Running Head: RESEARCH PROPOSAL

Research Proposal:
Effects of Seating Arrangements on Interpersonal Closeness on Patients in an Emergency
Waiting Room

Kelly Erazo
COH 611
National University

Research Proposal

Introduction
The emergency waiting room of a hospital is an environment of its own, filled with
diversity among people and the reasons for being there. Studies have researched multiple aspects
of a waiting room, from the effect of nature-related elements in the waiting room (Beukeboom et
al., 2012), to the behaviors of the patients (Alcock et al., 1985). One essential element of a
waiting room that has not been thoroughly researched is the seating arrangement. When a patient
enters an emergency waiting room, they first seek an information or registration counter, and
then almost always proceed to find a seat. Seating arrangements have been mostly studied in
fictional settings (Zhu and Argo, 2013), or in real settings such as in classrooms, but there is little
to no research on seating arrangements in emergency waiting rooms, where for instance, the
average waiting time for a child and parent is 1.5 hours (Alcock, et al., 1985). Additionally, some
research on seating has focused on interpersonal closeness (Holland et al., 2004), but this
research is mostly in prepared settings. Therefore, the purpose of this study will be to observe the
effects of seating arrangements on interpersonal closeness of patients in an emergency waiting
room. Seating arrangements will be categorized as either connected (rows of chairs are
connected in a bench-like style with shared arm rests) or disconnected (rows of individual chairs
that stand alone and have their own arm rests). Interpersonal closeness will be analyzed by the
distance between patients in terms of chairs, as well as choice of leaning side (right, left, or no
leaning). It is hypothesized that patients sitting in connected seating arrangements will have more
interpersonal closeness between one another than disconnected arrangements. Additionally, it is
hypothesized that patients in disconnected seating arrangements will move their chair from its
original location to alter their interpersonal closeness with other patients. The following literature

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review discusses related studies that contributed to the development of the present study, as well
as explanations of how the present study will contribute to existing research.
Literature Review
Holland et al. (2004) conducted a study on the behavioral effect of self-construal on the
interpersonal closeness. This study was conducted through a series of three studies, with three
different hypotheses for each. All three studies were similar in the sense that the participants
were initially primed for some type of self-construal (independent, interdependent or a mixture
of both), and then were moved to a new location with seating arrangements props for cues. Here,
the researchers observed the participants behavior when choosing where to sit. In the first study,
the chair on the far left had a jacket hanging over it, indicating that someone was sitting there. In
the second study, the chair also on the far left had a jacket, but in this study other materials were
added to indicate clearly the presence of someone sitting there. The third study was slightly
different; the chairs were placed at right angles around a square table. In the first two studies,
participants were individually observed and asked to take a seat, while in the third study
participants were in pairs and asked to take a seat. The distances were measured by the number
of chairs between the participant and the occupied chair in the first two studies, while in the third
study the distance was measured by the distance between the tips of the noses of the participants,
which were measured using a photo that was taken of them at the end of the session. The first
two studies included a mix of male and female participants, while the third study had only
female participants. The gender variables were taken into consideration and measured (male vs.
female) in the first two studies. The subsequent summary discusses the findings of the studies.
All three hypotheses that the researchers had were proven by the findings. In the first
study, the researchers hypothesized that participants who were prepared with the thought of the

Research Proposal

independent self would sit further away from the occupied chair, which coincided with the
studys results. In the second study, the researchers hypothesized that those who were prepared
with the thought of the interdependent self would sit closer to the occupied chair, which was
proven correctly with the results. Lastly, in the third study, the researchers hypothesized that the
duos who had more independent self thoughts would sit further away from each other than those
with interdependent self thoughts. The results of the third study proved this hypothesis.
Additionally, study two found that females had a smaller interpersonal distance than male
participants (Holland et al., 2004). The discussion of the findings reveals that there are many
studies about interpersonal behavior based on cultural differences, but not many focus on the
individual and their self-construal, regardless of their cultural background.
The research article by Holland et al. provides a plentiful amount of references to
previous studies similar to theirs and how they relate to their present study. Additionally, the
article discusses limitations of the studies, as well as validity of their methods, and suggestions
for future research, such as studies that may further clarify how peoples interpersonal behavior
is shaped by the way they construe themselves (Holland et al., 2004, p. 241). This present study
proposes to use elements of interpersonal closeness discussed in Holland et al.s study and apply
them to the real-life setting of an emergency room, as well as observe the interactions between
patients, rather than focus on one patient at a time.
In another seating arrangement study, Zhu and Argo (2013) analyzed the impact of
various shaped seating arrangements on consumer behavior. In a series of three studies, the
researchers used multiple variables to analyze different scenarios. The main variables they used
were the seating arrangement of circular versus angular, where chairs were arranged in a circle
with equal distance from each other or were arranged in a shape with corners. Additionally, the

Research Proposal

researchers studied the multiple variables of majority vs. minority and sense of belonging vs.
sense of uniqueness, and how these influenced persuasion. Before diving into their studies, the
researchers conducted a pilot study to ensure [their] basic notion is supported before proceeding
any further (Zhu and Argo, 2013, p. 338). This pilot study found that indeed the geometrical
shape of a seating arrangement can influence a persons needs (need to belong or need to be
unique). From these initial results, the researchers hypothesized that 1) Consumers in a circularshaped seating arrangement will evaluate persuasive material more favorably when it conveys
belongingness-related information (vs. uniqueness-related information) and 2) Consumers in an
angular-shaped seating arrangement will evaluate persuasive material more favorably when it
conveys uniqueness-related information (vs. belongingness-related information) (Zhu and Argo,
2013, p. 339). Three studies, in which almost 350 undergraduates from different universities
participated, tested for multiple conditions with different variables. The first study used a 2 x 2
experimental design, where the variables were circular vs. angular seating arrangements, and
family-oriented vs. self-oriented type of advertisement. The third study used a 4 x 2 experimental
design, where the variables measured were circular, L-shape, equal number of chairs in both
arms, and square seating arrangements, versus majority and minority endorsement types. The
third study used a 3 x 2 experimental design where the variables measured were circular, angle-1
and angle-2 seating arrangements, versus a table present or not present. Angle-1 was described as
having an equal number of chairs on both arms and having the participant sit halfway through the
shape, and angle-2 was described the same as angle-1 but the participant sat in a chair within the
angle of the seating arrangement. Once all the studies were completed, the researchers
summarized their findings.

Research Proposal

The first study revealed that participants in the circular seating arrangement responded
more favorably to the family-oriented advertisement, while participants in the angular seating
arrangement responded more favorably to the self-oriented advertisement, indicating a
relationship between seating arrangement and the preferred need (need to belong or need to be
unique) (Zhu and Argo, 2013). In order to check that the peculiar angular seating arrangement
was not affecting the research (since all participants sat at the only and last seat placed at a right
angle from the rest of the row of chairs), the researchers included other types of angular seating
arrangements. However, the results showed that there was no significant difference between the
different shapes, as long as they were angular. The second study also revealed that participants in
the angular seating arrangements favored minority endorsements, while participants in the
circular seating arrangement favored majority endorsements. Lastly, the researchers added the
variables of the presence or absence of a table to the study, a measurement of the commonality of
the arrangements in real life locations, and a different location of seating within the seating
arrangement. The third study revealed that the presence or absence of a table, the commonality of
the seating arrangements, or the location of seating had no significant effect; the shape of the
seating arrangement still showed to be the most important aspect.
Zhu and Argo discuss their research findings in a great manner and clearly explain their
results as compared to previous studies, as well as how it contributes to literature. Additionally,
they discuss limitations to their work and highlight that it is the first of its kind and therefore
allows for many options for future research studies. Furthermore, they suggest multiple areas of
study for the future, including the following: one could explore how the shape of a seating
arrangement may positively influence consumers during different types of waiting situations
(Zhu and Argo, 2013, p. 344). The present study proposes to analyze seating arrangements in the

Research Proposal

emergency waiting room, and is influenced by Zhu and Argos study, which focused on the
shapes of the seating arrangements, to focus on the connectedness of the seating arrangements.
The following study expands on the hospital waiting room topic to analyze the impact of the
elements within the waiting room that may affect the patients stress levels.
Beukeboom et al. (2012) conducted a study on the stress-reducing effects of real and
artificial nature in a hospital waiting room. Their study focused on analyzing how nature can
play a role on reducing the stress a patient feels in a waiting room. They discuss how the time
spent in a waiting room gives the patient time to think about the procedures they are about to go
through and what the possible outcomes could be (Beukeboom et al., 2012). Thus, their focus
was on the natures impact in a waiting room and additionally, they observed whether have real
nature or artificial nature would make a difference. They hypothesized that the presence of real
plants or photos of plants would lead to lower levels of stress compared to the absence of both
(Beukeboom et al., 2012). Beukeboom et al. conducted the study in the Radiology Department of
a hospital. There, they chose two out of five waiting rooms to use for their study in which 457
male and female participants were analyzed through a questionnaire they completed. The
researchers picked three variables to observe: the presence of real plants, the presence of pictures
of plants, or the absence of real plants or photos, with this last one being the control variable.
Each week, the researchers placed two different variables the two rooms, alternating each week
until all three variables had been combined in some way. They collected their data through
questionnaires that patients completed while waiting to be called in, which they would deposit in
a mail box in the waiting room. This questionnaire included questions related to the
attractiveness of the waiting room, the experienced level of stress, and patient characteristics.

Research Proposal

Once the researchers collected 457 completed questionnaires out of the 748 distributed, they
summarized their results.
Beukeboom et al. first found that there was no significant difference between the patient
characteristics in all three variables. Thus, the researchers could focus on testing their hypothesis.
As they predicted, the patients in both rooms with real plants and with photos of plants reported
lower levels of experienced stress compared to the room with no plants or photos (Beukeboom et
al., 2012). Additionally, the real plants and the photos of plants showed no difference, meaning
that the type of plants did not matter as much as their presence or absence in the room to reduce
stress. Furthermore, the researchers found that patients rated the rooms more attractive when
there was a presence of nature than when there was no nature at all, as in the control room.
Additionally, there was a correlation that indicated that with higher levels of attractiveness there
were lower levels of stress (Beukeboom et al., 2012). Finally, the researchers used the Preacher
and Hayes method to test for indirect causal effects and found that a significant part of the
stress-reducing effect of real plants and posters of plants is explained by the intervening variable
attractiveness of the waiting room (Beukeboom et al., 2012, p. 332).
The study concludes with the discussion of the effect that the presence of nature had on
the stress levels of the patients. Additionally, they state how most research has focused on the
health risks of having real plants in a hospital room rather than the health benefits, and how
having photos of plants is an alternative option. They also discuss the limitations of their work,
such as using only plants as a factor of nature when there are other factors such as water, rocks,
or wood. They suggest that future research could focus on finding whether these other types of
nature would have a similar effect as the plants did. Although this study focuses on natural
elements within a waiting room, the present study proposes to explore whether non-natural

Research Proposal

elements, such as chairs, has an effect on patients. The following study explores the behaviors of
patients in waiting rooms, particularly focusing on children and parents.
Alcock et al. (1985) conducted a study on the environment and waiting behaviors in
emergency waiting areas. They chose two locations for their study; a general hospital and a
childrens hospital. Within these locations, they set up three different environments at the suture
hall and emergency waiting room of each hospital. The three environments were: 1) receiving
child life intervention at the childrens hospital, 2) not receiving child life intervention at the
childrens hospital, and 3) not receiving child life intervention at the general hospital. It is
important to note that the childrens hospital had a child life intervention program since 1974,
while the general hospital had never had one (Alcock et al., 1985). The method of choice to
collect data was divided into stages, beginning with the note-taking stage, followed by the
drafting of a behavioral checklist, and then using the checklist to record the observations (Alcock
et al., 1985). A total of 625 children and parents participated in this study. Children and parents
were observed by the researchers during their waiting time at the emergency waiting room and
the suture hall of both hospitals, and their behaviors as well as total waiting time were recorded.
Researchers observed such elements as the noise level, the level of interaction between parents
and children, and the behavior of the child and parent separately. Alcock et al. then summarized
their findings into different categories, discussed ahead.
The findings were discussed in terms of waiting time, environment, children, and parents.
The researchers found that the average waiting time for children and parents was around 1.5
hours across all three groups. As for the environment, the study showed that both the suture hall
and the waiting room in the general hospital were much quieter than the waiting room and suture
hall in the childrens hospital (Alcock et al., 1985). Additionally, there was a difference in the age

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distribution between the patients of both hospitals. The children were found to have waited more
passively in in both environments where there was no child life intervention than in the
environment with the child life intervention. Passively waiting was defined as not interacting
with the environment and not playing, painting, or reading (Alcock et al., 1985, p. 176). Parents
were found to have been more active and interacting with their children in the suture hall than in
the waiting room. Additionally, parental agitation was higher in the suture hall than in the
waiting room.
Overall, the children were more passive in the environments with no child life
intervention, and more active in the environment with the intervention, since the child life
workers were present and their role was to facilitate the play of parents and children (Alcock et
al., 1985, p. 177). The researchers discuss how even in the childrens hospital where there was no
intervention, the children were more active than in the general hospital due to the child oriented
environment. Reading material, childrens furniture, as well as an aquarium made the childrens
hospital more appealing than the general hospital, where the environment was more adult
oriented. As Alcock et al. (1985) state, familiar and age-appropriate material and furnishings
convey the message that it is an OK place for children (p. 178). The researchers also present
the limitations and implications of the study, and suggest that waiting room environments
should be carefully planned so that children and parents can be purposefully active while
waiting (Alcock et al., 1985, p. 179). Lastly, the researchers also suggest that further studies
are required to investigate ways in which waiting periods for nonurgent patients can be optimally
used (Alcock et al., 1985, p. 180). The present study proposes to use observational methods like
the ones found in Alcock et al.s study to collect the data from the patients in the waiting room.

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Additionally, elements of this study such as the behavioral checklist influenced the development
of data colleting methods for the present study.
Sampling
Sampling will be obtained from the emergency waiting room of the Kaweah Delta
District Hospital (from here on called Hospital K) located in Visalia, California. The
observations will be recorded over a period of four weeks, where the first two weeks will have
the connected seating arrangement in the waiting room, and the following two weeks will have
the disconnected seating arrangement. Additionally, sampling will be randomized by choosing 4
random days out each week and 2 random time periods of 4 hours out of each day to observe and
collect data. Sampling will include male and female adult patients between the ages of 18 to 65
that are waiting for a medical service for themselves.
Data Collection
Data collection will occur via two methods. The first method will be a brief questionnaire
about the waiting rooms environment printed on a bright colored paper in order to easily
identify participants without them compromising their participation in the study. The
questionnaire will be handed to the patient after they have registered at the check-in window by
the check-in staff member. Additionally, the questionnaire will serve two purposes; the first
purpose will be to record the demographics of the patient, such as age, gender, and time they
began to fill out the questionnaire. The second purpose will be to keep the patients occupied and
acting in a natural manner while the researcher observes the patients interpersonal behavior. Due
to the different volumes of patients that the waiting room may experience at different times, it
would be too difficult to observe many patients sitting throughout the waiting room all at once.

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Therefore, the researcher will only observe patients sitting a specific section of the waiting room,
although the entire room will be conditioned for each of the two seating arrangements. The
researcher will begin observation as soon as the patient receives the brightly colored
questionnaire and begins walking to the chosen specific area, as instructed to do so by the checkin staff member. If at any time the observed area becomes full and a patient with a questionnaire
sits elsewhere, they will not be included as part of the sample. The researcher will have a
checklist to observe and record the behaviors of the patient that will include such things as the
distance between the patient and the person to their right and to their left in number of chairs,
whether the patient leans to the left, right or doesnt lean, and whether they rest their arms on the
left only, the right only, or both arms on each side. The checklist will also have space for
additional notes by the researcher. Once the patient completes the survey, they will deposit the
survey in a small box under their seat. This serves the purposes of keeping the patients
information confidential, while at the same time allows the researcher to match the questionnaire
to the patient sitting in each chair. Matching of patient-to-observation will be further verified by
matching as close as possible the time that the patient indicated they began the questionnaire
with the time that the researcher indicated they began observing the patient. Only questionnaires
that have the demographics section completed and that match with the researchers observations
will be included in this research.
Data Analysis
Once data is collected, it will be first analyzed by determining respondents versus
nonrespondents, based on the completion of the questionnaire or lack thereof. Once the number
of respondents and therefore participants of this study has been calculated, the demographics of
the participants will be calculated with frequencies and percentages for each category (i.e. male

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vs. female). Furthermore, the data will be presented in a table once calculated. It is important to
note that a copy of the questionnaire and checklist used in this study will be included in the
appendix of the research. Moreover, the data will then be analyzed in terms of the items on the
checklist. An analysis of covariance statistical test will be used to analyze each category such as
leaning to the right, leaning to the left, or no leaning. Data will be analyzed separately for the
connected arrangement phase and disconnected arrangement phase and then compared with each
other. Additionally, any extra notes or observations that the researcher records will be analyzed
for patterns and categories. If it is determined that the additional data contributes to the already
created categories, then it will be included and discussed more in depth. Descriptive analysis of
the data will also be included to explain if the results supported the hypotheses or not.
Ethical Considerations
In order to eliminate as many ethical considerations as possible, several steps have been
taken as discussed throughout this proposal. First of all, no names or personal information will
be asked on the questionnaire that may directly identify the patient. For purposes of the study
and the validity of the data, the only identifiable data that will be asked is the time of completion
of the survey, which will simultaneously be recorded by the researcher who will begin
observation on the patient as soon as they receive the questionnaire. It is important to note that
there is the possibility that the times may differ by a few minutes. To further improve the
accuracy of the data, the patient will leave the questionnaire under their seat in a small box to
reassure them that their questionnaire will remain anonymous, and additionally to assist the
researcher in matching the questionnaire to the right patient. The researcher will number the seats
on their own records in order to easily identify the patient in their notes (i.e. chair 1, chair 2,
etc.). Anonymity and confidentiality will be used as much as possible in order to prevent adding

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stress or pressure to the patient who already may be feeling this way in the emergency waiting
room. If participants become aware of the study and that they are being observed, they may ask
questions and choose to withdraw from the study at any time.
Conclusion
Previous research has focused on different elements included in this study, such as
waiting rooms, seating arrangements, and interpersonal behavior. However, no research was
found that specifically focused on seating arrangements in an emergency waiting room and the
interpersonal closeness of the patients waiting in it. This is surprising considering that there are
many studies that analyze the long waiting times and their effect on patients in waiting rooms.
This study proposes to investigate how a simple yet essential element of the waiting room such
as the chairs and their arrangement can affect a patient while they wait to be called. They may
spend a large amount of time surrounded by the same people, which could possibly affect their
interpersonal behavior. Furthermore, the results of this study will contribute to information
available for hospitals when designing or redesigning their waiting rooms in order to improve the
quality of the hospital.

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References

Alcock, D., et al. (1985). Environment and Waiting Behaviors in Emergency Waiting
Areas. Children's Health Care, 13(4), 174.
Beukeboom, C. J., et al. (2012). Stress-Reducing Effects of Real and Artificial Nature in a
Hospital Waiting Room. Journal Of Alternative & Complementary Medicine, 18(4), 329333. doi:10.1089/acm.2011.0488
Holland, R., et al. (2004). Research Article Don't Stand So Close to Me The Effects of SelfConstrual on Interpersonal Closeness. Psychological Science (Wiley-Blackwell), 15(4),
237-242.
Zhu, R., & Argo, J. J. (2013). Exploring the Impact of Various Shaped Seating Arrangements on
Persuasion. Journal Of Consumer Research, 40(2), 336-349. doi:10.1086/670392