Environmental graphics design as visual communication in pediatric waiting area: a comparative observational study of behavioral and affective responses

Waiting is an unavoidable aspect of paediatric healthcare and is frequently experienced as stressful. Although child-friendly visual environments are widely implemented, there is limited empirical evidence on whether passive Environmental Graphic Design (EGD) effectively supports children's engagement and emotional regulation during real waiting situations. This study examines how different environmental graphic communication strategies shape children's observable behavioural and affective responses in paediatric waiting areas. A comparative qualitative case-study approach was conducted in two Indonesian hospitals, comparing waiting environments dominated by passive EGD elements (Hospitals X and Y). Direct behavioural and affective observations were carried out with total of 43 children aged 2-9 years. Behavioural indicators included movement patterns, interaction with environmental elements, screen engagement, and social play, while affective indicators included visible expressions of calmness, enjoyment, restlessness, and distress. Findings show that passive EGD environments have minimal physical interaction; children remained caregiver-centered and frequently exhibited disengagement. In contrast, the interactive play-based environment supported sustained engagement, increased movement and peer interaction, and more positive affective responses. These results suggest that passive EGD contributes to the visual atmosphere of paediatric waiting areas, with limited impact on children's behavioural and affective responses, whereas interactive, play-based graphic environments are more effective.