHAN, A., & MOHAMMADI, E. (2021). Green hospital evaluation in Iranian teaching hospitals. Iranian Journal of Environmental Health Science & Engineering, 18(1), 95–104. https://doi.org/10.1007/s40201-020-00518-y
34. ZELEZNY, L. C., CHUA, P. P., & ALDRICH, C. (2000). Elaborating on gender differences in environmentalism. Journal of Social Issues, 56(3), 443–457. https://doi.org/10.1111/0022-4537.00177
35. ZHANG, D., WU, L., & LIU, Y. (2019). Biyofilik tasarımın sağlık tesislerine etkisi: Khoo Teck Puat Hastanesi örneği. Journal of Architecture and Urbanism, 43(2), 130–140.