From Yard to Healing Garden: The Role of Participatory Design in Shaping Therapeutic Landscapes

ObjectiveThis study aims to understand how the participatory design process of healing gardens unfolds in practice, and its relationship with the uses and benefits they provide to users in hospital and residential care home settings.BackgroundHealing gardens are increasingly recognized for their potential to support psychological, emotional, social, and therapeutic well-being. Yet, little is known about how participatory design processes influence their long-term usability and effectiveness, especially in institutional contexts with diverse user needs.MethodsThis study examines two contrasting case studies of healing garden projects-one in a hospital for individuals with neurological impairments, the other in a residential home for children who have experienced trauma. Using an exploratory sequential mixed methods design and an extreme case approach, the study analyzes how the structure and inclusiveness of the participatory design process shaped the perceived benefits, actual uses, and symbolic meaning of each space.ResultsFindings show that inclusive participation, especially by direct beneficiaries, fosters stronger alignment between user needs and design features, leading to increased use, greater perceived therapeutic value, and a deeper sense of space ownership. In contrast, designs dominated by institutional or staff perspectives failed to meet users' needs, resulting in underutilization, misappropriation of space, or limited therapeutic outcomes.ConclusionsThe results emphasize the necessity of embedding context-sensitive, bottom-up participatory strategies throughout the diagnostic and design phases to ensure therapeutic outcomes in landscape architecture. The study offers actionable insights for landscape architects, healthcare administrators, and policy-makers seeking to implement evidence-based, equitable therapeutic environments in care settings.