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This study aims at identifying the key perceived environmental attributes that can influence patients’ sense of coherence (SOC) in hospital public spaces and can improve hospital quality to create a salutogenic environment.

In total, 205 patients from the two hospitals in Sari City, Iran, participated in a questionnaire survey. The data were analyzed through structural equation modeling using partial least squares to investigate the impact of environmental qualities of public spaces on patients’ SOC.

Results confirmed that public spaces’ quality is positively associated with patients’ SOC. Accessibility has the most effective role in patients’ SOC, closely followed by relationability and intelligibility indicators. Environmental comfort also influences patients’ SOC in hospital public spaces. In comparison, the quality of the visibility is less important to patients’ SOC.

Findings will help hospital managers and designers to identify influential factors to improve the quality of health-care environments. Furthermore, the study will provide a picture of patients’ views and SOC intentions regarding public spaces in health-care environments.

To the authors’ knowledge, there is a lack of studies on the relationship between hospital public spaces and users’ SOC. Thus, this study investigates the experiences and perceptions of patients toward the quality of public spaces in hospital environments in physical, social and psychological aspects to find out its effects on patients’ SOC.

This study aimed at the identification of perceptional environment properties in hospital public spaces that can affect salutogenic components and patients' overall satisfaction and suggested a conceptual framework.

A systematic review focused on specific steps to clarify the impact of public spaces' environmental quality on patients' satisfaction through the salutogenic approach. Searches were conducted in five databases and four scientific journals.

Five perceptional environment components of hospital public spaces: physical–psychological comfort, visibility, accessibility, legibility and relationability can be related to three indicators of salutogenic approach: manageability, perception and meaning and can be evaluated in patients' overall satisfaction: desire to use hospital again, to recommend the hospital to others, to prefer hospital to other healthcare environments and to trust in the hospital.

Despite studies on healthcare environments, there is a lack of research on the salutogenic approach in hospital public spaces. Therefore, this paper focuses on the environmental quality in public spaces as an influence on patients' satisfaction with the salutogenic perspective to create a health-promoting environment.