Materials and Methods

This research adopted a mixed-methods approach for data collection, as detailed below:

Quantitative Survey

The study targeted two main groups: (1) users of hospital physical facilities including staff members, inpatients, and outpatients and (2) the physical buildings within the three Federal University Teaching Hospitals in Southwest Nigeria (UCH in Ibadan, LUTH in Lagos, and OAUTHC in Ile-Ife). Data regarding staff and hospital structures were sourced from the administrative records of each hospital, while patient numbers were determined based on bed counts and outpatient records from December 2019 to December 2020. Altogether, the study considered 39,787 users and 198 buildings.

The sampling frame consisted of both users and buildings from four core departments such as Medicine, Paediatrics, Surgery, and Obstetrics & Gynaecology in each hospital. This resulted in user counts of 468 at UCH, 538 at LUTH, and 241 at OAUTHC (a combined total of 1,247). For buildings, 45 departmental structures were included: 18 at UCH, 11 at LUTH, and 16 at OAUTHC.

Sample sizes were determined using the Krejcie and Morgan (1970) formula, resulting in 210, 217, and 148 user samples for UCH, LUTH, and OAUTHC, respectively, for a total of 575 questionnaires. Staff and patient samples at each hospital were allocated proportionally. For buildings, sampling was restricted to four core departmental buildings in each hospital that accommodate 4 main departments which gave birth to other departments and also carried out pure clinical activities for medical treatment. These departments are Paediatrics, Surgery, Medicine, Obstetrics and Gynaecology (See table 2.0). A stratified sampling technique was used for users, first categorizing respondents as either staff (clinical and non-clinical) or patients (inpatient and outpatient), followed by random selection within these groups.

The structured questionnaire consisted of sections designed to address the study’s research questions, objectives, and hypotheses. Three versions were developed: Type A for staff, Type B for inpatients, and Type C for outpatients. In total, 575 questionnaires were distributed 204 to staff and 371 to patients. The questionnaire items were based on operational definitions of variables (see Table 3.0), including codes, categories, Likert scale ranges, measurement scales, and analysis tools. Variables were selected from existing literature and previous studies, with Type A including most items from Types B and C.

Responses from the structured questionnaires were analyzed using descriptive statistics, such as frequency distributions, weighted means, and standard deviations. At the bivariate level, Kendall’s tau-b correlation was used to explore relationships between design features of physical facilities. For multivariate analysis, the Kruskal-Wallis Post hoc test was employed to test the Null Hypothesis H03b, which states that there are no significant differences in users’ assessments of physical facilities across the three hospitals.

Qualitative Interview

Semi-structured interviews were conducted on days with lighter clinical workloads typically Mondays and Wednesdays with key personnel, including department heads, consultants, matron nurses, and maintenance managers or architects/engineers. Access to conduct these interviews and collect relevant data was granted through formal approval from the management of each selected hospital.

Table 2 : Sampling Frame, Sample Size and Percentages of sample selected

Source: Study area records office, 2019 (Between the periods of December 2019- December 2020), Krejcie and Morgan (1970)

Table 3: Operationalisation of variables and Measurement scales for the research

Results

Quantitative Survey

A Kruskal-Wallis Post hoc test was conducted to investigate the significant difference in the users' assessment of physical facilities among the Federal Teaching Hospital in Southwest, Nigeria. The results of the differences in the physical facilities are discussed in the section below from the Null Hypothesis H₀3b.

Difference in Layout of the Building and Space at the FUTH

A significant difference was observed in users’ assessments of the layout of the building and space among the Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria. This analysis was conducted to determine whether users’ evaluations of physical facilities varied across the three study areas. The results, presented in Table 4.0 and Figure 1.0, indicate that the null hypothesis is rejected at a P-value of 0.000, which is less than the 0.05 significance level. The mean rank assessments of the physical facilities are as follows: Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 344.62, University College Hospital (UCH): 287.10 and Lagos State University Teaching Hospital (LUTH): 224.69. These rankings are presented in descending order of user satisfaction. To further identify the level of statistical significance in the differences, a Kruskal-Wallis post hoc test was performed. The test revealed statistically significant pairwise differences between all three hospitals:

LUTH vs. UCH

LUTH vs. OAUTHC

UCH vs. OAUTHC

All comparisons showed P-values < 0.05, confirming significant variations in the assessment of building layouts and spaces.

Figure 1: Difference in the users' assessment of the layout of buildings and space among the FUTH Click here to view Figure

Table 4: Difference in the users' assessment of the layout of buildings and space among the FUTH

source: Researcher’s Field Survey, 2021.

Difference in Organisation of the interior spaces and furniture at the FUTH

This analysis examined differences in the organisation of interior spaces and furniture across the three Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria. The null hypothesis stated that there is no significant difference in users’ assessments of the interior space and furniture organisation among the three hospitals. However, the results revealed that the null hypothesis is rejected at a P-value of 0.000, which is less than the 0.05 (5%) significance level. The mean rank assessments are as follows: Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 342.07, University College Hospital (UCH): 289.52 and Lagos State University Teaching Hospital (LUTH): 224.02. These values, as shown in Figure 2.0, indicate significant differences in user satisfaction levels regarding the interior space and furniture across the hospitals.

Furthermore, Table 5.0 presents the results of post hoc pairwise comparisons, which confirm statistically significant differences in user assessments between all pairs:

LUTH vs. OAUTHC

LUTH vs. UCH

UCH vs. OAUTHC

Each comparison yielded a P-value of 0.000, indicating strong statistical significance.

Figure 2: Difference in users' assessment on the organisation of the interior spaces and furniture among the three. Click here to view Figure

Table 5: Difference in users' assessment on the organisation of the interior spaces and furniture

Source: Researcher’s Field Survey, 2021

Difference in the Form/shape of building and spaces at the FUTH

The difference in the form and shape of the buildings and spaces across the three Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria was analysed using the Kruskal-Wallis post hoc test. The results revealed a statistically significant difference in users’ assessments of the form and shape of the buildings and spaces among the three hospitals. This indicates that the form/shape of the buildings and spaces is not uniform across the study areas. As presented in Table 6.0 and Figure 3.0, the mean rank scores were: Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 347.12, University College Hospital (UCH): 280.07, and Lagos State University Teaching Hospital (LUTH): 230.06

The pairwise comparison results showed statistically significant differences as follows:

LUTH vs. UCH: P = 0.04

LUTH vs. OAUTHC: P = 0.000

UCH vs. OAUTHC: P = 0.000

Since all p-values are less than 0.05, the null hypothesis is rejected, confirming that significant differences exist in the form and shape of buildings and spaces across the three FUTHs.

Figure 3: Difference in the users' assessment on the form/shape of the buildings and spaces among the three FUTH Click here to view Figure

Table 6: Difference in the users' assessment of the form/shape of the buildings and spaces

Source: Researcher’s Field Survey, 2021

Difference in Movement Pattern/flow within the Interior Spaces at the FUTH

This analysis examined the pattern of movement within the interior spaces of the three Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria: LUTH, OAUTHC, and UCH. The objective was to determine whether there is a statistically significant difference in the interior movement flow across the three hospitals.

The null hypothesis which states that there is no significant difference in the movement patterns was rejected, as the analysis yielded a P-value of 0.000, which is less than the 0.05 significance level. The mean rank scores for user assessments of movement patterns within the hospitals were as follows: Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 357.6, University College Hospital (UCH): 271.43, and Lagos State University Teaching Hospital (LUTH): 231.46.

These values, illustrated in Figure 4.0, indicate that movement within the interior spaces varies significantly among the hospitals. A pairwise comparison (as shown in Table 7.0) further confirmed significant differences:

LUTH vs. UCH: P = 0.030

LUTH vs. OAUTHC: P = 0.000

UCH vs. OAUTHC: P = 0.000

These results confirm the presence of statistically significant differences in the flow of movement within the interior spaces of the three FUTHs.

Figure 4: Difference in the user's assessment of the movement pattern/flow within the interior spaces among the FUTH. Click here to view Figure

Table 7: Difference in the user's assessment of the movement pattern/flow within the interior spaces

Source: Researcher’s Field Survey, 2021.

Difference in Accessibility to Building and Interior Spaces at the FUTH

To examine the differences in accessibility to buildings and interior spaces across the Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria, a Kruskal-Wallis H test was conducted. This test assessed whether there were statistically significant differences in users' assessments of physical facility accessibility among the three hospitals. As shown in Table 8.0, the result indicates that the null hypothesis is rejected, with a P-value of 0.000, which is less than the 0.05 significance level. This confirms a statistically significant difference in accessibility to buildings and interior spaces among the hospitals. The mean rank scores, as illustrated in Figure 5.0, are: Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 360.19, University College Hospital (UCH): 278.40, and Lagos State University Teaching Hospital (LUTH): 222.58

Further pairwise comparisons revealed significant differences between the following pairs:

LUTH vs. UCH: P = 0.01

LUTH vs. OAUTHC: P = 0.000

UCH vs. OAUTHC: P = 0.000

These values confirm that the accessibility conditions vary significantly across the three FUTHs in Southwest Nigeria.

Figure 5: Difference in the users’ assessment of the accessibility to buildings and spaces among the FUTH Click here to view Figure

Table 8: Difference in the users’ assessment of the accessibility to buildings and spaces

Source: Researcher’s Field Survey, 2021.

Difference in Visibility within the Interior Space at the FUTH

Visibility within the interior space was examined as a critical factor in users’ assessment of physical facilities across the three Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria. The aim was to determine whether a statistically significant difference exists in visibility assessments among the hospitals. As presented in Table 9.0, the null hypothesis which states that there is no significant difference in visibility was rejected, with a P-value of 0.000, which is less than the 0.05 (5%) significance level. This confirms that there is a statistically significant difference in users' assessment of interior space visibility across the study areas. The mean rank scores for visibility are as follows (as shown in Figure 6.0): Obafemi Awolowo University Teaching Hospital Complex (OAUTHC): 357.09, University College Hospital (UCH): 266.54 and Lagos State University Teaching Hospital (LUTH): 236.80.

These rankings suggest varying levels of visibility satisfaction among users.

A pairwise comparison using the Kruskal-Wallis post hoc test yielded the following results:

LUTH vs. UCH: P = 0.161 (not significant)

LUTH vs. OAUTHC: P = 0.000 (significant)

UCH vs. OAUTHC: P = 0.000 (significant)

These findings indicate that while LUTH and UCH are not statistically different in terms of visibility, both differ significantly from OAUTHC.

Figure 6: Difference in assessments of the visibility within the interior space of the FUTH Click here to view Figure

Table 9: Difference in assessments of the visibility within the interior space

Source: Researcher’s Field Survey, 2021.

Difference in Numbers of Windows and Doors within the interior space at the FUTH

The number of windows and doors within interior spaces was examined as a key design measure in the assessment of physical facilities across the Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria. The objective was to determine whether a statistically significant difference exists in the provision of these elements among LUTH, UCH, and OAUTHC.

Using the Kruskal-Wallis post hoc test, the analysis revealed that the null hypothesis is rejected at a P-value < 0.05, indicating a statistically significant difference in the number of windows and doors among the three hospitals. To further identify specific group differences, pairwise comparisons were conducted, as shown in Table 10.0:

LUTH vs. UCH: P = 0.359 ? Not statistically significant

LUTH vs. OAUTHC: P = 0.000 ? Statistically significant

UCH vs. OAUTHC: P = 0.000 ? Statistically significant

The mean rank scores, presented in Figure 7.0, indicate the following:

OAUTHC: 344.31

UCH: 268.25

LUTH: 244.04

These mean ranks highlight varying levels of user satisfaction regarding the quantity and distribution of windows and doors in the hospitals.

Figure 7: Difference in assessments of numbers of windows and doors in the interior spaces among the FUTH. Click here to view Figure

Table 10: Difference in assessments of numbers of windows and doors in the interior spaces

Source: Researcher’s Field Survey, 2021.

Difference in Users' Assessment of the Physical Facilities at the FUTH

The physical facilities of the Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria were assessed using seven design-related variables:

Layout of buildings and spaces

Organisation of interior spaces and furniture

Form/shape of buildings and spaces

Movement pattern/flow within interior spaces

Accessibility to buildings and interior spaces

Visibility within interior spaces

Number of windows and doors within interior spaces

These variables served as the design criteria for evaluating the performance of physical facilities across the three hospitals: LUTH, UCH, and OAUTHC.

The primary objective of the analysis was to test the null hypothesis that there is no significant difference in users' assessments of physical facilities across the hospitals. According to the decision rule, if P-value < 0.05, the null hypothesis is rejected.

As shown in the hypothesis testing results, the null hypothesis was rejected at P-value < 0.05, indicating that there is a statistically significant difference in the users’ assessment of physical facilities among the three hospitals.

The mean rank scores (illustrated in Figure 8.0) were:

OAUTHC: 364.80

UCH: 287.10

LUTH: 224.69

These results confirm that OAUTHC received the highest overall assessment, followed by UCH, and then LUTH. Additionally, a Kruskal-Wallis post hoc test was conducted to examine pairwise differences among the hospitals. The results, as presented in Table 11.0, show that all three pairings LUTH vs. UCH, LUTH vs. OAUTHC, and UCH vs. OAUTHC produced P-values < 0.05, confirming statistically significant differences in all comparisons.

Figure 8: Difference in the perception of users' assessment of the physical facilities among the FUTH Click here to view Figure

Table 11: Difference in the users' assessment of the physical facilities

Source: Researcher’s Field Survey, 2021.                                                

The Difference in the users’ assessment of the Physical Facilities at the FUTH

The users’ assessments of physical facilities at the Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria were analyzed based on seven key variables such Layout of buildings and spaces, Organisation of interior spaces and furniture, Form/shape of buildings and spaces, Movement pattern/flow within interior spaces, Accessibility to buildings and interior spaces, Visibility within interior spaces and Number of windows and doors. The results for each variable are summarized below and presented in Table 12.0. The result for layout of the buildings and spaces show that UCH shows the chi-square X_2(cal) = 257.98; Mean rank = 356.82, and p-value = 0.002; LUTH (chi-square X_2(cal) = 262.48; Mean rank = 342.67, and p-value = 0.012), and OAUTHC (chi-square X_2(cal) = 203.882; Mean rank = 396.45, and p-value = 0.000). For organisation of interior spaces and furniture in UCH (chi-square X_2(cal) = 121.65; Mean rank = 311.75, and p-value = 0.000); LUTH (chi-square X_2(cal) = 147.220; Mean rank = 299.79, and p-value = 0.003), and OAUTHC (chi-square X_2(cal) = 117.05; Mean rank = 331.89.10, and p-value = 0.000).

Forms/Shape of building and spaces for UCH shows the value of chi-square X_2(cal) = 129.146; Mean rank = 299.99 and p-value = 0.005; LUTH (chi-square X_2(cal) = 121.061; Mean rank = 289.11, and p-value = 0.000) and OAUTHC (chi-square X_2(cal) = 154.880; Mean rank = 305.18, and p-value = 0.000). The fourth variable which is the movement pattern/flow within the interior spaces shows the result of the UCH (chi-square X_2(cal) = 217.910; Mean rank = 378.56, and p-value = 0.004; LUTH (chi-square X_2(cal) = 218.593; Mean rank = 386.19, and p-value = 0.000), and OAUTHC (chi-square X_2(cal) = 247.272; Mean rank = 396.05, and p-value = 0.000).

Accessibility to building and interior space for UCH (chi-square X_2(cal) = 135.130; Mean rank = 344.13, and p-value = 0.002 ); LUTH (chi-square X_2(cal) = 140.225; Mean rank = 312.32, and p-value = 0.000), and OAUTHC (chi-square X_2(cal) = 152.259; Mean rank = 365.17, and p-value = 0.001); visibility within the interior spaces for OAUTHC (chi-square X_2(cal) = 217.275; Mean rank = 277.13, and p-value = 0.000); LUTH (chi-square X_2(cal) = 215.829; Mean rank = 298.902, and p-value = 0.000), and UCH (chi-square X_2(cal) = 259.902.061; Mean rank = 281.30, and p-value = 0.001). The last variable considered is the number of windows and doors in the three FUTH. For number of windows and doors in OAUTHC, the result of the analysis shows the value of chi-square X_2(cal) = 117.242; Mean rank = 259.10, and p-value = 0.003; LUTH (chi-square X_2(cal) = 152.858.061; Mean rank = 276.54, and p-value = 0.000) and UCH (chi-square X_2(cal) = 117.231; Mean rank = 244.13, and p-value = 0.001).

The findings however indicate that OAUTHC performs better than LUTH and UCH in the aspect of the layout of buildings and spaces; organisation of interior spaces and furniture; form/shape of building and spaces; movement pattern/flow within the interior spaces and accessibility to building and interior spaces while LUTH performs better than OAUTHC and UCH when considering the visibility within the interior spaces and the number of windows and doors within the interior space.

Table 12: Difference in the users’ assessment of the Physical Facilities in the FUTH

LAYBS=Layout of the buildings and spaces, ORGISF=Organization of interior spaces and furniture, FOSH-BS= Form/shape of building and spaces, M-FLOW= Movement pattern/flow within the interior spaces, AC-BIS = Accessibility to building and interior spaces, VIS-INT =Visibility within the interior spaces and SIZE-NEW =Number of windows and doors

Source: Researcher’s Field Survey, 2021.

Testing of Hypothesis 3 (H₀3_b)

Hypothesis 3 (H03b) was tested using the Kruskal-Wallis test to evaluate whether there is a statistically significant difference in users' assessments of physical facilities among the three Federal University Teaching Hospitals (FUTHs) in Southwest Nigeria: OAUTHC, UCH, and LUTH.

The null hypothesis (H?) states

There is no significant difference in the users’ assessment of the physical facilities among the three FUTHs in Southwest Nigeria.

The decision rule is as follows:

If the p-value is less than 0.05 (5% significance level), reject the null hypothesis; otherwise, do not reject it.

As presented in Table 13.0, the analysis yielded a p-value = 0.000, which is less than 0.05, and therefore, the null hypothesis is rejected. This result implies that there is a statistically significant difference in users’ assessments of physical facilities among OAUTHC, UCH, and LUTH, with a confidence level of approximately 95%.

Table 13: Kruskal-Wallis Test: Users’ assessment of the Physical Facilities among the FUTH

Where *** indicates P-value < 0.01, ** indicates P-value < 0.05, and ** indicates P-value < 0.1. Grouping variable: Federal University Teaching Hospitals in the southwest (OAU, UCH, and LUTH).

Source: Researcher’s Field Survey, 2021.

Discussion of the Study

The findings of this study reveal that both staff and patients perceive notable differences in the layout and spatial organization of the three hospitals examined. The null hypothesis was rejected at the 5% significance level, indicating that these variations are statistically significant rather than random. Of the three hospitals, OAUTHC achieved the highest mean rank, reflecting more positive evaluations of its spatial layout and arrangements. UCH ranked second, while LUTH received the lowest scores, suggesting greater dissatisfaction with its spatial design. These outcomes suggest that the architectural planning at OAUTHC is more attuned to user needs, potentially due to better navigation, zoning, or circulation pathways. This aligns with Joseph (2006), who highlighted the impact of well-structured layouts on reducing stress and enhancing efficiency in healthcare settings. The results point to a need for redesigning the layouts at UCH and, in particular, LUTH to foster better user experience and satisfaction. This is further supported by Reiling (2008), who noted that effective spatial planning can decrease adverse incidents and improve safety.

Significant differences were also reported regarding the organization of interior spaces and furniture. Again, OAUTHC led in user satisfaction, suggesting superior interior layout and ergonomics, while UCH followed, and LUTH lagged behind. These results reinforce the argument by Schweitzer, Gilpin, and Frampton (2004) that interior design including ergonomic furniture and spatial arrangement plays a direct role in patient recovery, staff performance, and overall wellness. The findings underscore the need for interior design upgrades at LUTH and UCH to provide more functional and healing-oriented environments.

Analysis of the form and shape of the hospital buildings revealed similar trends. OAUTHC was rated most favorably for its architectural form, with UCH receiving moderate scores and LUTH the lowest. This suggests that OAUTHC’s design offers a more effective combination of aesthetics and functionality. Levin (2007) also observed that the physical form of healthcare buildings influences user satisfaction, safety, and institutional image. Future improvements at UCH and LUTH should therefore consider architectural enhancements that blend visual appeal with practical utility, echoing Joseph & Rashid (2007), who emphasized that well-defined spatial layouts can serve as barriers to accidents and bolster safety.

When it comes to movement and traffic flow within the hospitals, OAUTHC again outperformed the others, suggesting more efficient circulation and easier navigation. Lower scores at LUTH indicate challenges with internal movement, which corresponds with Ulrich et al. (2008), who emphasized the value of intuitive circulation patterns in reducing patient stress and improving staff workflow. Enhancing wayfinding and movement in UCH and LUTH could yield improvements in both satisfaction and operational effectiveness.

Accessibility was another area where OAUTHC excelled, followed by UCH, with LUTH again trailing. Features like ramps, lifts, wide corridors, and clear signage were reportedly better at OAUTHC. These findings are consistent with universal design concepts (Mace, 1998), which advocate for accessible environments to increase inclusivity and functional outcomes in healthcare. The results highlight the urgent need for accessibility improvements at LUTH and UCH.

OAUTHC also received higher ratings for visibility within its spaces, likely due to better lighting, openness, and visual pathways. UCH and LUTH performed similarly but less favorably. This supports Verderber and Fine (2000), who noted the importance of visibility and natural lighting for comfort, safety, and wayfinding in hospitals.

With respect to windows and doors, OAUTHC was again rated best, attributed to better natural light, ventilation, and accessibility. While LUTH performed comparably to UCH in this area, both were rated below OAUTHC. Ulrich (1991) highlighted the significant role of access to daylight and fresh air in patient recovery and satisfaction, indicating that UCH and LUTH should focus on improving these features.

Overall, the study demonstrates statistically significant differences in users’ assessments of physical facilities among the three hospitals. OAUTHC’s higher performance is likely influenced by its more recent construction (1975) compared to UCH (1957) and LUTH (1962), and possibly by ongoing renovations and upgrades, as suggested by Ulrich et al. (2008), which are vital for keeping pace with modern healthcare demands.

While OAUTHC generally outperformed the other hospitals, LUTH showed relative strengths in visibility and environmental comfort, possibly due to its emphasis on windows and doors, reflecting the importance of natural light and ventilation (Ulrich, 1991). UCH ranked in between, with moderate performance across most variables.

In summary, the results confirm substantial differences in user perceptions of physical facilities across the three teaching hospitals. The findings highlight the need for targeted infrastructural improvements—especially at LUTH and UCH in areas such as spatial layout, accessibility, and circulation, while preserving advantages in natural lighting and ventilation. Ongoing evaluation and modernization are crucial to keep hospital environments aligned with best practices (Levin, 2007; Joseph, 2006), thereby enhancing user satisfaction and healthcare outcomes.

Results from the Qualitative Interview

Structured questionnaires were distributed to patients with the assistance of clinical staff directly involved in their care, as well as to other staff groups, with the support of a trained team of field assistants. These assistants received comprehensive training on the correct procedures for administering questionnaires, including appropriate locations, timing, and methods, and worked under the researcher’s direct supervision.

The research team consisted of twenty field assistants, comprising assistant lecturers, ten senior instructors, and 400-level Architecture students from Joseph Ayo Babalola University, Ikeji-Arakeji, Osun State. They were deployed to the study sites for three weeks.

Questionnaires were administered on designated clinical days such as Tuesdays, Thursdays, and Fridays between 8:00 a.m. and 4:00 p.m., ensuring the participation of all respondent groups across the selected departments.

In addition to the surveys, semi-structured interviews were conducted to further evaluate the physical facilities in Federal University Teaching Hospitals in Southwest Nigeria. The following outline was used as a guide for these interviews:

Interview Guide

Name of the University Teaching Hospital: …………………………………………

Status of the Respondent: …………………………………………
(e.g., Doctor – Consultant, Resident, House Officer; Nurse – Matron, Nursing Officer, Student Nurse)

What are your views about the physical facilities in your hospital generally?

How do you perceive your wards/clinical spaces, considering the following features?

Layout and organization of the buildings and interior spaces

Form/shape of the building and interior spaces

Movement and visibility within the interior spaces

Accessibility to buildings and interior spaces

Number and size of components within the interior spaces, such as windows and doors (height and width).

The result from the qualitative content analysis were displaced below in the table 14.0;

Table 14: Typical Transcripts (Contents Analysis) For Semi-Structured Interview (SSI) Discussion for the FUTH, South-West, Nigeria

Source: Researcher’s Field Survey, 2021.

Conclusion

This research demonstrates that users’ evaluations of physical facilities vary significantly among the three Federal University Teaching Hospitals (FUTH) in Southwest Nigeria, as shown by both bivariate and multivariate analyses. OAUTHC consistently achieved the highest ratings in key design elements, including building layout, spatial organization, architectural form, movement flow, and accessibility. In contrast, LUTH was rated above both OAUTHC and UCH in terms of interior visibility and the number of windows and doors.

Further analysis using post hoc tests affirmed OAUTHC’s leading performance in the overall assessment of physical environments. This advantage is likely linked to the hospital’s more recent establishment in 1975, as opposed to LUTH (1962) and UCH (1957). The older institutions appear to face challenges related to aging infrastructure and may be less equipped to cope with increasing healthcare demands. In comparison, OAUTHC has benefited from regular maintenance, renovations, and new construction, allowing it to better fulfill modern healthcare needs.

The variation in the age, design philosophy, and upkeep of these facilities explains the differences in user satisfaction observed across the hospitals. The findings highlight the vital role of ongoing infrastructure upgrades and adaptive architecture in improving user experience within healthcare settings.

Results from the structured questionnaires revealed that many respondents indicated a willingness to recommend the hospital to friends or other potential users. However, some participants interviewed through the Semi-Structured Interviews (SSI) at FUTH expressed reservations. They reported that they were not fully satisfied with the current state of the hospital and would only recommend its physical facilities if significant improvements were made particularly in staff efficiency, patient health outcomes, and the reduction of disease and germ transmission.

In summary, OAUTHC emerges as the most satisfactory hospital for physical infrastructure, followed by LUTH, with UCH ranking lowest, reflecting both the strengths and the limitations of older hospital designs.

The Study Recommendations

Based on the evaluation of physical facilities at the three FUTH in Southwest Nigeria, and given OAUTHC’s consistent superiority in architectural and spatial aspects, the following steps are recommended:

Upgrade Design Standards

Hospital architects, planners, and facility managers should systematically review and modernize the design standards at LUTH and UCH. Special emphasis should be placed on improving layout, spatial arrangement, accessibility, and internal circulation. Adopting user-focused and evidence-based design principles will enhance both functionality and satisfaction for all users.

Government Support

The Federal Government of Nigeria, through the Ministry of Health and related agencies, should make the revitalization of aging infrastructure at LUTH and UCH a priority. This should involve comprehensive renovation, rehabilitation, and reconstruction programs, as well as the construction of new buildings to expand capacity and improve service quality.

Sustained Maintenance

Establishing a culture of continuous maintenance and periodic modernization is crucial for all FUTH. Instituting a robust maintenance framework will preserve the quality of hospital facilities and support better patient experiences, higher staff productivity, and improved healthcare outcomes.

Ultimately, implementing these recommendations will enable LUTH and UCH to better align with modern healthcare delivery standards and meet the growing demands of Nigeria’s urban populations.

Acknowledgement

The author would like to thank the Federal University of Technology, Akure, Ondo-State for granting the Ph.D. research work. The Department of Architecture, School of Environmental Technology, Maintenance Unit of OAUTCH, My supervisor and The research institute of the of the University for their guidance during the course of study.

Funding Sources

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

The authors do not have any conflict of interest.

Data Availability Statement

The manuscript incorporates all datasets produced or examined throughout this research study.

Ethics Statement

This research did not involve human participants, animal subjects, or any material that requires ethical approval.

Informed Consent Statement

This study did not involve human participants, and therefore, informed consent was not required.

Permission to Reproduce Material Permission to Reproduce Material from Other Sources

Not Applicable

Author Contributions

Muyiwa Lawrence Akinluyi: Conceptualization of the research Idea, Methodology, Writing and Original Draft.

Falilat Yetunde Olowu : Questionnaire and interview Administration, Data Collection and Resource

Fadamiro Joseph Akinlabi: Visualization, Supervision, Project Administration, Review & Editing.

Adeniyi Damilare Akinluyi : Data Collection, Analysis, Writing and Resources.

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