The rapid demographic, epidemiological, and technological changes, combined with new patient expectations and reduced resources, are prompting many countries to rethink their healthcare delivery models. The COVID-19 emergency has exposed the limits of a predominantly hospital-centered approach, highlighting the urgent need for integrated community-based solutions that prioritize prevention and personalized care. In this context, Community Health Centers are emerging as hybrid structures that combine clinical services, social support, and community engagement. This thesis aims to develop a comprehensive framework of design strategies and a corresponding evaluation checklist to support the planning and analysis of CHCs focused on community well-being. The objective is to foster a healthcare model that addresses not only clinical needs but also prevention, social health, and integration with the broader territory. The research follows a mixed-method approach in several phases: (1) analysis of the regulatory context and existing knowledge on the topic, (2) review of scientific literature and existing design support tools, (3) creation of the initial draft of the framework and its application to international best-practice case studies, (4) development of the final framework and two practical design support tools, and (5) operational testing in two Italian “Case della Comunità.” A review of 34 scientific articles and an analysis of 42 design support tools highlighted existing gaps and good practices, enabling the creation of an initial framework for designing social health components within local socio-health facilities. This framework was then applied to 14 architecturally significant international case studies, allowing for validation, refinement, and the collection of additional design strategies. Subsequently, the final framework was established, structured around three macro-dimensions, nine categories, and eighteen criteria, each of which can be translated into both qualitative and quantitative indicators. Building on this theoretical foundation, two practical tools were developed: a design strategies toolkit and an evaluation tool. The latter was tested on two Italian “Case della Comunità” to verify its applicability and robustness. Results indicate that, compared to international examples, Italian models show limited integration of spatial and social dimensions, underscoring the absence of specific guidelines. The proposed tools thus provide an interdisciplinary method for helping professionals and decision-makers design socio-health facilities oriented toward holistic well-being and community engagement, paving the way for more inclusive, innovative, and sustainable CHCs.
I rapidi cambiamenti demografici, epidemiologici e tecnologici, uniti alle nuove aspettative dei pazienti e alla riduzione delle risorse disponibili, stanno spingendo numerosi paesi a ripensare i propri modelli di assistenza sanitaria. L’emergenza COVID-19 ha messo in evidenza i limiti di un approccio prevalentemente ospedalocentrico, ribadendo l’urgenza di soluzioni territoriali integrate che privilegino prevenzione e personalizzazione delle cure. In questo scenario, i Community Health Centers si configurano come strutture ibride che coniugano prestazioni cliniche, supporto sociale e coinvolgimento comunitario. La presente tesi mira a sviluppare un quadro organico di strategie progettuali e una checklist di valutazione per favorire la progettazione e l’analisi di CHC orientati al benessere della comunità. L’obiettivo è promuovere un modello di assistenza fondato non solo su esigenze cliniche, ma anche su prevenzione, salute sociale e integrazione con il territorio. La ricerca adotta una metodologia mista articolata in fasi: (1) analisi del contesto normativo e della conoscenza attuale sul tema, (2) indagine su letteratura scientifica e strumenti progettuali esistenti, (3) realizzazione della prima draft del framework e applicazione su casi studio best practice internazionali, (4) redazione del framework finale e sviluppo di due strumenti progettuali e (5) applicazione operativa su due Case della Comunità italiane. La revisione di 34 articoli scientifici e l’analisi di 42 strumenti progettuali hanno evidenziato lacune e buone pratiche, consentendo di definire un primo framework per la progettazione della social health nelle strutture territoriali socio-sanitarie. Tale framework è stato poi applicato a 14 casi studio internazionali di rilevanza architettonica, consentendo di validare e modificare il framework e anche raccogliere ulteriori strategie di progettazione. In seguito, è stato elaborato il framework finale, strutturato in tre macro-dimensioni, nove categorie e diciotto criteri, tutti traducibili in indicatori sia qualitativi sia quantitativi. Da questo impianto teorico sono nati due strumenti pratici: un toolkit di design strategies e un tool di valutazione. Quest’ultimo è stato testato su due Case della Comunità italiane per verificarne applicabilità e robustezza. I risultati mostrano una limitata integrazione tra dimensione spaziale e sociale nelle realtà italiane, se confrontate con quelle internazionali, evidenziando l’assenza di linee guida specifiche. Gli strumenti proposti offrono dunque un metodo interdisciplinare per supportare professionisti e decisori nella progettazione di strutture socio-sanitarie orientate alla salute olistica e alla dimensione comunitaria, aprendo la strada a CHC più inclusivi, innovativi e sostenibili.
Community Health Centers as the heart of community well-being. Design strategies and evaluation checklist to foster social health through the built environment of local-health facilities
Brusamolin, Erica
2024/2025
Abstract
The rapid demographic, epidemiological, and technological changes, combined with new patient expectations and reduced resources, are prompting many countries to rethink their healthcare delivery models. The COVID-19 emergency has exposed the limits of a predominantly hospital-centered approach, highlighting the urgent need for integrated community-based solutions that prioritize prevention and personalized care. In this context, Community Health Centers are emerging as hybrid structures that combine clinical services, social support, and community engagement. This thesis aims to develop a comprehensive framework of design strategies and a corresponding evaluation checklist to support the planning and analysis of CHCs focused on community well-being. The objective is to foster a healthcare model that addresses not only clinical needs but also prevention, social health, and integration with the broader territory. The research follows a mixed-method approach in several phases: (1) analysis of the regulatory context and existing knowledge on the topic, (2) review of scientific literature and existing design support tools, (3) creation of the initial draft of the framework and its application to international best-practice case studies, (4) development of the final framework and two practical design support tools, and (5) operational testing in two Italian “Case della Comunità.” A review of 34 scientific articles and an analysis of 42 design support tools highlighted existing gaps and good practices, enabling the creation of an initial framework for designing social health components within local socio-health facilities. This framework was then applied to 14 architecturally significant international case studies, allowing for validation, refinement, and the collection of additional design strategies. Subsequently, the final framework was established, structured around three macro-dimensions, nine categories, and eighteen criteria, each of which can be translated into both qualitative and quantitative indicators. Building on this theoretical foundation, two practical tools were developed: a design strategies toolkit and an evaluation tool. The latter was tested on two Italian “Case della Comunità” to verify its applicability and robustness. Results indicate that, compared to international examples, Italian models show limited integration of spatial and social dimensions, underscoring the absence of specific guidelines. The proposed tools thus provide an interdisciplinary method for helping professionals and decision-makers design socio-health facilities oriented toward holistic well-being and community engagement, paving the way for more inclusive, innovative, and sustainable CHCs.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/239337