Designing for Health and Learning: Lessons Learned from a Case Study of the Evidence-Based Health Design Process for a Rooftop Garden at a Danish Social and Healthcare School

Abstract

This article presents a case study from a Social and Health Care School in Denmark, where a rooftop garden was designed to promote student health and support nature-based teaching across subject areas. A novel aspect of the project is the formal integration of the garden into teaching, implying that its long-term impact may extend beyond the students to the end-users they will later encounter in nursing homes and hospitals nationwide. This study applies the Evidence-Based Health Design in Landscape Architecture (EBHDL) process model, encompassing evidence collection, programming, and concept design, with the University of Copenhagen acting in a consultancy role. A co-design process with students and teachers was included as a novel source of case-specific evidence. Methodologically, this is a participatory practice-based case study focusing on the full design and construction processes, combining continuous documentation with reflective analysis of ‘process insights,’ generating lessons learned from the application of the EBHDL process model. This study identifies two categories of lessons learned. First, general insights emerged concerning governance, stakeholder roles, and the critical importance of site selection, procurement, and continuity of design responsibility. Second, specific insights were gained regarding the application of the EBHDL model, including its alignment with Danish and international standardised construction phases. These insights are particularly relevant for project managers in nature-based initiatives. The results also show how the EBHDL model aligns with Danish and international standardised construction phases, offering a bridge between health design methods and established building practice. The case focuses on the EBHDL process rather than verified outcomes and demonstrates how evidence-based and participatory approaches can help structure complex design processes, facilitate stakeholder engagement, and support decision-making in institutional projects.

1. Introduction

1.1. Nature, Human Health and Landscape Architecture

Since ancient times, humans have held an intrinsic belief that being in, and connected to, nature promotes health and wellbeing. This perspective waned during the twentieth century but has been rediscovered in recent decades as research in this field has expanded significantly [1,2]. While a clear causal relationship remains elusive, the cumulative evidence consistently indicates positive associations between contact with natural environments and improved health outcomes [3]. Natural environments can support human health across multiple spatial scales. At the regional scale, forests and wetlands may provide opportunities for psychological restoration while also improving health through improved air quality, mitigating urban heat island effects, and reducing flood risks [4]. At the urban scale, parks and other public green spaces have been shown to facilitate stress reduction [5,6], increase levels of physical activity [7] and foster social cohesion [8]. At the site scale, health care-related green spaces and therapy gardens may promote stress recovery and rehabilitation [9], while school landscapes have been found to encourage play behaviour and child development [10,11], support movement and overall wellbeing [12] and enhance academic attainment [13,14], while adults may also experience psychological restoration through informal environmental education in managed forest settings [15].

This growing awareness has been recognised by both researchers and practitioners in landscape architecture. Today, a range of design approaches within the discipline explicitly aim to promote human health and wellbeing, resulting in the emergence of several overlapping concepts. These include Biophilic Design, Therapeutic Landscapes, Healing Gardens, Salutogenic Design, Restorative Design, Neuroarchitecture, Healing Architecture and Health Design. While each approach has its own more or less clearly defined theoretical basis, they share a common emphasis on integrating living plant material and other natural elements into landscape projects, and on creating sensory-rich environments that engage multiple senses simultaneously to support improved health outcomes. Moreover, these approaches often reflect a shared understanding of the importance of context-specific and user-responsive design, whether in therapeutic landscapes situated in natural environments, such as forests, arboreta or coastal areas, or in outdoor spaces connected to built environments, such as schools, hospitals or rehabilitation centres.

In this article, the term Health Design is used to denote a specific approach within landscape architecture: the intentional and deliberate design of green spaces and gardens to support health processes and achieve predetermined health outcomes [16]. The concept is part of a broader international tradition of health-promoting design, shaped by foundational contributions from Roger Ulrich, whose research laid the groundwork for evidence-based design and who was among the initiators of the Center for Health Design in the United States. This tradition continues to evolve through institutions such as the International Academy for Health and Design, which foster interdisciplinary collaboration and knowledge exchange across design, health, and research. Within this context, Health Design integrates evidence-based methods with landscape architectural practice to support human health and wellbeing across diverse settings and spatial scales.

1.2. Working Evidence-Based in Landscape Architecture for Human Health

Designing outdoor environments to promote health entails a significant responsibility for the landscape architect, toward both the commissioning client and—more importantly—toward the users, and also toward the living systems of plants, animals, and ecosystems in the landscape [17]. When designing for vulnerable or severely ill populations, the designer assumes a duty not to fail those who may be particularly sensitive to their surroundings. Individuals with physical, mental, or cognitive vulnerabilities may perceive and interpret environments differently from the staff or other professionals working in those setting [1]. For instance, a green space perceived as calming and restorative by school staff or rehabilitation personnel may be experienced by some users as stressful or even harmful. Such environments may, in worst cases, adversely affect health. This places considerable demands on the landscape architect to ensure that their designs truly support the users’ health and wellbeing in the way it claims to. This provides the core rationale for landscape architects working within health design to adopt evidence-based approaches [1,7].

Three prominent conceptual models have been proposed to support evidence-based practice in landscape architecture by Zeisel [18], Brown and Corry [19] and Stigsdotter [16,17,20,21]. While all three models share a common focus on health and landscape architecture, they have been developed independently and reflect distinct disciplinary perspectives and methodological approaches. The three models differ primarily in how evidence is conceptualised, sourced and integrated into the design process. Zeisel [18] adopts a hypothesis-driven approach where scientific evidence, particularly from neuroscience and environmental psychology, is generated and applied through collaboration between researchers and designers; Brown and Corry [19] propose a structured model that translates empirical health data into design principles, assuming access to established research findings; whereas Stigsdotter et al. [17,21] advance a contextual and integrative model that allows landscape architects to independently navigate between design stages, drawing on broader evidence that includes scientific studies, professional experience and user insights. Together, these models illustrate the evolving and multifaceted nature of integrating research into landscape architectural practice. The EBHDL model by Stigsdotter and colleagues was selected for this study for its validated structure, guiding participation in the design across cultural contexts.

1.3. Applying the EBHDL Process Model

The EBHDL model is increasingly being applied in international practice. Notable implementations include landscape design projects in Iceland [22] and in China, the latter receiving an Honour Award from the American Society of Landscape Architects in 2023 [23]. Its approach provides a practical framework for designing health-promoting landscapes in diverse contexts while actively involving stakeholders in the design process.

The EBHDL process model provides the overarching framework for both the case description and the design process within which the work was carried out. It accommodates multidisciplinary evidence from research, practice, and other sources, and systematises this in relation to the design aims. Transparency is ensured by documenting the rationale behind design decisions. Although evidence collection may be time- and resource-intensive, the model is intended to guide, rather than dictate, the landscape architect’s professional judgement, and should be balanced with aesthetic considerations [24]. It respects the expertise of practising landscape architects and integrates their knowledge throughout the process.

Structured around four interlinked steps, (1) Evidence Collection, (2) Programming, (3) Design and (4) Evaluation, the EBHDL model mirrors the typical phases of landscape architectural projects and centres on human–nature relations, making it adaptable to specific cases and contexts. A detailed overview of each step, including its internal components and thematic focus, is presented in Figure 1, which serves as a visual summary of the model’s operational logic.

1.4. The Case—Context and Commission of the Care Outside Project

This article presents a case study from Care Outside, a project initiated by the Social and Health Care School (SOSU) in Vejle, Denmark, a vocational school for social and health care helpers and assistants. Students are diverse in age, ranging from 16 to 65 years, and the majority are women. Many speak Danish as a second language, and a significant proportion face physical, psychological and/or social challenges. The school reports high levels of absenteeism and a substantial dropout rate.

Based on evidence suggesting that access to nature can promote wellbeing, Care Outside was launched to improve student health and enhance engagement and thereby reduce dropout. However, many students lacked a prior relationship with nature, and some expressed discomfort or unease in natural settings. The project has broader significance because graduates from SOSU programmes often work with elderly or medically vulnerable individuals in nursing homes, psychiatric hospitals and rehabilitation centres. By integrating nature-based knowledge into vocational education, the project not only supports student wellbeing and learning, but may also influence the quality of care environments experienced by future end-users.

The project is managed by a team comprising the school’s principal, resource manager, and head of communication and marketing, who holds a professional master’s degree in nature-based rehabilitation.

The project comprises two overarching tracks (see Figure 2). Track 1 focuses on designing and establishing a rooftop garden on the school premises, guided by the EBHDL model. Track 2 centres on training the teachers to integrate nature into their teaching practices. Although closely connected in content, track 1 (the rooftop garden) was initiated first due to considerations related to staff capacity and project timing. The University of Copenhagen (UCPH) was commissioned to lead both tracks.

In track 1, researchers applied the EBHDL model to design the rooftop garden, including a co-design process and documentation for evaluation purposes. The design phase has been completed; however, work on garden is still in process and is planned to be completed in fall 2025. A post-occupancy evaluation will be conducted once the garden is fully established and has been taken into use. Track 2 involved training the teachers in nature-based pedagogy, supervising its implementation, and evaluating the educational activities as well as health impact on the students.

The three overarching aims of the Care Outside project are primarily addressed through track 2: (1) To enhance student learning and engagement through nature-based teaching and environments; (2) To explore how students might transfer this knowledge to real-world care settings; (3) To examine whether nature-based interventions during vocational training support health and wellbeing and educational outcomes, particularly for vulnerable learners.

If successful, the project’s methods may inform similar initiatives across Denmark’s other SOSU schools or other stakeholders interested in nature-based learning. A core requirement was that track 1 apply the EBHDL model to ensure the design supports both educational and recreational use.

1.5. Motivation and Aim of the Case Study

Nature-based health interventions are gaining recognition internationally, and universities and professional organisations increasingly train practitioners in these methods. In Denmark, the landscape includes a two-year professional master’s programme in nature-based rehabilitation and health promotion at the University of Copenhagen, along with courses offered by other universities and private providers. While practitioners often secure funding and lead projects, they frequently lack experience with design and construction processes, regulatory requirements, and multi-stakeholder collaboration. Documentation is also limited on how EBHDL principles can be successfully applied into such projects.

The aim of this case study is to illustrate how the EBHDL process model can be applied in the development of a multifunctional rooftop garden supporting nature-based teaching and student health and wellbeing. By conducting continuous reflective analysis of observations and project documentation throughout the design and construction process, this study generates ‘process insights’ that are then used to identify practical lessons learned which may inform future projects with similar aims and contexts. Focus questions guiding the analysis include: Which practical lessons emerge from the design and construction process regarding project management, stakeholder involvement, and design integration? How can the EBHDL process model be operationalised in practice in a complex institutional project? How can these lessons be made transferable to other institutions implementing nature-based interventions?

To contextualise the application of the EBHDL process model, we first outline the structural and procedural framework within which the project was implemented.

2. Project Context and Construction Framework

This section describes the alignment between Danish construction phases and the EBHDL model, and identifies the key stakeholders involved in implementation. These elements form the foundation for understanding how the design process was structured and executed.

2.1. Danish Construction Phases

In Denmark, construction projects are typically structured into seven distinct phases, with design management (projekteringsledelse) and information and communication technology (ICT) management (IKT-ledelse) as cross-cutting management services [24]. This phased approach provides a framework for clarifying project goals, scope, resources and timelines, and facilitates more effective planning, enhanced control, improved risk management and clearer communication between the client and other stakeholders. The seven phases are (1) Initial Advisory Service (Indledende rådgivning), comprising Concept Development (Idéoplæg) and Project Brief (Byggeprogram); (2) Design Proposal (Forslag), comprising Outline Proposal (Dispositionsforslag) and Project Proposal (Projektforslag); (3) Regulatory Documentation (Myndighedsprojekt); (4) Tender Documentation (Udbudsprojekt); (5) Construction Documentation (Udførelsesprojekt); (6) Construction Execution (Udførelse); and (7) Handover and Deficiencies (Aflevering) (see

Table 1. Overview of Danish construction phases and associated deliverables.

Order	Phase	Phase in Danish	Content	Selected Deliverables	Key Stakeholders
1	Initial Advisory Service, comprising Concept Development and Project Brief	Indledende rådgivning, bestående af Idéoplæg og Byggeprogram	Identification of needs, establishment of project vision and goals, functional requirements, site analysis, feasibility studies, stakeholder dialogue, and preparation of a Concept Proposal and Project Brief.	Functional requirements, concept sketches and conceptual descriptions, initial budget and schedule, project brief	Client, Client Advisor, Users
2	Design Proposal, comprising Outline Proposal and Project Proposal	Forslag, bestående af Dispotions- forslag og Projektforslag	Conceptual ideas are developed into concrete design solutions by defining spatial organisation and design principles, considering materials and technical options, assessing sustainability and costs, and preparing preliminary design documentation.	Drawings and digital models, descriptions and updated budget	Consultants, Users (Approval of Design Proposal: Client, supported by Client Advisor)
3	Regulatory Documentation	Myndighedsprojekt	Preparation and submission of building permit applications, including energy, fire safety, accessibility and other statutory documentation required by authorities.	Permit application package, compliance documentation	Consultants
4	Tender Documentation	Udbudsprojekt	Preparation of a complete tender package that defines the project clearly and in sufficient detail to form the basis for tendering and contracting, and to support the subsequent preparation of construction documentation and execution.	Tender conditions, drawings and digital models, specifications, bills of quantities and draft contracts	Consultants (Approval of Tender Documentation: Client, supported by Client Advisor)
5	Construction Documentation	Udførselsprojekt	The construction documentation is based on the accepted tenders and develops the tender documentation into a final coordinated execution project, ensuring constructability and cross-disciplinary consistency.	Detailed working drawings and digital models, coordinated specifications, execution documents, updated budget and risk assessment	Consultants, Contractor (Approval of Construction Documentation: Client, supported by Client Advisor)
6	Construction Execution	Udførelse	Implementation of the construction works according to approved plans and documentation, supported by construction management, site supervision and project follow-up.	Executed construction works, supervision reports, site meeting minutes, updated project documentation	Contractor (supervision by Consultants)
7	Handover and Deficiencies	Aflevering	Final inspections, preparation of deficiency lists, testing and commissioning, delivery of as-built documentation, and formal transfer to the client.	Handover protocol, deficiency report, as-built documentation, and operation and maintenance manuals	Contractor, Consultants, Client, supported by Client advisor

). While each project is unique and the composition and scope of these phases may vary, the framework remains a central tool for structuring professional collaboration.

International construction frameworks follow similar principles. The widely accepted international framework RIBA Plan of Work organises projects into eight stages: Strategic Definition, Preparation and Brief, Concept Design, Spatial Coordination, Technical Design, Manufacturing and Construction, Handover, and Use [25]. A key difference is that the Danish framework does not include a dedicated post-occupancy evaluation phase, which may affect how long-term stakeholder engagement and feedback are formally integrated into projects.

2.2. Stakeholder Roles and Phase-Specific Engagement

The allocation of responsibilities across the seven phases varies depending on the project type, the client’s needs, and the consultants’ competencies. For instance, a landscape architecture firm may be involved during early conceptual stages due to its expertise in evidence-based health design, but may not meet the regulatory, technical or contractual requirements necessary for later phases such as Design Proposal or Construction Documentation. Consultants are therefore not necessarily engaged throughout all phases. This division of labour enables tailored contributions and supports overall project coherence, provided that the client and/or project manager has sufficient insight to coordinate the process effectively. Given this variability, it is rarely meaningful to assign consultants to fixed phases in a generalised table format. Instead, roles and responsibilities must be understood as project-specific and negotiated within the framework of each commission.

2.3. Mapping the EBHDL Process onto the Danish Construction Framework

While the Danish construction model is structured into seven distinct and sequential phases, the EBHDL process model operates through four broader and more iterative steps: Evidence Collection, Programming, Design and Post-Occupancy Evaluation. When mapped against the Danish framework (see Table 1), Evidence Collection and Programming correspond to the first phase of the Danish construction process, Initial Advisory Service (Indledende rådgivning), where user needs, contextual factors and health-related evidence are gathered and synthesised. The EBHDL Design step comprises four sub-stages—Conceptualisation, Design, Construction and Occupation—and therefore spans all other phases of the Danish construction process (see Figure 3). The insights and requirements identified during the earlier EBHDL steps should be carried forward and embedded in all subsequent documentation, ensuring the built outcome does not become disconnected from the original health-oriented intentions and user needs.

One notable distinction between the EBHDL process model and the Danish construction framework lies in the treatment of Post-Occupancy Evaluation (POE). Within EBHDL, POE is a dedicated and essential step that focuses on assessing the built environment’s impact on users, gathering feedback and generating insights for future design improvements. This step aligns closely with the In Use stage found in many international construction models, such as the RIBA Plan of Work [26], and, more generally, also in the German HOAI framework [26], where systematic evaluation and operational feedback are integrated into the project lifecycle. In contrast, the Danish construction model does not formally include POE as a distinct phase. While the Handover and Deficiencies (Aflevering) phase marks the handover of the completed project, it typically lacks structured mechanisms for post-occupancy assessment. This omission highlights a key difference in emphasis: whereas EBHDL and international frameworks recognise the value of continued learning and user-centred evaluation beyond project completion, the Danish model remains primarily focused on delivery and regulatory compliance. This divergence underscores EBHDL’s contribution to health-oriented landscape architecture, where evidence and feedback are not only foundational in early design stages but also critical after implementation and occupation.

2.4. Key Stakeholders

In Danish construction practice, four key professional roles structure the development and execution of building projects: the client (bygherre), the client advisor (bygherrerådgiver), the consultants (rådgivere) and the contractor (entreprenør). The client is the initiating party, responsible for financing, defining project goals and requirements, and overseeing the construction project. This includes strategic decision-making, procurement, and coordination of contracts and stakeholders. Compared to many other countries, Danish clients tend to be more actively involved throughout the project lifecycle, reflecting a governance model that prioritises transparency and early stakeholder engagement [27]. The client advisor acts as the client’s representative and independent strategic partner, providing professional support from the earliest project stages through to project completion. Responsibilities include project planning, budgeting, quality assurance, legal and technical guidance, and coordination among architects, engineers and contractors. Consultants are technical experts contracted to deliver specific services such as architectural and landscape architectural design, engineering or environmental analysis. Their responsibilities are governed by standard contracts that outline the general conditions for consultancy services in building and construction works [24]. The contractor is responsible for executing the construction works according to the approved documentation and contract terms. This includes construction planning, site management, coordination of subcontractors and quality assurance, as well as providing as-built documentation and operation and maintenance manuals at project handover [28]. Although not formally defined as a contracting party in the Danish standards, the end-users (brugere) of the built environment are also a key stakeholder group, particularly in evidence-based health design projects. Their needs, experiences and feedback are essential for shaping design aims, informing co-design processes and evaluating outcomes, thereby ensuring that health-supportive intentions are realised in practice.

The composition of the project team and the allocation of responsibilities among consultants may vary depending on the nature, scale and contractual arrangements of the project. Typically, consultants such as architects, landscape architects, structural and civil engineers, mechanical, electrical, and plumbing engineers, quantity surveyors, and sustainability or accessibility specialists contribute at different stages. However, the specific distribution of these responsibilities is typically negotiated for each project (see Table 1).

3. Materials and Methods

3.1. Methodological Approach: Documenting and Analysing an Evidence-Informed, Practice-Based Design Process

This paper reports on a real-world case: the design of a rooftop garden at a Danish social and health care school, intended to promote health and support educational activities. The UCPH team, serving as landscape architects in the early phases, applied the EBHDL process model from Evidence Collection through Programming, up to the first stage of Design, Conceptualisation (corresponding to the Outline Proposal, Dispositionsforslag, in the Danish construction framework).

While EBHDL is not a research methodology, it serves as a structured framework guiding both design and documentation. This study is framed as a practice-oriented case study, drawing on empirical material from multiple sources collected before and during the design and construction phases, and analysed continuously.

The methods described in this section are the overarching methods used to present Care Outside as a case study. The methods applied within the individual steps of the EBHDL model are described in Section 4, Process Insights.

3.2. Analysing the Design and Construction Process

This study reflects on the procedural dynamics and practical insights gained during the design and construction of the rooftop garden, identifying critical junctures, decision points, and stakeholder roles, with the aim of providing guidance for future projects implementing nature-based design in institutional settings. Data were collected continuously from the first project meeting in August 2023 until construction was largely completed in September 2025, and included funding application, project meeting notes, minutes, emails, and design drawings. Weekly research team meetings were held to review collected material, reflect on developments, and identify items of significance, which were coded as ‘process insights’—a form of participatory observation notes—and subsequently analysed to generate a set of lessons learned, reviewed, discussed and approved by the project team.

The analysis focusing on recurring challenges, decision-making processes, and the interaction between design intentions and practical constraints. Knowledge was generated through active participation in design practice and reflective analysis. This approach recognises that insights emerging from complex, context-sensitive design processes constitute meaningful contributions to the broader body of knowledge and offer practical lessons for future nature-based health design projects. Process diagrams were also developed and iteratively updated to visualise the evolving structure of the project, supporting reflective practice and enabling dynamic assessment of procedural adaptations and improvements. While qualitative and reflective in nature, these lessons are based on structured documentation rather than empirical measurements, and aim to provide guidance for future projects implementing nature-based design in educational and institutional settings.

At the time of writing, the garden is still under construction; a post-occupancy evaluation (POE) will be conducted once the site is completed and in active use.

4. Process Insights

This section presents the lessons learned from the design and construction process of the rooftop garden, focusing on practical and procedural insights. The first four lessons address overarching aspects of the process, including governance structures and roles, required competences and the aim of the design, the premises and constraints of the selected site, and a process diagram to support overview and coordination. The final three lessons address experiences gained from implementing the first three phases of the EBHDL model: Evidence Collection, Programming, and Design.

4.1. Identification of Governance Structures and Roles

The Care Outside project was initiated by the SOSU school with advisory input from UCPH. Funding from The A.P. Møller Foundation enabled the construction (still ongoing) of a rooftop garden and an associated teacher training programme. The SOSU school serves as both project owner and client, and is responsible for land ownership, project management and funding administration. UCPH served in a consultancy role for landscape architecture during the early stages of the construction phases, up to the Outline Proposal. The project has a total budget of DKK17.7 million (~EUR2.37 million/USD2.65 million) and a planned duration of five years (2023–2028).

The first meeting following confirmation of funding focused on clarifying project governance, communication pathways and consultant interfaces, and on reviewing the schedule and budget. As the UCPH team could not serve as consulting landscape architects throughout all phases, the SOSU school was advised to appoint a design landscape architect for the later stages. These clarifications were essential for establishing effective governance and ensuring smooth project coordination.

The project team was established, and the steering committee was appointed to provide strategic oversight. The project team operates under the steering committee, which includes representatives from the funding body (The A.P. Møller Foundation) and from Vejle Municipality, and the head of department of geosciences and natural resource management at the UCPH. The steering committee operates based on the approved project application and funding agreement, ensuring that the project aligns with its objectives, budget, and timeline.

Since most landscape projects affect neighbouring properties and/or protected natural areas and require municipal approval, local authorities and neighbouring stakeholders were invited to participate. Additionally, a local FGU school—a Danish preparatory education programme supporting young people under 25 in transitioning to further education or employment—was included to contribute to the long-term maintenance of the rooftop garden. Figure 4 illustrates the governance structures and the relationships between the key actors involved in Care Outside.

Lessons Learned

Clearly defining governance structures and roles at the outset is essential for ensuring smooth project execution. Establishing a shared understanding of responsibilities and required competencies allows both the project team and external stakeholders to coordinate effectively, anticipate potential challenges and develop realistic budgets and timelines. In turn, this approach reduces the risk of misunderstandings, internal conflicts and delays, contributing to a more coherent and transparent construction process.

Transitions between project stakeholders, such as consultants or project managers, represent a moment of vulnerability, where essential knowledge and relationships risk being lost. This can be mitigated through planned, gradual handovers involving joint collaboration and dialogue, thereby ensuring continuity and safeguarding core design intentions.

4.2. Clarifying Required Competences and Establishing the Aim of the Design

In landscape architecture projects that apply the EBHDL model, it is essential for commissioned landscape architects to establish a clear understanding of the expectations regarding the intended functions and outcomes of the garden. This corresponds to the task of articulating the aim of the design during the programming step of the EBHDL model. Without this clarity, implementation may be challenging, as original intentions can be difficult to interpret or fulfil. While this may seem straightforward, aims are often vaguely expressed or absent.

The objectives of Care Outside are ambitious, novel and highly relevant. From the project application, the following expectations for the garden were identified: (1) support physical, mental and social health; (2) support students’ learning and life skills by bridging theoretical instruction with embodied, sensory and experiential learning; (3) promote ecological sustainability and biodiversity; (4) support professional development and adaptation of nature-based teaching programmes; and (5) serve as a demonstration model for other schools interested in nature-based learning by documenting its development and use to support dissemination and guide similar initiatives.

The specific objectives require distinct competencies among the consultants involved in the project. Track 1 was led by two landscape architects (who are also researchers). The UCPH was responsible for delivering the Initial Advisory Service and Outline Proposal, based on the first three steps of the EBHDL model. As the UCPH lacked the required insurance to formally deliver this type of output, it partnered with Sundhedslandskab, a private architectural studio with extensive experience in evidence-based practice. Detailed design and technical documentation require specialised competencies, and following a tender process, VEGA landskab was appointed as the design consultant for the subsequent phases, due to their substantial experience with rooftop gardens, schools and care facilities. Track 2 was implemented by two UCPH physiotherapists and a psychologist. Close collaboration and transparency between the two tracks is essential to achieve the project’s objectives.

Lessons Learned

Clearly defining the project’s aims of the garden and the client’s expectations at the outset is essential for guiding the design process. Articulated objectives support evidence collection, inform design criteria and help align expectations among stakeholders.

Early identification of the professional competences required ensures that all aspects of the design and construction process are appropriately supported. Furthermore, close collaboration and transparency between involved consultants are critical for coherence and for achieving the intended outcomes of the landscape design.

4.3. Understanding the Premises of the Chosen Site

From the outset of Care Outside, it was decided that the garden would be located on the rooftop of the SOSU school building (see Figure 5). This location offers several advantages: it is easily accessible from the school’s teaching and social areas, and for students who are not accustomed to spending time in natural environments, a rooftop garden may serve as a more approachable alternative to wilder nature. In addition, it avoids potential challenges related to land protection or soil contamination. However, compared to a ground-level garden, establishing a rooftop garden also presents several limitations.

The most significant concern was whether the roof could structurally support the soil required to create a natural environment. As part of the project application, calculations of the roof’s load-bearing capacity had been conducted, indicating that a rooftop garden would be feasible. However, during the design of the garden, detailed assessments of the precise capacity across different sections of the roof were required. An engineer was therefore commissioned to perform final calculations, but the process was time-consuming and affected both the project timeline and the advisory process. Another limitation of a rooftop site is the absence of existing vegetation that can be integrated into the project, as is often possible in ground-level sites. A core principle in UCPH’s approach is to preserve existing vegetation and avoid tree removal. In this case, however, there was no existing planting apart from a few planter boxes with ivy.

Regardless of whether a garden is established at ground level or on a rooftop, it is also important to investigate the regulatory requirements associated with the site. In the Care Outside project, an early meeting was held with representatives from Vejle Municipality’s planning department, and a close dialogue continued throughout the process until regulatory approval was granted, resulting in a swift and seamless approval procedure.

Lessons Learned

The advantages and disadvantages of potential sites should be thoroughly examined before project approval, ideally in collaboration with relevant consultants such as landscape architects and engineers. Multiple sites may offer similarly beneficial outcomes, but differ in terms of complexity and construction costs. A thorough understanding of the site’s physical conditions supports realistic planning, evidence-based design and alignment with project objectives.

Attention should be given to regulatory opportunities and constraints, and dialogue with the relevant authorities should be initiated early in the process to ensure that potential challenges are addressed as part of the project development rather than only during the formal approval stage.

4.4. Process Diagram: A Tool for Overview and Coordination

In Care Outside, detailed planning was required to coordinate multiple stakeholders and ensure the collection of baseline data, as the project aimed to assess the effects of nature-based teaching in the rooftop garden on students’ learning, health and wellbeing. To support this, a process diagram was developed that integrated the project timeline, the EBHDL steps, and the construction phases and deliverables associated with the design and construction process. While the full process diagram for the Care Outside project (see Appendix A) may appear complex, it has proven to be a practical and effective tool. A simplified version is presented below (see Figure 6). Although the development of such a diagram is initially time-intensive, it can evolve into an active working document for all project partners, thereby facilitating communication and enhancing shared understanding of the project.

Lessons Learned

To obtain a comprehensive overview of the entire project process including the phases, stakeholders and deliveries, a dynamic process diagram can serve as a valuable tool. It supports communication across project partners and helps ensure that key steps are not overlooked at the outset, particularly in projects following the EBHDL model. Early planning of evaluation elements, such as baseline measurements, is an example of a step that is often overlooked but that may be critical for assessing outcomes and informing future design and implementation decisions.

4.5. Evidence Collection: First Step of the EBHDL Process Model

Following the four preparatory steps, the first step of the EBHDL process begins: evidence collection. This step focuses on four key areas: (1) the target group, (2) the relationship between nature and human health, (3) the physical environment, and (4) the use of nature. In the Care Outside project, evidence was gathered from multiple sources, and from the beginning of the project, it was evident that a co-design approach was necessary to gather concrete, specific input on the needs of both teachers and students, and to foster ownership and engagement with the rooftop garden among both groups.

Target group: The primary target group comprised students at the SOSU school in Vejle, while teaching staff constituted a secondary group that was responsible for implementing nature-based teaching. Information about the student population was obtained through review of the project application and other internal documentation, and through discussions with the project team, all of which were documented in writing.

Relationship between nature and human health: Evidence in this area focused on how contact with nature may support health in this specific design project, and was drawn from established theoretical frameworks. The project was underpinned by five key theories: Attention Restoration Theory [29]; Prospect-Refuge Theory [30]; Affordance Theory [31]; Supportive Environment Theory [32]; and Perceived Sensory Dimensions [33]. These theories were identified and interpreted by the research team based on their prior experience with similar design projects, and are briefly introduced in the programme.

Environment: Evidence was obtained through relevant municipal plans, calculations of the roof’s load-bearing capacity, and landscape analyses of the site’s existing characteristics and conditions, potential and limitations in relation to achieving the design aims. As the rooftop was largely bare, analyses focused on indoor-outdoor connections, circulation and flow, microclimate (including wind and sun exposure), acoustic conditions, and views. Analyses were conducted both on site and graphically, through sketches, diagrams, and drawings.

Use of nature: Evidence related to the intended use of the rooftop garden was partly unique to this project, as the implementation of 5254 nature-based teaching was novel. To capture this, a co-design process with key stakeholders was conducted, allowing direct input into the design process.

Co-design is a user-centred design method for understanding users’ needs, preferences and experiences, in which users may act as co-designers depending on their level of engagement and expertise [34,35]. In Care Outside, teachers and students were involved as key stakeholders, and the co-design process consisted of four workshops (see

Table 2. Overview of the co-design workshops conducted in the Care Outside project.

Work- Shop	Title of Workshop	Objectives of the Workshop	Workshop Participants
1	Input for the EBHDL Programme and the design of the rooftop garden	1. To introduce participants to the rooftop garden development process and clarify their role within it.	Participants included teachers selected according to their subject areas and roles within the school; students from the student council; a member of the service staff; a mentor from Vejle Municipality; the project team; the landscape architect from VEGA landskab; and facilitators from the UCPH team.
		2. To encourage participants to reflect on elements that contribute to a meaningful experience of the rooftop garden.
		3. To collect participants’ input regarding potential activities in the rooftop garden.
		4. To identify key facilitators and barriers to the use of the rooftop garden.
2	Feedback on the rooftop garden design	1. To prompt participants to consider how they might adapt their current practices to enhance the benefits of the rooftop garden.	Same as Workshop 1
		2. To gather feedback on the initial rooftop garden design, based on various teaching and wellbeing scenarios.
3	Testing Design Elements in a Natural Forest Environment	1. To provide participants with hands-on experience in using nature within educational programmes, including group work, individual immersion and restorative activities.	Same as Workshop 1
		2. To support reflection on how this experience informs their expectations and aspirations for the rooftop garden.
4	Presentation and Discussion on the Final Rooftop Garden Design	1. To present and discuss the final rooftop garden design, demonstrating how input from staff and students has been integrated through the co-creation process.	Participants included all students and staff; internship providers and other partners from Vejle Municipality; neighbouring residents; potential collaborators; the project team; the landscape architect from VEGA landskab; and a landscape architect from the UCPH team.
		2. To provide an update on the status of the teacher training programme.
		3. To provide an update on the collaboration with internship sites on nature-based activities

) that addressed spatial requirements, pedagogical ambitions and practical constraints. As the potential contributions of participants were initially uncertain, only the topics for the first and final workshops were predefined. The theme for the first workshop was “Input for the EBHDL Programme and the Design of the Rooftop Garden,” while the theme for the final workshop was “Presentation and Discussion on the Final Rooftop Garden Design”.

Participants in Workshops 1–3 were consistent and comprised teachers, students from the student council, a member of the service staff, a mentor from Vejle Municipality, the project team, the landscape architect from VEGA landskab, and facilitators from the UCPH team. For the final workshop, participation was broadened to include all students and staff, internship providers and other partners from Vejle Municipality, neighbouring residents, potential collaborators, the project team, the landscape architect from VEGA landskab, and a landscape architect from the UCPH team. Participants were selected to ensure representation of key stakeholders involved in the design, implementation, and use of the rooftop garden.

Workshops 1, 2, and 4 were conducted on-site under normal school operating conditions, whereas workshop 3 took place in a nearby forest. This relocation was chosen because key themes emerging from workshop 2 indicated that participants required hands-on experience with the use of nature in educational activities to provide qualified input to the rooftop garden design. All workshop artefacts were digitised and stored for subsequent analysis. Preparatory and follow-up meetings with the project team ensured continuity, guided workshop content and determined which inputs should be integrated into the design.

Multiple data collection methods were employed, including notes taken by the research team during the workshops, photographs, posters, other artefacts containing participants’ comments, as well as written feedback and reflections from participants. All observations and notes were recorded immediately during or after the workshops, and following each workshop, all collected material was thoroughly reviewed by the research team. The collected material were processed using a structured protocol: (1) initial independent coding and grouping into preliminary themes carried out by one researcher, (2) subsequent review and feedback on the coding and themes provided by another researcher, (3) revision and refinement of the coding and thematic structure by the researcher who conducted the initial coding, and (4) validation and selection of the most significant themes together with the project team. This procedure ensured consistency and reproducibility. Finally, the research team examined how the identified themes could be incorporated as evidence within the EBHDL model’s Programme step, thereby informing and guiding the rooftop garden’s design. Based on the themes emerging from each workshop, the project group and research team collaboratively planned the objectives of the subsequent workshops (workshops 2 and 3).

The co-design process preceded the teacher training programme (track 2), which aimed to support nature-based teaching. The rooftop garden was intended to be ready for use during the programme, allowing teachers to apply and test their nature-based methods. However, conducting the co-design process before the teacher training programme meant that participants lacked the pedagogical framework needed to effectively articulate their requirements for the rooftop garden. A closer alignment between the co-design process and the teacher training programme would have facilitated a more cohesive and pedagogically informed design outcome.

Lessons Learned

Participatory methods, such as co-design, can generate context-specific insights that are often not captured through literature or standardised tools. Effective co-design requires careful planning, flexibility to respond to emerging needs, and maintaining momentum through preparatory and follow-up meetings.

To achieve meaningful and lasting impact on the design, the physical environment should be developed alongside evolving educational practices and institutional culture. When participants receive professional development first, they can provide pedagogically informed input that enhances the relevance and usability of the final design.

Early involvement of stakeholders from later project phases fosters continuity and shared understanding, reducing procedural friction and supporting informed decision-making.

4.6. Programming: Second Step in the EBHDL Process Model

Programming in the EBHDL process model refers specifically to ensuring clearly articulated project aims and to translating evidence into design criteria and solutions. It should not be confused with the Danish Project Brief (Byggeprogram), which serves as a formal planning document outlining spatial, technical and financial requirements. While both frameworks aim to clarify project intentions, the EBHDL programme functions as a practical design tool rather than a contractual or regulatory document.

Programming is an active part of the design process, and design teams typically produce a long and comprehensive programme. However, it is important to simplify the content in order to communicate the core message effectively to other stakeholders. This requires the landscape architect to actively present the most relevant evidence points and design solutions that are central to the development of the design. Put simply, the programme should clearly and accessibly explain Why (evidence), What (design criteria) and Where (site-specific design solutions). In Care Outside, 13 key evidence points were selected, resulting in 13 corresponding design criteria and design solutions, all presented in

Table 3. EBHDL programme for the Care Outside rooftop garden.

Target Group
Evidence	Design Criteria	Design Solution	Number	Conceptualisations
Students; Wide age range, culturally diverse, many not keen on outdoor experiences	The design should be inclusive, safe and supportive, where all students and staff have the opportunity to participate based on their own abilities.	The rooftop is designed so it is experienced as a secure, non-threatening space in regard to design or plant material.	1
	The garden should be easy to interpret and there is no single ‘right way’ to use the garden.	A clear design language that guides students’ use of the garden.
Students not always used to spending time in natural environments. Teaching staff not used to nature-based teaching.	The design should support both the students and teachers to actively use the garden all year around.	Transition zones between indoors and outdoors are needed to support both students and teachers.	2
The students are challenged with poor mental, physical and social health.	The design should offer nature experiences (PSDs, four components from ART that constitute restorative environments) and activities preferred by the students.	Nature experiences offering mental restoration. Possibilities for different levels of physical training along paths and in specific spaces. Possibilities for both social and solitary activities.	3
Nature and Human Health Relationship
Evidence	Design Criteria	Design Solution	Number	Conceptualisations
Attention Restoration Theory posits that humans use two types of attention: directed attention, which requires effort and can lead to mental fatigue, and involuntary attention, which is effortlessly captured by certain stimuli. Exposure to natural environments that engage involuntary attention can support recovery from mental fatigue.	In order for an environment to be perceived as restorative it should offer the following components: Being away Extent Fascination Compatibility	All four components should be present throughout the garden. Being away: Visiting the garden enables students to leave the school’s physical environment behind. Long views from the site guide the placement of spaces and functions to reinforce this sense of detachment. Extent: A coherent spatial character is created through a continuous ground layer of vegetation, with varied planting that supports orientation and exploration. Fascination: The site’s elongated views offer visual interest at key vantage points, while the diversity and detail of the planting provide sensory engagement at a smaller scale. Compatibility: The garden is intuitively readable and supports intended activities. What users imagine doing in the space is both understandable and achievable.	4
The Supportive Environment Theory Pyramid illustrates how individuals’ experiences of nature—and the level of demands they can manage—depend on their emotional and cognitive resources. The model consists of four levels, with a greater need for low-demand green spaces at the base and a lesser need at the top.	The design should address all four levels of the pyramid, considering mental, physical and social demands.	All four levels are represented across the area. Locations are arranged to avoid conflict between high- and low-demand environments. Off-track paths and smaller spaces offer opportunities for closer contact with nature, either individually or in groups.	5
Prospect-Refuge Theory suggests that humans seek environments offering both prospect—open, brightly lit views over long distances—and refuge—places of concealment and protection, typically small and enclosed. These contrasting perceptions must co-exist to create a sense of safety and comfort.	The design should provide simultaneous experiences of prospect and refuge.	Refuge is created using terrain, vegetation and lightweight constructions, reducing structural load. Prospect is offered through open views to the surroundings. Refuge areas are placed to avoid disturbance from more dynamic or ‘wild’ activities, ensuring calm and protected experiences.	6
The Perceived Sensory Dimensions (PSD) framework describes how people experience green spaces through eight distinct dimensions, some of which are more preferred than others. In general, ‘serene’ is the most preferred, followed by ‘space’, ‘nature’, ‘rich in species’, ‘refuge’, ‘culture’, ‘prospect’ and ‘social’. Among these, ‘refuge’, ‘nature’ and ‘rich in species’ are most strongly associated with the preferences of individuals experiencing stress. A combination of these dimensions, with minimal presence of ‘social’, is considered to best match the needs and preferences of this group.	All eight PSDs should be represented in the design.	Different areas of the site support different health dimensions: Areas targeting mental health emphasise ‘refuge’, ‘nature’ and ‘rich in species’. Areas targeting physical health include ‘prospect’, ‘refuge’, ‘rich in species’ and ‘space’. Areas targeting social health are dominated by ‘social’, combined with other PSDs. To meet the school’s request for high biodiversity, the PSD ‘Rich in Species’ is present throughout the garden. Plant selection is based on perceived biodiversity to enhance users’ experience and understanding.	7
Affordances are functional properties of an environmental feature relative to an individual, indicating which actions are possible in the setting and which may be excluded.	The design should encourage meaningful functions that the individual user is able to carry out.	Environmental features offering multiple meaningful functions are distributed throughout the area. The diversity of user groups (age, gender, experience with nature, etc.) is supported by a range of activity options, combining more naturalistic elements with constructed ones.	8
Environment
Evidence	Design Criteria	Design Solution	Number	Conceptualisations
Allowing vegetation to dominate through extensive use of living plant material creates positive effects on psychological restoration and sensory engagement.	The rooftop garden should be one cohesive space shaped by living material, in which spaces with appropriate sizes for the teaching needs are created.	Maximises vegetation coverage within the roof’s load-bearing capacity constraints, while creating smaller spaces sized appropriately for teaching activities and students’ free periods.	9
The view from the rooftop garden is currently its greatest resource.	The design should enhance the views of the surroundings.	Important views of the forest, the city, the mill, the stream and the sunrise should be preserved and enhanced, for example, by shielding disruptive views.	10
The roof’s load-bearing capacity is a crucial factor in determining the potential for experiences and activities in the rooftop garden.	The rooftop garden will be designed in accordance with the roof’s load-bearing capacity.	The rooftop garden will be designed so that vegetation is placed where the roof’s load-bearing capacity is greatest, thereby allowing for the thickest soil layer. In this way, the garden’s plants can achieve their maximum growth potential. A steel skeleton will carry the main path, which must be constructed from wood due to weight constraints; consequently, organic forms are not feasible.	11
Use of Nature
Evidence	Design Criteria	Design Solution	Number	Conceptualisations
Students should be able to visit the rooftop garden during breaks from teaching activities.	The garden should be open to students, allowing them to use it freely.	The garden’s spaces, varying in size and furnished for multifunctional use, offer students opportunities for both short and extended breaks, supporting moments of solitude as well as social interaction.	12
Teaching staff: The design of the rooftop garden is intended to meet the teaching staff’s needs in relation to implementing nature-based teaching practices.	The garden space should serve as a framework for various teaching activities: classroom teaching; station-based learning; group work; 1:1 conversations; individual immersion; subject-specific teaching activities.	Spaces of various sizes and subject-specific layers are placed to create synergy rather than conflict between the spaces/layers.	13
		A main path system connects the larger spaces. A secondary path system connects the smaller spaces for individual immersion.

. The selection process was based on professional judgement by the responsible landscape architects. As evidence was collected, it was added to a gross list organised under the four main topics of evidence. The list was then reviewed by the responsible landscape architects to remove duplicates and allocate each point to the most appropriate topic. Evidence points included in the final programme were chosen by the responsible landscape architects based on the relevance of the evidence and its potential contribution to the design, and were formulated in a way that could be understood by stakeholders with varying levels of experience in the area. To facilitate the connection between the programme and the next step in the EBHDL model, Design, a column has been included outlining conceptualisations as well as broad indications of where and how the design solutions may be translated into drawings for the specific project site. This approach reflects the EBHDL principle that while evidence is objectively collected, the formulation of design criteria and solutions requires subjective professional judgement, allowing the landscape architect to gradually move from evidence-based reasoning toward creative design decisions.

Lessons Learned

Programming is not only a matter of structuring evidence; it also requires prioritisation and simplification for strategic communication. While a comprehensive working programme is necessary during the design step, a simplified version is often more effective for stakeholder engagement.

4.7. Design: Third Step in the EBHDL Process Model

This step comprises four stages: 1. Conceptualisation; 2. Design; 3. Construction; and 4. Occupation. As this paper concludes with the delivery of the Construction Documentation and refers only briefly to construction, which is currently in progress, the post occupation step will not be addressed.

4.7.1. Conceptualisations

In the EBHDL model, conceptualisation refers to schematic representations derived from the design solutions. As previously mentioned, these sketches are included in the programme (see Table 3) and guide specific design decisions, indicating how and where design solutions may be realised on the site. Not all design solutions require a sketch; conceptualisations are created only where they add value to the design process.

4.7.2. Design

To ensure that the garden (see Figure 7) is inclusive and easily interpreted by students regardless of their background, the overall composition is kept simple (Design Solution 1). It is essential that the garden does not place greater demands on the students than their mental resources allow (Design Solution 5), and that they can visit the garden effortlessly during breaks from teaching activities (Design Solution 12). Therefore, it must be easy to access areas of the garden where the demands are low, for example, where they cannot be observed by others. More demanding areas remain optional and can be approached when students feel ready. Being in a rooftop garden may also feel safer for students than being in more untamed natural environments. In addition, a rooftop garden at school can provide a sense of mental and physical detachment from everyday demands and stress, corresponding to the ‘being away’ component of restorative environments (Design Solution 4).

To further support students who are unfamiliar with natural environments, and to assist teachers in moving their teaching outdoors and adopting nature-based approaches, transition zones (Design Solution 2) are established by integrating existing indoor spaces with the rooftop garden. This is achieved by opening the façade with large windows and glazed doors, and by aligning indoor and outdoor functions and materials. The inclusion of transitional indoor rooms is essential for encouraging the use of the rooftop garden, supporting both restorative and educational functions.

A main path connects the points of entry from the building to rooms of varying sizes that are designed to accommodate different teaching formats, including group work, individual study and larger gatherings (Design Solution 13). These rooms also support students’ health by offering opportunities for physical activity, social interaction and individual reflection (Design Solution 3). The design includes four types of space: two large gathering spaces with multifunctional furniture, affording a range of activity options (Design Solution 8); one medium-sized nature-enclosed room for mid-sized groups; two smaller secluded rooms with views of valuable surroundings such as woodland and historic buildings; and three niches for one or two individuals, also directed towards pleasant and engaging views (Design Solution 10). The latter two types feature protective backing elements—vegetation where possible or constructed elements where weight constraints prevent planting. These correspond to the Prospect-Refuge theory (Design Solution 6), supporting a fundamental preference for safety and tranquillity. These smaller spaces are placed at a distance from the larger ones to minimise noise and disturbance from teaching, social interaction or physical activity.

Due to the roof’s load-bearing capacity, the main path is constructed as a wooden boardwalk, which is lighter than, for example, gravel. The boardwalk is anchored to a steel frame, which for structural reasons prevents an organic layout (Design Solution 11). To enable close interaction with natural elements, a secondary path with an organic shape is created using natural materials such as stones and tree trunks. These elements aim to capture students’ attention effortlessly, corresponding to the ‘fascination’ component central to restorative experiences (Design Solution 4).

The overarching design approach treats the site as a single spatial entity filled with vegetation, within which smaller rooms are created (Design Solution 9). The overall expression of the vegetation is supported by a combination of perceived sensory dimensions—‘refuge’, ‘nature’ and ‘rich in species’—which align with nature preferences among individuals experiencing stress (Design Solution 7). This also contributes to high biodiversity and a sense of richness and coherence, evoking the feeling of being in another world, corresponding to the ‘extent’ component of restorative environments (Design Solution 4).

VEGA landskab (see Figure 8) demonstrated great understanding and respect for the original design developed by the UCPH team, and the core spatial, health and pedagogical intentions are clearly reflected in the final design. However, a significant change took place after VEGA landskab assumed responsibility for the continued development of the design, as the final engineering calculations for the roof’s load-bearing capacity were completed. These calculations revealed that the central area of the roof, from north to south, had the lowest capacity, allowing only wooden decking, light structures or very low vegetation. Consequently, the large multifunctional wooden structure originally planned for the north-western corner was relocated there. In contrast, the eastern and western sections of the roof could support a heavier load, making it possible to establish a thicker soil layer and thereby larger plantings, which ensured the establishment of natural environments with smaller niches and seating areas.

4.7.3. Construction

VEGA landskab is responsible for site supervision during the construction phase carried out by the contractor Winther & Trolle, but the UCPH team participated in relevant decision-making and maintained ongoing dialogue with the project team and VEGA landskab to stay informed about the construction process. Supervision during construction is crucial to safeguarding the integrity of the original design intent and to ensuring that evidence-based decisions are implemented as planned. This applies not only to health-supportive features but also to spatial and material elements intended to support nature-based teaching. This continued involvement helped ensure that core intentions related to nature-based teaching and health are upheld during construction.

4.7.4. Lessons Learned

In the design step of the EBHDL process model, there is a risk that the original design intentions become disconnected from their implementation, as at this step, responsibility typically shifts from one landscape architecture consultant to another, and then from the consultant to the contractor.

The EBHDL programme helps to ensure continuity throughout this step by providing a clear and transparent foundation for the design, thereby facilitating the smooth transfer of essential knowledge. Moreover, the risk of disconnection between aims and execution can be mitigated, not only through thorough handover meetings but also by establishing a gradual transition, in which outgoing and incoming actors collaborate for a period before the final handover. Continued involvement of the evidence-based design consultant across all phases of the project further helps to ensure that the health-promoting and pedagogical intentions remain clearly reflected in the completed environment.

5. Discussion

5.1. EBHDL as a Framework for Design and Decision-Making

Designing outdoor environments that serve health, wellbeing, learning, and teaching simultaneously is inherently complex. Generic design guidelines rarely suffice, as each project emerges at the intersection of institutional ambitions, user needs, and regulatory frameworks [1]. In this context, EBHDL provides an overarching, evidence-based framework, guiding both design and decision-making processes. Approaches such as Biophilic Design and Neuroarchitecture are closely related to EBHDL, sharing its focus on promoting human health, cognitive restoration, and sensory engagement. By reflecting on these approaches in relation to EBHDL, the Care Outside project situates itself within a broader discourse on health-promoting environments, demonstrating how related but different paradigms intersect and inform contemporary design practice.

In the following sections, the discussion addresses the guiding questions introduced earlier by examining (1) practical lessons from project management, stakeholder involvement, and design integration, (2) the operationalisation of EBHDL in a complex institutional project, and (3) the potential transferability of these lessons to other contexts.

5.2. Operationalising EBHDL Across Diverse Contexts

While EBHDL has so far primarily been applied in landscape projects related to therapy gardens and health care facilities e.g., [17,22,23], Care Outside focuses on a school environment in which health and learning are equally important outcomes. The Care Outside case illustrates how EBHDL can be adapted to new institutional cultures and priorities. This flexibility aligns with findings from Icelandic research, which demonstrate the model’s applicability across diverse contexts, including climatically challenging environments [22].

This section directly addresses the second guiding question, showing how EBHDL can be operationalised within a vocational school context and aligned with institutional priorities By operationalising EBHDL within a vocational school setting, this study contributes to a growing body of research exploring how evidence-based design frameworks may support learning, wellbeing, and pedagogical development [10,11,12,13,14,15]. The focus here is on process rather than verified outcomes, illustrating how the model may help structure complex design processes, facilitate stakeholder engagement, and support decision-making in institutional projects. This outcome aligns well with findings from other projects in which EBHDL has been applied [22,23].

5.3. Practical Lessons and Co-Design

The participatory approach strengthened the project by generating context-specific insights and aligning co-design outcomes with pedagogical aims. However, the situated nature of co-produced evidence limits generalisability. These findings respond to the first guiding question, highlighting practical lessons on project management, stakeholder involvement, and the importance of documentation for continuity. Lessons learned from structured process additions, such as appointing a knowledgeable project leader and maintaining supporting documentation, provide transferable insights for similar institutional projects. While the case focuses on a vocational school in Denmark, the EBHDL model demonstrates value in structuring how evidence is mobilised, rather than prescribing identical solutions across contexts.

5.4. Transferability, Strengths and Limitations

As in previous EBHDL studies, this case has both strengths and limitations. The Care Outside case suggests that a structured, evidence-based design process may help make a complex project more manageable and support interdisciplinary collaboration, systematic processes, transparency, adaptability, and clarity and alignment across phases. Its user-centred structure helps practitioners navigate diverse evidence types and provides clear rationale for design decisions. These outcomes align well with findings from other projects in which EBHDL has been applied [17,21,22,23]. EBHDL’s alignment with both Danish and internationally recognised construction phases (e.g., RIBA, HOAI) further supports its relevance across diverse institutional and regulatory contexts.

At the same time, the Care Outside case underlines potential risks. Consultative roles with EBHDL expertise, such as that of the UCPH team in Care Outside, are influential in enabling process quality, yet they may not be engaged throughout the entire project and do not hold decision-making authority over process and delivery. The emergence of continuity as a key lesson in the case study indicates that such risks are tangible; evidence can be lost during handovers unless responsibility is clearly assigned. This underscores the importance of both clients and consultants being familiar with EBHDL and the model’s role in achieving project objectives. Moreover, a post-occupancy evaluation (POE) is planned as a central component of the Care Outside project. While other EBHDL projects have noted that POE is rarely included in conventional construction processes [17,22,23], integrating POE here ensures verification of whether the intended health and educational benefits are achieved. It also supports systematic learning and feedback for future projects, highlighting the value of continuity, documentation, and long-term process evaluation.

Other projects have noted that EBHDL is a time- and resource-intensive process, which can make it difficult to integrate into conventional construction projects that, for example, rarely include post-occupancy evaluation [17,22,23]. This challenge was not present in Care Outside, where the project was planned and budgeted with an EBHDL process as the overarching management framework. This points to the importance of integrating EBHDL considerations already in the early planning phases, when budgets and timelines are developed. Moreover, post-occupancy evaluation must be emphasised as essential for determining whether intended benefits are realised.

In relation to the third guiding question, the case illustrates which lessons may be transferable to other institutions, particularly those concerning continuity of responsibility, participatory co-design, and the integration of post-occupancy evaluation.

5.5. Future Research

Beyond the planned Post-Occupancy Evaluation (POE) to verify the real-world effectiveness of the design, future research should investigate the institutionalisation of EBHDL across sectors, the formalisation of advisory roles to maintain evidence integrity, and longitudinal evaluation of participatory, evidence-based processes. Comparative analyses across multiple EBHDL cases could help identify consistent process elements as well as context-dependent features.

6. Conclusions

This case study highlights key lessons for planning, designing and constructing evidence-based landscapes using the EBHDL model to support health and nature-based teaching at a vocational school, employing a participatory, practice-based methodology centred on the design and construction phases of a school landscape intended to promote health and support educational activities.

This study contributes theoretically by extending EBHDL to educational contexts, demonstrating its adaptability to pedagogical objectives alongside health promotion. Practically, it shows how co-design enhances alignment with user needs while identifying risks related to continuity and stakeholder engagement. Methodologically, it illustrates how EBHDL can be adapted to Danish construction phases, offering a replicable structure for managing complex institutional projects.

A post-occupancy evaluation is planned to assess the design’s impact on health and teaching outcomes. Empirical follow-up will be essential to validate the design’s effectiveness and guide any necessary refinements.