Liane Hewitt


Background and Purpose. Literature supports the importance of the environment on promoting or compromising health. However, little is known about how the semi-fixed environment affects client perceptions and recovery from a debilitating condition. The purpose of this study was to investigate beliefs about control within the semi-fixed environment and client perceptions of the rehabilitation process.

Design and Method. This study utilized a basic qualitative research design with 10 rehabilitation clients whose average inpatient length of stay was 14 days. Data were collected in two phases. Phase I included two inpatient visits involving semi-structured interviews on the rehabilitation process and videotaping of the client’s semi-fixed environment. Phase II included a home visit, face-to-face interview using guiding questions about the client’s perception of their rehabilitation stay and how the environment impacted these perceptions, and a review of the videotapes taken during the client’s inpatient stay.

Results. Six themes emerged from the semi-structured interview data which were: Had Choices, It’s in the Room, View of Nature, Meaningful to Me, Being Connected, and God’s Plan. The majority of clients identified that having control within their semi-fixed environment was not as important as being supported by and connected to significant others such as family and friends. Feeling connected also included having ready access to nature and the outdoors. For several of the clients it did not matter where personal semi-fixed items were placed within their room; just knowing that a meaningful object (being connected) was nearby and that they could have access to it at anytime was sufficient. A majority of clients shared that staff attitude and a faith in God’s plan facilitated the recovery process. The discussion section addresses the concepts of temporality (time) and social support/connectedness as they relate to this research population.

Conclusions and Implications for Health Education. The rehabilitation client has special needs and these needs are often dependent on the severity of functional limitations. To develop meaningful and effective intervention strategies, health care professionals must understand the varied perspectives of those individuals who struggle with disabling conditions and how the semi-fixed environment might enhance or worsen their recovery. For the health educator, this study yields a better understanding of the multiple factors that impact perceptions of health promoting environments, specifically related to inpatient rehabilitation clients.


School of Public Health

First Advisor

Helen Hopp Marshak

Second Advisor

Joyce W. Hopp

Third Advisor

Patricia S. Jones

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Physical Medicine; Rehabilitation; Health Promotion; Health Behavior; Environment; Health Facility Environment; Adaptation, Psychological.



Page Count

x; 106

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives