[dis]placed by illness

[DIS]PLACED BY ILLNESS:EXPLORING NARRATIVES OF CHRONIC ILLNESS FOR

A MORE INCLUSIVE BUILT ENVIRONMENT

1

PURPOSE

The physical environment plays a critical role in human health. Research shows that the experience of a place with certain qualities can enhance our physical and emotional wellbeing. For populations living with chronic conditions without effective medical treatment or cure, our surrounding environment presents an even greater potential as a source of healing. However, current built environment research in the context of public health largely focuses on illness prevention measures, and existing accessible spatial design guidelines mostly targets wheelchair access, overlooking the experience of people who live with complex and invisible chronic illnesses. To explore how urban design can benefit those living with chronic illnesses, a qualitative research study was conducted through semi-structured interviews with eight individuals living with Lyme disease. Interviews revealed unique challenges faced by people living with chronic illnesses related to the experience of place. These challenges indicate the lack of support for this population in the design of our built environment and the unexplored potential for intentional design strategies to improve the quality of life for those living with chronic illness. Interview findings were synthesized with existing therapeutic design theories to inform a set of design guidelines that includes a list of design principles and respective physical/spatial design elements that would serve to support people living with chronic illnesses.

2

Our environment can affect our health in many different ways. For example, exposures to positive or negative stimuli, spatial affordances that facilitate healthy or unhealthy behavior, access to resources and provisions, and urban forms that promote or limit social capital can all impact our physical and emotional wellbeing.

Literature ReviewA review of several major textbooks [1], [2], [3], [4] and design and planning journals, including Journal of Landscape Architecture, Journal of Urban Planning, Landscape and Environmental Design, Journal of Planning, Journal of Landscape and Urban Planning, revealed that research related to the creation of healthy built environments is well-established, and topics are wide-ranging. However, keyword and index searches in the aforementioned literature showed that chronic illnesses that can manifest themselves as invisible disabilities are rarely if ever addressed in built environment research. Though aspects of other common topics, such as physical disability and psychological wellbeing, are indeed relevant, the lack of acknowledgement by urban designers and researchers of a broad category of illness that is experienced by a significant proportion of the population reveals our lack of understanding in the uniqueness of the experience and the lack of research on how the built environment may have potential to support this population.

Nevertheless, different studies have explored qualities of a healing environment more generally. Environmental psychologist Roger Ulrich put forth the Stress Reduction Theory, suggesting four elements that are key to alleviating stress: a sense of control,

social support, physical movement and exercise, and positive natural distractions; these provide strong implications for the design of therapeutic landscapes [5], [6]. Kaplan & Kaplan further pioneered the idea of nature’s restorative effects, leading to the conception of the Attention Restorative Theory, suggesting four characteristics that make up a restorative setting: being away, extent, fascination, and compatibility; they then derived four key principles in designing restorative places: coherence, complexity, legibility, and mystery [5], [7]. The idea of inclusion in built spaces has also been explored through the concept of Universal Design, which highlights seven principles that can allow environments to be maximally accessible to people of different abilities: equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, and size and space for approach and use [8].

These existing theories provide a helpful basis for creating supportive places for people with different health conditions and physical abilities, but their broad-stroked approaches are not comprehensive in addressing the specific needs of people living with invisible chronic illnesses. Furthermore, in the outdoor environment, therapeutic guidelines are mostly applied to healing garden settings, which are typically attached to a medical facility, and thus not conducive to effectively benefiting a large and scattered population living with chronic illness. A more thorough understanding of the experience of illness as it pertains to place and a different approach to design and planning therapeutic landscapes could help spatial and urban design to more effectively support populations living with chronic illness.

BACkgROUND

3

TOTAL COUNTS:

ACTIVE, PHySICAL ACTIVITy:

1860

ILLNESS, CHRONIC ILLNESS:

112*

*Mostly related to lifestyle and lack of physical activity

InvIsIble dIsabIlIty




JOURNAL Of LANDSCAPE & URBAN PLANNINg

MAkINg HEALTHY PLACES

BUILT ENvIRONMENT & PUBLIC HEALTH

(Dannenberg, Frumkin, Jackson, 2011)

(Lopez, 2012)

JOURNAL Of LANDSCAPE ARCHITECTURE

0

0

0

0

4

0

0

21

19

0

4

5

11

7

11

29174

71

5

1369

11

22

240

150

ChroniC illness

ChroniC illness

ChroniC illness

ChroniC illness

disability

disability

disability/ies

disability

illness

ChroniC diseases

Illness(es)

illness

ExErcisE

active

active

active, Physical activity

active

physical activity

physical activity

physical activity

RELEVANT ARTICLES FROM kEy wORd SEARCHES

ReLevant aRticLes FRom key woRD seaRches

inDex count

woRD count

Figure 1: Summary of search results from built environment journals and text books

4

To explore how urban design strategies can support individuals living with chronic illnesses, a qualitative study was conducted through open-ended interviews with individuals living with Lyme disease (Table 1).

Lyme Disease as a Case StudyLyme disease was selected as a case study due to its growing prevalence in the United States and the level of impact on the everyday function and quality of life it poses. Lyme disease accounts for 95% of all reported cases of vector-borne illnesses, with over 300,000 individuals contracting the disease each year [9]. An estimated 1.5 million people in the U.S. live with Lyme disease [10]. A recent survey found that chronic Lyme disease patients suffer a lower quality of life compared to individuals living with most other chronic diseases, including those with congestive heart failure, strokes, and multiple sclerosis [11]. The same survey also found that 75% of Lyme patients

METHODS

experience severe symptoms on a daily basis.

Lyme disease is a tick-borne bacterial infection of the spirochete bacteria, Borrelia burgdorferi that is commonly transmitted to humans by certain species of Ixodes ticks. The bacterial infection can affect the health and function of multiple body systems [12]. Though Lyme disease is widely considered as treatable and even curable if caught early, as many as 36% of diagnosed individuals will develop chronic, debilitating symptoms that can last for years to decades, even with treatment [13]. As a chronic illness with limited relief from medicine [14], environmental factors are crucial in supporting people who live with Lyme disease. Understanding the experience of illness can help us recognize how to cater the built environment to better support people living with different types of chronic illnesses.

300,000200,000

40,000 362

Chronic Lyme Patients*

Lyme dise

ase

Lung Cancer

HIV/AId

S

Zika Virus

Figure 2: Reported new cases in 2017 and estimated number of people living with Lyme disease in the U.S.

source: cDc, 2017 *mayer, 2011

1,550,000

source: Johnson et al., 2014

72%62% 59% 54% 51% 47% 46% 43%

37%

16%

Lyme dise

ase

Cong. Heart F

ailure

Fibromiyalgia

Cd: Stro

ke

Cd: Heart A

ttack

PTSd (vets

only)

diabetes

Systemic Lupus

Multiple Sclerosis

General Populatio

n

Figure 3: Percentage of respondents reporting fair or poor health in a quality of life survey for different chronic illness patients

# o

f rep

orte

d ca

ses

% re

porti

ng fa

ir or

poo

r hea

lth

5

Data Collection and AnalysisPrior to conducting interviews, an interview protocol and informed consent form were developed and submitted to the Institutional Review Board (IRB). Upon approval, participants were recruited through postings on an online support group page for Lyme disease, at a clinic in Seattle, WA, and through snowball sampling. The interviews were all recorded with the participants’ consent.

Eight individuals who live with Lyme disease volunteered to take part in the study, and were given an informed consent form prior to the interviews. Interviews took place in-person or via phone in a semi-structured format using narrative research. Narrative research is a design of inquiry in which the lived experiences of individuals is studied through stories that the study subjects provide [15]. After each interview, the recording was reviewed to identify broad themes and to generate an understanding of participants’ illness experiences in relation to place. Recordings were then transcribed and analyzed

using open coding techniques, in which repeated concepts, words, or phrases across the interviews were identified in order to gather more specific commonalities in shared experiences or needs related to place [15].

STUDY SAMPLE

METHODOLOgY PARTICIPANT RECRUITMENT

DATA COLLECTION

DATA ANALYSIS

PUBLIC POSTINgS

SEMI-STRUCTURED INTERvIEwS

OPEN CODINg

ADULTS wITH LYME

DISEASE

QUALITATIvERESEARCH

SNOwBALL SAMPLINg

RECORD & TRANSCRIBE

IDENTIfY COMMON THEMES

NARRATIvE APPROACH

Figure 4: Research design and process

Table 1: Interview participants’ demographic

P#

1 27 F 5 2

4 64 F 32 3

2 41 F 10 3

5 60 M 27 8

7 30 F 12 5

3 18 F 4 1

6 28 F 9 6

8 44 F 17 2

Age Gender Years Sick

Years w/ Diagnosis

6

Interviews revealed that living with Lyme disease results in the experience of isolation, physically, socially, and emotionally, that stems from the loss of access to everyday places and the loss of shared activities with others due to increased physical limitations from illness and reduced perception of comfort or safety away from home.

Physical SymptomsEach participant reported experiencing many wide-ranging physical symptoms due to Lyme disease. Collectively, their symptoms include neurological

abnormalities such as migraines/headaches, vertigo and dizziness, cognitive dysfunction, and visual disturbances; digestive issues; musculoskeletal pain; and nervous system dysfunction. All participants experience some level of post-exertion malaise, in which symptoms are aggravated through physical activity. Many participants experience increased environmental sensitivities, including discomfort when exposed to mold, synthetic scents, bright lights and loud noises. Many participants described frequent fluctuations of symptoms, and having “good days and bad days.”

RESULTS

Neurological Symptoms:Confusion

Migraines/HeadachesCognitive dysfunction

Brain fogMemory issues

Vertigo/Dizziness

Digestive Symptoms:Nausea

Abdominol painIrritable bowel

PRIMARY SYMPTOMS

Systemic Symptoms:

Weakened immunity

Systemic fatigue

Weakness

Environmental sensitivityFlu-like symptoms

Muscularskeletal:

Joint pain/Arthritis

Muscle ache

Figure 5: Participants’ reported physical symptoms of Lyme disease

7

Physical DisplacementLiving with these debilitating and unpredictable symptoms can result in physical exclusion from everyday places. For example, places with stimulating triggers may deter those with environmental sensitivities; and places without universal access or resting spots may discourage those with exacerbated pain or fatigue. One participant discussed needing places to rest while on a walk:

“It was difficult at times when there weren’t places to rest [along the trail].” (Participant 5)

There is more planning and caution involved in venturing away from safe and familiar settings and much less spontaneity with leaving home. For instance, one participant said:

“I always just have to scope out my environment wherever I go. Make sure there’s ways to get out of it

and a quiet safe space.” (Participant 2)

The inability to control one’s own body can make people feel powerless and generate anxiety, resulting in growing distrust and insecurity with unfamiliar environments.

Additionally, getting to different destinations is also more difficult for people living with chronic illness. Walking and biking can be difficult for those experiencing post-exertion malaise or muscle and joint pain, and neurological symptoms may limit the ability of people to drive. One participant explained:

“I can’t drive with all my [neurological] symptoms...I would end up somewhere else.” (Participant 3)

Furthermore, taking mass transit can increase one’s exposure to different triggers and be anxiety provoking with the unpredictable onset of symptoms.

1ST PLACE

2Nd PLACE

3Rd PLACE

Figure 6: Chronic illness impacts on place and the loss of third-place

8

As one participant stated:

“I don’t take public transit, especially by myself. I’m afraid of collapsing.” (Participant 4)

Even ride-sharing platforms like Uber and Lyft present challenges for individuals with chemical sensitivities, as there is no option to request for drivers that do not use artificially scented air fresheners. These limitations lead to a loss in mobility that results in even greater spatial confinement.

As a result, most people living with Lyme disease spend more time in their own homes, where they are most able to control their immediate surroundings. But even with a greater need for and dependence on a safe home environment, they often face significant

challenges in finding safe housing because of the limitations their illness poses. One person described her experience:

“Every year I’ve been moving…my last place was mold-free, but then we started getting chemicals coming through the vents from upstairs.” (Participant 8)

Though chronic illness results in many competing needs, there is limited institutional support for these types of invisible disabilities. Most people can only resort to trial-and-error to figure out where they can live comfortably. One interview participant explained:

“There is no way to get safe housing in a formal way. I keep ending up in these situations where I can’t find a safe place to live.” (Participant 7)

Figure 7: Summary of issues reported by participants related to transportation

Figure 8: Summary of issues reported by participants related to safe housing

MOLD

COST

INSTITUTIONAL SUPPORT

SCENTS & ALLERgENS

• triggers symptoms

• not immediately noticeable

• many forms of triggers

• unable to share spaces

• Limited income from inability to work and heavy medical expenses

• no easy or systemic way to find safe housing other than trial and error

ISSUES wITH SAfE HOUSINg

$

MASS TRANSIT

DRIvINg

RIDE-SHARINg

BICYCLE

PROBLEMS gETTINg THERE

• Lack of control & flexibility

• stimulation & triggers

• Lack of physical ability

• unpredictable symptoms

• cognitive & neurological difficulties

• access to parking

• triggering scents

• affordability

9

8 pt

Diet

Ability to travel

Environmental triggers

Confusion with treatment

Frustration with lack of medical

help

Feeling of loss & grief

Anxiety with unpredictable

symtptoms

Feeling disbelieved

Physical Activities

LImited engergy for socializing

Joint painachiness

PRIMARY SYMPTOMS

SECONDARY IMPACTS

PHYSICA

L LIMITATIO

NS

EMO

TIO

NA

L R

ESP

ON

SES

LOSS IN

SOC

IAL N

ETWO

RK

GREA

TER

NEE

D F

OR

SO

CIA

L N

ETW

ORK

Support healthy

activities

Programming

Physical comfort

Ability to get away

Increasing Access

Give way to more research

Start conversations

Feeling sense of control

Feelin acknowleged

Bridging social capital

Bonding social capital

HEALING

SECONDARY IMPACTS

EXPAND

EVER

YDAY G

EOG

RAPHY

SUPP

ORT

HEA

LTHY PROGRAMMING

EXPAN

D U

ND

ERST

AN

DIN

G &

ED

UCA

TION

CREATE HEA

LTHY &

INCLU

SIVE PLACES

ADVO

CACY

/AW

AR

ENES

S

FOSTER SO

CIAL O

PP

ORTU

NITIES

SUPPORTIVE APPROACHESTERTIARY IMPACTS

Low physical exersion

Minimize trigeers

Ability to get away

Increasing Access


Start conversations


Feelin acknowleged



HEALING

SECONDARY IMPACTS

EXPAND

EVER

YDAY G

EOG

RAPHY

PHYSICA

L COM

FORT

PROMOTE SOCIAL CAPITAL

EMOTIONAL RESTORATION

EXPAND EVE

RYDA

Y GE

OGRAPHY SUPPORT HEA

LTHY ACTIVITIESFO

STER

AW

AR

ENES

S

CREATE HEA

LTHY &

INCLU

SIVE PLACES

AD

VO

CACY

SUPPORTIVE APPROACHES

PHYSICA

L COM

FORT



EXPAND EVE

RYDA

Y GE

OGRAPHY SUPPORT HEA

LTHY ACTIVITIESFO

STER

AW

AR

ENES

S

Community DisplacementThe physical displacement faced by people living with Lyme disease can lead to a loss in social capital as the illness persists and forces changes upon the daily life of the individual. With debilitating and unpredictable symptoms, many people become limited in their ability to travel, work, and play, and most people lose the “third places” in their lives – community-oriented spaces where people go to socialize with others outside of the home (first place) and workplace (second place) [16] – losing not only the spaces themselves but the activities, interactions, and shared experiences that come with them. As one person described:

“I’ve not done a lot of things in the last 27 years. You avoid going to events, crowded places and noisy places. You don’t interact with your friends and family as much.” (Participant 5)

Similarly, many people stop going to places because they can no longer keep up with or participate in the activities that take place on those sites. Physical limitations can make people feel excluded from being a part of a space or community. These forced changes in daily activities lead to further loss of relationships. One person explains:

“It’s hard if I can’t reciprocate… I try to build community, but I just don’t have the energy for it. It’s just hard. It’s hard to make new friends and it’s hard to sustain friendships.” (Participant 4)

Figure 9: Cascading impact of chronic illness

ISOLATION

10

DESIgN IMPLICATIONS

Interviews demonstrated that, over time, living with a chronic illness can become extremely isolating. Participants described exacerbated physical and emotional symptoms when they leave their homes or familiar environments and go to public or unfamiliar places, which often deters them from doing so. This results in not only the loss in everyday spaces but also from the loss of community that comes with different places. However, “third places” and their programming have strong implications and potential to contribute to healing.

As a response, a set of design guidelines was created synthesizing interview findings associated with place-related needs and spatial affordances with three existing therapeutic design theories (Stress

Reduction Theory, Attention Restoration Theory and Universal Design Principles, marked with respective superscripts) shown in Table 2. As shown in the first three columns, the principles, needs and elements represent nested levels of attributes that measure qualities of a space. The principles represent overarching design objectives organized based on their relevance to physical, emotional, and social well-being. The spatial needs represent more specific qualities of a space, and the design elements are tangible and measurable features that can support each need. The design elements were derived from healing garden literature [3], [17] and completed with specific spatial needs expressed by interview participants, highlighted in gray.

8 pt

EXP

RES

SIO

N

Diet

Ability to travel

Environmental triggers

Confusion with treatment

Frustration with lack of medical

help

Feeling of loss & grief

Anxiety with unpredictable

symtptoms

Feeling disbelieved

Physical Activities

LImited engergy for socializing

Joint painachiness

PRIMARY SYMPTOMS

SECONDARY IMPACTS

PHYSICA

L LIMITATIO

NS

EMO

TIO

NA

L R

ESP

ON

SES

LOSS IN

SOC

IAL N

ETWO

RK

GREA

TER

NEE

D F

OR

SO

CIA

L N

ETW

ORK

FOSTER SO

CIAL O

PP

ORTU

NITIES

TERTIARY IMPACTS


Minimize triggers

Ability to get away

Increasing Access


Start conversations


Feelin acknowleged



HEALING

SECONDARY IMPACTS

PHYSICA

L COM

FORT



EXAP

ND ENABLE

EMPOWERFOST

ER A

WA

REN

ESS

INCLU

SION

EXP

RES

SIO

N

DESIGN APPROACHES


Minimize trigeers

Ability to get away

Increasing Access


Start conversations


Feelin acknowleged



HEALING

SECONDARY IMPACTS

PHYSICA

L COM

FORT



EXAP

ND ENABLE

EMPOWERFOST

ER A

WA

REN

ESS

INCLU

SION

EXP

RES

SIO

N



Minimize trigeers

Ability to get away

Support

Legibility & Coherence


Foster Awareness


Feelin acknowleged



HEALING

PHYSICAL COM

FORTSOCIAL S

UPPO

RT


EXAP

ND ENABLE

EMPOWER

FOST

ER A

WA

REN

ESS

INCLU

SION


GOALS

Figure 10: Design hypothesis and objectives - supportive third-places as a form of healing

EXPANDeveryday geography

healthy activities

with agency

ENABLE

EMPOwER

11

Equitable use# Accessibility Wheelchair AccessSmooth ground surfaces

Access to essential facilities Access to restroomsAccess to easy transportationAccess to food and water

Low physical exersion# Resting spots Comfortable seatingFrequent seatingSeating along pathsPlaces to lie downFlat paths

Minimize stimulation Control of lighting Shade structureTree canopy

Temerature regulation Heating sourceWind breakShade structureTree canopyIndoor nature connection

Limit olfactory triggers Mold-freeNo chemical scentsNo smoking

Low noise Quiet spaceSound barrierslow traffic

Tolerance for error# Minimal hazards# Traffic calmingSmooth ground surfacesAvoid harmful materialsProtection from bugs

Allow for gentle exercise*+ Places to walk Flat pathsSeating along path

Places for flexible movement Open flexible spaceOpen lawnFlat surface

Feeling of being away^ Positive distractions* Views of naturePeople-watching spaceWildlife habitatsoothing natural soundsPlayful colorsIntercative object

Spaces with complexity^ Variety of viewsVariety of texturesVariety of soundsVariety of activities

Places for reflection+ Views of natureDedicated memorial spaceQuiet spacePrivate/enclosed space

Spaces with mystery^ Curving pathsFraming of views

Sense of control*^ Having choices/flexibility# Seating optionsChoice of destinationSun or shadePrivate or open space

Perceived safety Well maintainedVisual accessProtection from bugsLighting at night

Access to essential facilities Access to restroomsAccess to transportation Access to food and water

Legibility & coherence^ Perceptible information# Visual AccessLandmarksSignage or signalingSpatial deilineation

Simple & intuitive use# Clear/simple layoutAppropriate destination pointCircular paths

Facilitate social interaction*+ Informal gathering spaces Sociopetal seatingOpen flexible spaceMovable tables and chairsIntimate spaces

Spaces for group activities Gardening areaRecreational amenitiesOutdoor games

Open flexible space

Facilitate expression & dialogue+ Space for artistic expression Display spaceViewing space around focal pointFraming of viewsDedicated memorial space

Perceptible information# SignageSignalling

Formal gathering Quiet spacePrivate/enclosed space

*Stress Reduction Theory ^Attention Restoration Theory #Universal Design +Affordances

Lyme DiseasePRINCIPLES NEEDS DESIGN ELEMENTS

APPLICABILITY TO OTHER POPULATIONS EXISTING GUIDELINES

Invisible Chronic Illness

Any Illness or Disability

General Public

ADA Guidelines

Seattle Design Guidelines

South Lake Union Street Concept Plan

Healing Garden Design

PH

YS

ICA

L C

OM

FO

RT

EM

OT

ION

AL

RE

ST

OR

AT

ION

SOCI

AL

SUPP

ORT

Table 2: Synthesizing existing theories of therapeutic design with interview results yields new principles for the design of place

12

Consideration in Everyday PlacesThe resulting design principles were compared to existing design guidelines catered to different types of public spaces, including ADA guidelines [18], urban design guidelines [19], street design guidelines [20], and healing garden design guidelines [3],[17]. This analysis showed that the needs of people with chronic illnesses are not well reflected in the design of everyday places. Though many design considerations are mentioned in healing garden literature, they are largely lacking in design considerations for other public spaces.

This project serves as a guide and reminder for spatial designers in designing the different places in our lives, particularly places that are the most meaningful and frequented by people living with illness. Bringing healing environments beyond medical facilities and into the everyday environment – sidewalks, parks, parking lots, grocery stores – can have a profound positive impact on people living with chronic illnesses.

Design ApplicationsFinally, the findings from this study present an opportunity for the creation of a digital application for spatial navigation that can inform people of the locations and qualities of healing environments. Using the derived physical elements in the design guidelines as qualitative filters for public spaces, the app could utilize crowd-sourcing to create a spatial database that can support people with different conditions in finding the “third-places” with specific qualities that can best support them. Each individual can customize their searches of a place based on their unique needs, and users can share recommendations and experiences. Furthermore, once populated, this crowd-sourced spatial database could also help designers, planners and decision makers understand the geographical and qualitative patterns of healing environments and identify “healing deserts.” It could also inform designers of spatial qualities or design elements that may be lacking in a given area, and ultimately serve to inform and prioritize opportunities for implementing therapeutic design.

Figure 11: Bringing healing environments to everyday places

13

EXPAND

ENABLE

EMPOWER

UNDISPLACED

PLACES NETWORK

ASK

ROUTE HOUSING PLACES NETWORKROUTE HOUSING PLACES NETWORKROUTE HOUSING PLACES NETWORKROUTE HOUSING

WELLNESS

FOOD

OUTDOOR

COMMUNITY

Search box for getting

PARKS

PARKS

GARDENS

WATER FRONT

PLAZAS

RECOMMENDASK

FILTERSBathrooms

Easy parking

Transit stop nearby

ADA Accessible

Heated area

Low noise

Shade/rain shelter

Vending

Comfortable seating

Scent-free

Each type of place would have its own set of filters. For example, you might want to know if there are bathrooms at a park, but for lodging options, you might want to know if its a scent free. environment.This app coud not only inform individuals living with chronic illness where to find the amenities they are seek-ing before they set off on their journey,or while they are out, if they are having an episode, it could also inform de-signers, advocates, and public officials where there are a lack of resources

RECOMMENDASK RECOMMENDASK

Where are you going?

What are your limitations?

Scents

Noise

Steep Slopes

Steep Slopes

FILTERS FILTERS

WALK

DRIVE

TRANSIT

RIDESAHRE

PARKS

FILTERS

Steep Slopes

Show

Steps

Noise

Construction Zones

Major roads

FROM

TO

SCENT-FREE

SERVICE ANIMAL

WHEELCHAIR

!

!

!

!

House

Apartment

Co-op

Lodging

PARKSFILTERS

Mold-free

Scent-free

Low noise

Easy parking

ADA Accessible

Allows service dogs

Room

Apartment/house

Smoke-free

WHERE

DATES TO

Support groups

Related events

Chat/Ask a question

Resources

WELLNESS

LECTURES/WORKSHOPS

WALKS/RALLIES

EXHIBITS

SCREENINGS

ARTS

MEET-UPS

NATURE

COMEDY

ORGANIZE

ADVOCACY

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

EXPAND

ENABLE

EMPOWER

UNDISPLACED

PLACES NETWORK

ASK


WELLNESS

FOOD

OUTDOOR

COMMUNITY


PARKS

PARKS

GARDENS

WATER FRONT

PLAZAS

RECOMMENDASK

FILTERSBathrooms

Easy parking

Transit stop nearby

ADA Accessible

Heated area

Low noise

Shade/rain shelter

Vending

Comfortable seating

Scent-free





Scents

Noise

Steep Slopes

Steep Slopes

FILTERS FILTERS

WALK

DRIVE

TRANSIT

RIDESAHRE

PARKS

FILTERS

Steep Slopes

Show

Steps

Noise

Construction Zones

Major roads

FROM

TO

SCENT-FREE

SERVICE ANIMAL

WHEELCHAIR

!

!

!

!

House

Apartment

Co-op

Lodging

PARKSFILTERS

Mold-free

Scent-free

Low noise

Easy parking

ADA Accessible

Allows service dogs

Room

Apartment/house

Smoke-free

WHERE

DATES TO

Support groups

Related events

Chat/Ask a question

Resources

WELLNESS

LECTURES/WORKSHOPS

WALKS/RALLIES

EXHIBITS

SCREENINGS

ARTS

MEET-UPS

NATURE

COMEDY

ORGANIZE

ADVOCACY

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

EXPAND

ENABLE

EMPOWER

UNDISPLACED

PLACES NETWORK

ASK


WELLNESS

FOOD

OUTDOOR

COMMUNITY


PARKS

PARKS

GARDENS

WATER FRONT

PLAZAS

RECOMMENDASK

FILTERSBathrooms

Easy parking

Transit stop nearby

ADA Accessible

Heated area

Low noise

Shade/rain shelter

Vending

Comfortable seating

Scent-free





Scents

Noise

Steep Slopes

Steep Slopes

FILTERS FILTERS

WALK

DRIVE

TRANSIT

RIDESAHRE

PARKS

FILTERS

Steep Slopes

Show

Steps

Noise

Construction Zones

Major roads

FROM

TO

SCENT-FREE

SERVICE ANIMAL

WHEELCHAIR

!

!

!

!

House

Apartment

Co-op

Lodging

PARKSFILTERS

Mold-free

Scent-free

Low noise

Easy parking

ADA Accessible

Allows service dogs

Room

Apartment/house

Smoke-free

WHERE

DATES TO

Support groups

Related events

Chat/Ask a question

Resources

WELLNESS

LECTURES/WORKSHOPS

WALKS/RALLIES

EXHIBITS

SCREENINGS

ARTS

MEET-UPS

NATURE

COMEDY

ORGANIZE

ADVOCACY

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

EXPAND

ENABLE

EMPOWER

UNDISPLACED

PLACES NETWORK

ASK


WELLNESS

FOOD

OUTDOOR

COMMUNITY


PARKS

PARKS

GARDENS

WATER FRONT

PLAZAS

RECOMMENDASK

FILTERSBathrooms

Easy parking

Transit stop nearby

ADA Accessible

Heated area

Low noise

Shade/rain shelter

Vending

Comfortable seating

Scent-free





Scents

Noise

Steep Slopes

Steep Slopes

FILTERS FILTERS

WALK

DRIVE

TRANSIT

RIDESAHRE

PARKS

FILTERS

Steep Slopes

Show

Steps

Noise

Construction Zones

Major roads

FROM

TO

SCENT-FREE

SERVICE ANIMAL

WHEELCHAIR

!

!

!

!

House

Apartment

Co-op

Lodging

PARKSFILTERS

Mold-free

Scent-free

Low noise

Easy parking

ADA Accessible

Allows service dogs

Room

Apartment/house

Smoke-free

WHERE

DATES TO

Support groups

Related events

Chat/Ask a question

Resources

WELLNESS

LECTURES/WORKSHOPS

WALKS/RALLIES

EXHIBITS

SCREENINGS

ARTS

MEET-UPS

NATURE

COMEDY

ORGANIZE

ADVOCACY

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

LOCATION

DATE

TIME

PLACE ROUTE

HOUSINg NETwORk

Figure 12: An application that can help people navigate place and navigate through illness

Thank you to Prof. Ken Yocom and Prof. Rachel Berney for guidance throughout this project. Thank you to Julie Parrett on graphic feedback and Prof. Jen Mankoff for suggestions on narrative editing.

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[2] Russel P. Lopez. 2012. The Built Environment and Public Health. San Francisco: Jossy Bass.

[3] Clare Cooper Marcus and Naomi A. Sachs (Eds.). 2014. Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. Hoboken, NJ: John Wiley & Sons, Incorporated.

[4] Esther M. Sternberg. 2010. Healing Spaces: The Science of Place and Wellbeing. Cambridge, MA: Belknap Press.

[5] Clare Cooper Marcus and Naomi A. Sachs. 2014. Theory, Research and Design Implications. In C. Cooper-Marcus & N. A. Sachs (Eds.). Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces (pp. 14–35). Hoboken, NJ: John Wiley & Sons, Incorporated.

[6] RogerS.Ulrich.1991.EffectsofInteriorDesignonWellness:TheoryandRecentScientificResearch.JournalofHealthCareInterior Design, 3, 97-109.

[7] StephenKaplan.1995.TheRestorativeBenefitsofNature:TowardanIntegrativeFramework.JournalofEnvironmentalPsychology 15, 162-82.

[8] Molly Follette Story, James L. Mueller, Ronald L. Mace. 1998. The Universal Design File: Designing for People of All Ages and Abilities.RevisedEdition.CenterforUniversalDesign,NCStateUniversity.Retrievedfromhttps://files.eric.ed.gov/fulltext/ED460554.pdf

[9] Center for Disease Control and Prevention. 2015. “How Many People Get Lyme Disease.” Retrieved from https://www.cdc.gov/lyme/stats/humancases.html

[10] AlixMayer.2011.“TouchedbyLyme:WhatDoesCDC’s300,000NumberReallyMean.”Retrievedfromwww.lymedisease.org/alix-mayer-cdc-2/

[11] LorraineJohnson,SpencerWilcox,JenniferMankoff,andRaphaelB.Stricker.2014.SeverityofChronicLymeDiseaseCompared to Other Chronic Conditions: A Quality of Life Survey. PeerJ, 2, e322. https://doi.org/10.7717/peerj.322

[12] Allen C. Steere. 1994. Lyme Disease : A Growing Threat to Urban Populations. In Proceedings of the National Academy of Sciences of the United States of America, 91(7), 2378–2383.

[13] John N. Aucott, Alison W. Rebman, Lauren A. Crowder, and Kathleen B. Kortte. 2013. Post-Treatment Lyme Disease Syndrome Symptomatology and the Impact on Life Functioning: Is There Something Here? Quality of Life Research, 22(1), 75–84. https://doi.org/10.1007/s11136-012-0126-6

[14] Mark S. Klemper, Linden T. Hu, Janine Evans, Christopher H. Schmid, Gary M. Johnson, Richard P. Trevino, DeLona Norton, Lois Levy, Diane Wall, John McCall, Mark Kosinski, and Arthur Weinstein. 2001. Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease. New England Journal of Medicine, 345(2), 85–92.

[15] JohnW.Creswell.2014.ResearchDesign:Qualitative,QuantitativeandMixedMethodsApproaches.SagePublications.

[16] Ray Oldenburg.1999. The Great Good Place. Cambridge, MA: Da Capo Press.

[17] Daniel Winterbottom and Amy Wagenfeld. 2015. Therapeutic Gardens: Design for Healing Spaces. Portland, OR: Timber Press.

[18] Department of Justice. 2010. 2010 ADA Standards for Disability Design. Retrieved from: https://www.ada.gov/regs2010/2010ADAStandards/2010ADAStandards.pdf

[19] City of Seattle Department of Planning and Development. 2013. Seattle Design Guidelines. Seattle. Retrieved from http://www.seattle.gov/Documents/Departments/OPCD/Vault/CitywideDesignGuidelinesUpdate/SeattleDesignGuidelines.pdf

[20] Weinstein A+U, CMG Landscape Architecture, & CPL Civil Engineers. 2013. South Lake Union Street Concept Plans. Seattle. Retrieved from: http://www.seattle.gov/Documents/Departments/OPCD/OngoingInitiatives/SouthLakeUnion/SouthLakeUnionStreetConceptPlans.pdf

ACkNOwLEDgMENT

REfERENCES