Designing Healing Environments: A Literature Review on the Benefits of Healing Gardens for Children in Healthcare Facilities and the Urgent Need for Policy Implementation
Round 1
Reviewer 1 Report
1.Please confirm whether there is a formatting problem in lines 110-113 of the manuscript? For example: line 112 colon pull out line period. Comma of (1) and semicolon of (2).
2.Please confirm the format of line 124.
3.Please verify that the period on line 171 is correct.
Author Response
Response: We want to thoroughly thank Reviewer #1 for the valuable comments.
1.Please confirm whether there is a formatting problem in lines 110-113 of the manuscript? For example: line 112 colon pull out line period. Comma of (1) and semicolon of (2).
Response: Agree. We thank the reviewer for the comment.
2.Please confirm the format of line 124.
Response: Agree. We thank the reviewer for the comment.
3.Please verify that the period on line 171 is correct.
Response: Agree. We thank the reviewer for the comment.
Reviewer 2 Report
A well-written paper. Current topic and a well-defined need in healthcare settings.
line 71 add research before studies
167 remove space
222 remove 'till'
263 add 'this after' and
I like the way you bring in Asian input to the topic.
I would consider reviewing information about the following gardens to deepen your study
Legacy Emmanuel Health Portland OR-some recent studies with Roger ulrich on nurse burnout and garden usage
Alnarp Sweden-well designed therapy garden utilized for various populations
Glass Garden Rusk Institute Award winning childrens garden destroyed by hurricane in 2012 Book available
St Louis Children's hospital also has a nice play garden
These cases can broaden your perspective and provide more info regarding design recommendations
Also it is good to include the disciplines which you want to use the garden in the planning stages so they will use it when it is built
Author Response
Reviewer 2
A well-written paper. Current topic and a well-defined need in healthcare settings.
Response: We want to thoroughly thank Reviewer #2 for the valuable comments.
line 71 add research before studies
Response: Agree. We thank the reviewer for the comment and have addressed this.
167 remove space
Response: Agree. We thank the reviewer for the comment and have addressed this.
222 remove 'till'
Response: Agree. We thank the reviewer for the comment and have addressed this.
263 add 'this after' and
Response: Agree. We thank the reviewer for the comment and have addressed this.
I like the way you bring in Asian input to the topic.
I would consider reviewing information about the following gardens to deepen your study
Legacy Emmanuel Health Portland OR-some recent studies with Roger ulrich on nurse burnout and garden usage
Alnarp Sweden-well designed therapy garden utilized for various populations
Glass Garden Rusk Institute Award winning childrens garden destroyed by hurricane in 2012 Book available
St Louis Children's hospital also has a nice play garden
These cases can broaden your perspective and provide more info regarding design recommendations
Also it is good to include the disciplines which you want to use the garden in the planning stages so they will use it when it is built
Response: Thank you for your feedback. We have incorporated the suggested case studies into our review and made the necessary revisions to improve the flow and grammar of the text. We appreciate your help in enhancing the quality of our work. We have also included “Furthermore, to improve the design of healing gardens for children in hospital settings, a collaborative and interdisciplinary approach involving various disciplines and educational backgrounds is necessary. This includes landscape architecture, horticulture, psychology, paediatrics, and other relevant scientific and professional disciplines [124].”
Reviewer 3 Report
There are consideratble typos and errors, including punctuation, capitalization, and spelling. The outline of the literature search process and terms used is loose and additional rigor should be outlined (ie: list all terms, not just "such as" which leaves a considerable gap in possibilities). There is also no review of the data analysis, only that there was a search and now there are results. The theming and data analysis process should be detailed. Ultimately the study should be replicable and the readers need the details that would allow them to replicate it. Right now that would not be easy, or maybe even not possible. I am also curious about the four emergent themes. If they are really emergent, the reader should understand *how* they emerged. However, based on the intro, is seems like there were predetermined themes that the authors were exploring intentionally. Table 1 is valuable! Nice outlining of the key points. The bulk of the Theories section is about biophilia when it might be better to frame the different theories from the four listed in the last paragraph of that section and give more support to those. Biophilia is well-covered in literature.
The section on play and children's development is also well-covered in literature and seems to be missing significant context around the inclusion of this topic in healthcare. The emphasis is spent on the benefits of play, and the different types, which is well-known. It would be more beneficial to talk about why play should be incorporated into healthcare environments, and how. There is a lot of context around healthcare environments that may work in contrast to the benefits of play literature.
Identifying play policies in the policies section doesn't tell the reader anything. "... could be associated...." It needs to be more than that to be meaningful. Possibly the pollution statement around line 374 could be addressed under policies. That would be more valuable. And one sentence about edible gardens? If it is important enough to include, say more than one sentence.
It may be more valuable to do comparison case studies and see what is being done successfully than a literature review. You could then tie the findings from the case studies back to the literature.
Author Response
Reviewer 3:
There are consideratble typos and errors, including punctuation, capitalization, and spelling. The outline of the literature search process and terms used is loose and additional rigor should be outlined (ie: list all terms, not just "such as" which leaves a considerable gap in possibilities). There is also no review of the data analysis, only that there was a search and now there are results. The theming and data analysis process should be detailed. Ultimately the study should be replicable and the readers need the details that would allow them to replicate it. Right now that would not be easy, or maybe even not possible. I am also curious about the four emergent themes. If they are really emergent, the reader should understand *how* they emerged. However, based on the intro, is seems like there were predetermined themes that the authors were exploring intentionally.
Response: Agree. Thank you for your comments and suggestions regarding our manuscript. We appreciate your feedback and have taken your suggestions into account. We have thoroughly proofread the text and made necessary corrections to address the issues related to typos, punctuation, capitalisation, and spelling. Additionally, we have revised the methodology to provide more rigorous details regarding the literature search process. We agree with your comment that we used predetermined themes, and we have modified the methodology to reflect this. Specifically, a deductive approach was adopted to gather evidence from previous research (Bandara et al. 2015) and to categorise the findings from the selected publications based on the following predetermined themes: (1) the definition of a healing garden, (2) theories, (3) the value of play and its impact on children's development, and (4) policies.
Furthermore, we included a comprehensive list of keywords to ensure a thorough search of the available literature. The literature search process was conducted using a combination of relevant keywords such as "healing gardens," "children," "healthcare facilities," "policy," "biophilic," and "design," as well as other related terms such as "therapeutic gardens," "paediatric healthcare," and "restorative environment." The search terms were used in conjunction with Boolean operators such as "AND" and "OR" to join sets of concepts together and narrow or broaden the search results, respectively (Atkinson and Cipriani 2018). As Atkinson and Cipriani (2018) noted, "AND" was used to retrieve articles that contained all the search terms within a concept, while "OR" was used to expand the search and find articles that contained at least one of the search terms within a concept.
Reviewer 3: Table 1 is valuable! Nice outlining of the key points. The bulk of the Theories section is about biophilia when it might be better to frame the different theories from the four listed in the last paragraph of that section and give more support to those. Biophilia is well-covered in literature.
Response: Agree. We appreciate your suggestion and have made changes to the Theories section to address your comment. Specifically, we have expanded on the other theories beyond biophilia. We have highlighted the medical geography school's focus on the concept of sense of place and its identification of four dimensions of therapeutic landscapes, including the natural environment, built environment, symbolic environment, and social environment. We have also described the two major theories in the environmental psychology school, namely the Attention-Restoration Theory (ART) and the Aesthetic-Affective Theory (AAT), and their respective features of a restorative environment. In addition, we have discussed the ecological psychology school, which includes the salutogenic environment and therapeutic landscape based on theories of environmental affordances and ecological psychology.
Reviewer 3: The section on play and children's development is also well-covered in literature and seems to be missing significant context around the inclusion of this topic in healthcare. The emphasis is spent on the benefits of play, and the different types, which is well-known. It would be more beneficial to talk about why play should be incorporated into healthcare environments, and how. There is a lot of context around healthcare environments that may work in contrast to the benefits of play literature.
Response: Agree. We thank the reviewer for the comment. We have added new text.
Reviewer 3: Identifying play policies in the policies section doesn't tell the reader anything. "... could be associated...." It needs to be more than that to be meaningful.
Response: As stated in our limitation section, we were unable to identify any specific policies related to play in healthcare settings.
Reviewer 3: Possibly the pollution statement around line 374 could be addressed under policies. That would be more valuable. And one sentence about edible gardens? If it is important enough to include, say more than one sentence.
Response: We thank the reviewer for the comment. We have revised this part. We have included the following text in the revised manuscript: An excellent example of a community-based edible healing garden is the Edible Heal-ing Garden in Los Angeles, which aims to address nutrition insecurity in the medically underserved population [101].
Through the provision of education on gardening, nutrition, and cooking, the garden empowers families and children with knowledge, food sovereignty, and access to healthy foods. Moreover, it advocates for food equity and cultural diversity while also creating a safe space for people to cultivate their own food. The garden's ultimate objective is to empower every family and child struggling with food insecurity, ena-bling them to access healthy and culturally appropriate foods. Additionally, the garden has been designed as a healing environment for the paediatric population at LAC+USC hospital [101].
Reviewer 3: It may be more valuable to do comparison case studies and see what is being done successfully than a literature review. You could then tie the findings from the case studies back to the literature.
Response: We thank the reviewer for the comment. We have included additional case studies in the revised manuscript, which demonstrate the potential benefits of healing gardens for various individuals in healthcare settings. These case studies, along with the literature review, provide evidence for the positive impact of healing gardens on health and wellbeing and demonstrate the value of incorporating nature-based interventions in healthcare settings.
Round 2
Reviewer 3 Report
Comments were addressed.
