Eletta Naldi

Marginal territories facing socioeconomic decline, demographic contraction, and progressive abandonment require integrated and human-centered approaches capable of linking cultural heritage, local identity, and sustainable development. This article examines cultural landscape as a resource for regenerating such territories and interprets it as a generative ecosystem: a relational, dynamic, and evolving system capable of connecting tangible and intangible heritage, local actors, and capacities for change. The study presents the REACT research project, conducted in the Casentino pilot area in Tuscany, Italy. Conceived as people-centered collaborative research, REACT combined interdisciplinary investigation, territorial and case-study analysis, and community engagement within a methodological approach designed for transferability. The research developed a five-level Framework whose application in Casentino produced Guidelines comprising 36 Strategies and 165 Actions, while its generalization led to a Strategic Guide for adaptation to other marginal contexts. The findings show how cultural landscape can link territorial interpretation with collaborative strategy development, strengthening epistemic, territorial, and collaborative integration. They also suggest that shared cultural identity can support community engagement and collective responsibility for territorial transformation. The REACT Framework provides an open and adaptable approach for place-based sustainable regeneration grounded in heritage resources, identity, and community capacities.

The physical environment is one of the factors that affect mother’s experience of childbirth and psychological health. A woman’s childbirth experience has been found to influence not only the mother’s own health and future births but also the well-being of her child and family. The present study’s objective was to investigate mothers’ perceptions of spatial-physical humanization, affective quality of place, and emotions during childbirth. To achieve this goal, the first part of our work was dedicated to selecting two birth environments (hospital and birth center) with different degrees of humanization. The methods include observations and field survey which mainly concerned the environmental quality of the spaces and the layout of the birth unit, and self-report questionnaire about perceived environment, affective quality attributed to place, and delivery experience. Participants are 66 low-risk women, choosing hospital or birth center. The findings indicate an enhanced perception of both the spatial-physical aspects and the social and functional aspects of the care unit among mothers who give birth at the birth center. These same mothers also report a more positive perception of the childbirth experience. In conclusion, this study contributes to the understanding of the role of birth environments in shaping mothers’ emotional experiences during childbirth.

Objectives: This article investigates how the physical birth environment is perceived by the users (women and midwives) in different settings, a midwife-led unit and an obstetric-led unit, placed in Italy. Background: In the field of birth architecture research, there is a gap in the description of the spatial and physical characteristics of birth environments that impact users’ health, specifically for what concerns the perception by women. Methods: The study focuses on multi-centered mixed methods design, employing both quantitative and qualitative research methods (questionnaire, spatial analysis) and covering different disciplines (architecture, environmental psychology, and midwifery). Results: The results revealed significant differences between the two settings and some associations between perceived and spatial data concerning: calm atmosphere, greater intimacy, spacious birth room, clarity of service points, clarity in finding midwives, sufficient space for labor, noise, privacy, and the birth room adaptability. Conclusions: The findings confirm the importance of the spatial layout and indicate documented knowledge as an input to consider when designing birth spaces in order to promote user well-being.

The research study aims at identifying the optimal birth layout according to users’ needs and staff organization, in supporting the design of a new Midwifery-Led Unit in Italy. Midwifery-Led Units are connected to reduced childbirth medical interventions and better health outcomes. This model of care needs a proper architectural response that lacks knowledge around physiological birth space design. The Research Group (architects, environmental psychologists and midwives) entrusted with reshaping an existing Midwifery-Led Unit project, analysed how to better respond to the specific spatial and organizational needs. The process, initially based on literature review, case studies and interdisciplinary meetings lead to the analysis of critical aspects of the preliminary project. To better investigate some relevant architectural topics and set new requirements, supplementary research was conducted to understand stakeholders’ needs. Spatial layout analysis was compared to users' perception, experience, thoughts and expertise collected through questionnaires and focus groups. The research identified new requirements and design suggestions able to address the future design process and project, and created a new layout for a Midwifery-Led Unit. The results, as translation of spatial and environmental users’ needs, increased the knowledge about birth spaces and represents an innovative model for Hospital Management and Technical Office. The findings represented the base field to create a built environment able to improve health outcomes, achieve healthy behaviors and foster staff practice, also inside a traditional and rigid hospital layout.

Purpose: The Covid-19 pandemic has placed health-care systems and their facilities throughout the world under immense pressure. The pandemic has highlighted the crucial role of health-care facilities design in looking beyond the ongoing crisis and considering how hospitals can better prepare for unexpected future health situations. This study aims to investigate how hospitals reacted to the crisis in terms of their physical spaces, which architectural features permitted the necessary transformations, and how this data can inform hospital design research in the future. Design/methodology/approach: The research adopted a qualitative and multi-method approach to case studies. Data was collected directly (field survey and interviews) and indirectly (literature, periodicals, specialised websites, webinars, conferences and forums), and a strengths, weaknesses, opportunities, threats analysis supported the data evaluation. Findings: Hospitals’ responses to the crisis were guided by a host of variables depending on the specific intervention context and risk scenario. Some key issues emerged as particularly meaningful to drive future research in hospital design, namely, architectural typology, layout and spatial proximities, technological systems, the quality of care spaces, the role of public spaces, facility management tools to drive the transformation, territorial health care networks and new technologies. Originality/value: The paper suggests that the current crisis can be transformed into an opportunity, in terms of research and innovation, to rethink and improve the quality and efficiency of health-care spaces, restoring their crucial role of promoting health by design.

(1) Background: The aim of this study is to establish which specific elements of the built environment can contribute to improving the physical activity of self-sufficient, noninstitutionalized and living in the city adults > 65 years. (2) Methods: An extensive literature search was conducted in several database. Umbrella review methodology was used to include the reviews that presented a sufficient methodological quality. (3) Results: Eleven reviews were included. The elements positively associated with physical activity in older adults were: walkability; residential density/urbanization; street connectivity; land-use mix-destination diversity; overall access to facilities, destinations and services; pedestrian-friendly infrastructures; greenery and aesthetically pleasing scenery; high environmental quality; street lighting; crime-related safety; traffic-related safety. The elements that were negatively associated with physical activity were: poor pedestrian access to shopping centers; poor pedestrian-friendly infrastructure and footpath quality; barriers to walking/cycling; lack of aesthetically pleasing scenery; crime-related unsafety; unattended dogs; inadequate street lighting and upkeep; traffic; littering, vandalism, decay; pollution; noise. (4) Conclusions: Evidence shows that specific elements of the built environment can contribute to promoting older people’s physical activity. The city restructuring plans should take into consideration these factors.

This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals. Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users’ health. A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates. The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people’s behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives’ hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements. The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers.

Many studies highlight how health is influenced by the settings in which people live, work, and receive health care. In particular, the setting in which childbirth takes place is highly influential. The physiological processes of women's labor and birth are enhanced in optimal ("salutogenic," or health promoting) environments. Settings can also make a difference in the way maternity staff practice. This paper focuses on how positive examples of Italian birth places incorporate principles of healthy settings. The "Margherita" Birth Center in Florence and the Maternity Home "Il Nido" in Bologna were purposively selected as cases where the physical-environmental setting seemed to reflect an embedded model of care that promotes health in the context of childbirth. Narrative accounts of the project design were collected from lead professional and direct inspections performed to elicit the key salutogenic components of the physical layout. Comparisons between cases with a standard hospital labor ward layout were performed. Cross-case similarities emerged. The physical characteristics mostly related to optimal settings were a result of collaborative design decisions with stakeholders and users, and the resulting local intention to maximize safe physiological birth, psychosocial wellbeing, facilitate movement and relaxation, prioritize space for privacy, intimacy, and favor human contact and relationships. The key elements identified in this paper have the potential to inform further investigations for the design or renovation of all birth places (including hospitals) in order to optimize the salutogenic component of any setting in any country.