Exploring children's perspectives on essential elements in a child-centred hospital environment: a descriptive qualitative approach.

Abstract

Child-centred care emphasises children's active involvement in healthcare, grounded in dignity, respect, equity, privacy, and autonomy. Yet despite growing recognition of children's rights, their own perspectives remain underrepresented in the design of healthcare environments. This study operationalises child-centred care for the hospital setting by exploring what primary school children themselves consider important during a hospital stay, how they perceive the physical environment, and how far they wish to be involved in their care. Children attending the annual science day at Hasselt University (Belgium) were recruited through convenience sampling; parents observed the sessions, which were facilitated by design-thinking experts. A descriptive qualitative approach, informed by the LEGO® Serious Play® methodology, enabled children to express their experiences through creative modelling. Thematic analysis was used to identify core themes across the data. Twenty-three children took part in three focus groups. Their ages ranged from 6 to 13 years, with a median of 8 years. Children highlighted the importance of a colourful environment with outdoor access and open, transparent spaces. They valued engaging distractions-such as educational games or therapy animals-the continuous presence of loved ones, and a positive atmosphere shaped by supportive healthcare professionals. Nutrition was also important, with a clear preference for fresh food and vegetables. Desired levels of involvement varied, underscoring the need to ask each child how they wish to participate in their care. Safety emerged as a central concern: children suggested adding a severity indicator to the patient call system, and viewed hospitals as spaces that should be protected through measures such as surveillance cameras.

Conclusion:  Children express a need for hospital environments that integrate comfort, play, social connection, and safety, supported by an individualised, genuinely child-centred approach.

What is known: • Evidence on child-centred care has largely been generated through family-centred or observational approaches, with limited direct input from children about their own experiences.

What is new: • This study uses LEGO® Serious Play® to elicit children's perspectives directly, identifying their priorities for the physical environment, ambience, involvement in care, and safety. • They ask for hospital environments that combine comfort, play, social connection, and safety, delivered through an individualised, genuinely child-centred approach.