The Hospital Murals Evaluation: A mixed-methods evaluation of the impact of murals on patients, healthcare workers, and visitors

Abstract Objective This study investigated how hospital murals influence the experiences of patients, healthcare staff, and visitors across four sites. Background Evidence shows that visual art in healthcare settings can improve well-being but few studies focus specifically on murals or compare their effects across cultural contexts. The Hospital Murals Evaluation project addresses this gap through an investigation of murals in hospitals in Nigeria, Slovenia, the United Kingdom, and the United States. Methods Using a mixed methods cross-sectional design, the study integrated surveys, interviews, and participatory photography. A total of 525 unique responses were collected from 229 patients (131 adult, 98 pediatric), 245 staff, 49 visitors, and 2 undisclosed. Results Interviews across all three participant groups (n=115) revealed themes of positive affects, perception of care, as well as stress or indifference. Surveys (n=327) showed moderate positive correlations between mural viewing and positive emotions among patients, and between mural exposure and well-being, positive emotions, social connection, and workplace belonging among staff in the UK and USA, with null findings for staff in Nigeria and Slovenia. Participatory photography (n=83) illustrated how murals conveyed comfort, though abstract or poorly placed murals sometimes evoked discomfort. Meta-inferences across the methods indicate that viewing murals were associated with positive emotions for patients and did not induce negative emotions for staff or visitors. Conclusion Murals act as health-promoting infrastructure that can enhance well-being, foster positive experiences, and signal intentions of care. The findings highlight the need for culturally attuned designs to create healthcare environments that nurture well-being.