Healthy Choices = Healthy Campuses: Point-of-Decision-Design

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Healthy Choices = Healthy Campuses: Point of Decision Design is a research study conducted by HKS, CADRE, and Planning4Health Solutions in 2016. This research was funded by an AIA Upjohn Grant, with additional support provided by PatcraftDuPont and McCarthy. For additional information or to discuss the findings, contact [email protected]

What Was the Aim of the Research?

U.S. college campuses have become obesogenic environments, or in other words, places that contribute to obesity.

This is highly impactful on students’ mental health and academic performance. Habits formed in college can define post-college life, establishing a critical window of influence that deserves our attention.

A key challenge for students is poor decision making regarding healthy choices with regard to physical activity and diet. Can design help in this critical decision making?

Changing the Context

Utilizing a socio-ecological approach that takes advantage of human interactions within our environments, we see opportunities for providing environmental modifications that make healthy living, easy living.

The Choice Conundrum

Students face many daily choices that directly impact their health and wellbeing. The premise behind this research, point-of-decision design (PODD), is that healthy decision-making can be “prompted” by our physical environments through the implementation of effective design intervention strategies at critical points-of-decision throughout the college campus.

We seek to identify “tipping points,” defined as “the points at which a series of small changes or incidents becomes significant enough to cause larger, more important changes.”

Research Question

Where are the tipping points on campus, the points-of-decision where students have the opportunity to make either healthy or unhealthy choices? And critically, how can design influence college student health choices by targeting points-of-decision?

Research Objectives

  • To understand the chronic problem of obesity on college campuses and the link between campus design, diet and activity decisions.
  • To discern where and how college students make decisions about physical activity and nutrition.
  • To synthesize design strategies implemented at these points-of-decision to prompt healthy decisions amongst the myriad choices on typical college campuses.
  • To generate a design guide for practitioners, to assist them in designing healthier campuses for students.
  • To develop a concept for future research bringing together the fields of public health and architecture around point-of-decision design.

What We Did

Literature Review
Our team conducted a literature review to understand existing design strategies that target better health on college campuses, with a particular eye toward identifying any research that linked health to student decision-making. We discovered that point-of-decision design was used by the Centers for Disease Control (CDC) to promote tobacco cessation, and also to encourage greater use of stairs. However, point-of-decision design has not been extensively incorporated by the design community, and has not been used to assess the points where design could have the greatest health impacts for college students.

Ideation Session
Informed by the literature review, we led a cross-disciplinary Ideation Session with 36 participants from across the United States. Participants included campus facilities planners, architects, designers, public health and student health experts, and undergraduate and graduate students. We discussed critical points-of-decision on college campuses and deliberated upon point-of-decision design strategies that would promote healthy choices.

Participant Survey
We sent a follow-up survey to all attendees of the Ideation Session to clarify themes that emerged from the conversation.

Visual Design Guide
Combining and analyzing our findings from the literature review, ideation session and participant survey, we created a visual design guide, comprised of specific design guidelines, to assist campus planners in creating environments that promote student health.

What We Found

  1. Current literature on designing healthy campuses focuses more on movement and physical activity than diet. We see this gap as an opportunity for future design research.
  2. Using design for better decision-making is not a well understood construct. Literature focuses on how a healthy context can be created, but not as much on how design can be a catalyst for healthier decisions.
  3. Current thinking on healthy colleges focuses on urban design and campus planning strategies, whereas our findings show that decisions about activity/ diet could be made by students before ever stepping into campus. Leveraging technology/ smartphones as part of the design solution is imperative.
  4. Point-of-decision is a person-centric, not a place-centric, construct across settings. Understanding diverse user personas and mapping their journeys can aid in determining points of decision. Key points of decision emergent from this literature review include: the smartphone, path, home, dining facility, courtyard, bed, car, corridor, recreation center, classroom, parking location, public space, workstation and online.
  5. Behavioral decisions students make are often influenced by a range of factors, and these factors can be sorted into four key constructs: availability, access, affordability, and appeal.
  6. Design strategies to address a person-centered framework that can respond to myriad dynamic influences must be considered along a design continuum. This continuum ranges from information and product design to interior, architecture and urban design. Some strategies emergent from the literature review and ideation include: farmers’ markets, communal kitchens, healthy food offerings and placement, hydration stations, recharge zones, open flex spaces, mixed use buildings, lighting strategies, street trees, bike parking systems, and street furnishings.

What the Findings Mean

In summary, our findings are a call for designers to take a person-centered approach to designing campuses, and to consider the design continuum that spans from information design, environmental graphic design and product design to interior design, architecture and urban design.

The research suggests that at every point of decision, and from the scale of the campus to the scale of a handheld device, design can promote making healthy choices.

Our Visual Design Guide creates a step-by-step “how to” guide for higher education designers and planners to begin using Point of Decision Design today.

What’s Next

This research project had a relatively small scope. Although the Ideation Session was cross-disciplinary, we would like to expand its breadth by including disciplines such as product design and behavioral economics to conduct more comprehensive sessions in the future.

Additional empirical research on:

  1. student decision making,
  2. the role of the environment in these decisions, and
  3. robust case studies are needed at a larger scale in order to impact thinking about design.

We think this expanded research could prove that design is not a latent context, but rather an active trigger that could change health on college campuses.


Team Members:
Upali Nanda, Ph.D.
Michelle Eichinger, MS, MPA
Jessica Hedge
Shelli Dent
Giyoung Park, Ph.D.
Timothy Lalowski, MPH
Sheba Ross, MUD
Ileana Rodriguez, M. Arch
Erin Peavey, M. Arch