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Evidence-based design (EBD) is traditionally limited to using empirical research findings based on randomized controlled trials. The purpose of this study is to explore stakeholder experiential knowledge as alternate credible evidence in redesigning health-care facilities for improved usability.

This research, based on critical participatory action research, involved a case study of redesign and post-occupancy evaluation (POE) of an emergency department (ED) at Holy Family Hospital, Techiman, Ghana. Observation, interviews and document analysis were used to collect data in the redesign and POE. The data was analyzed through directed content analysis.

Findings indicate that the redesign interventions, generated from stakeholder experiential knowledge, led to improved effectiveness, efficiency and satisfaction in the ED. This presents stakeholder experiential knowledge as alternate credible evidence in EBD. Furthermore, the POE revealed that open and flexible spatial arrangement, zoning care areas according to severity, and providing staff-support amenities are some redesign interventions for improving ED usability.

Compared to the hard and controlled nature of experimental research knowledge, the soft and fluid experiential knowledge of stakeholders could be more useful for health-care redesign process, especially in iteratively structuring design thinking and making choices.

This paper contributes to theory by validating and illustrating stakeholder experiential knowledge as credible evidence for EBD. Practically, it provides strategies, based on POE findings, for designing EDs to improve usability.

Compliance with standard specifications in stairway design and construction, particularly the step geometry, is imperative for the safety and usability of stairs. The purpose of this study, was to assess the compliance of stair step geometry parameters with standard specifications in selected public buildings in Ghana. Specifically, the study investigated the prevalence of deviations in step geometry parameters from standard provisions; how significant these deviations are in comparison, and by theoretical association, the potential risk of accidents.

Field measurement of the geometric parameters of a total of 1954 steps in 204 flights of stairs within 28 university buildings was undertaken using a calibrated Multi Digit Pro + digital spirit level and a tape measure following the Nose-to-Nose Method. The results were analyzed using in Microsoft Excel 2016 and Minitab 18 and interpreted based on mean values, one-sample t-test and percentages.

Although some parameters generally complied with standard specifications, dimensional inconsistencies in risers and treads of adjacent steps were most prevalent, and significantly at margins far above standard specifications. The findings of the study show the unique limitation of the step geometry design requirements specified in the current Ghana National Building Code and the National Building Regulation, and by association, the potential risk of accidents and discomfort in the use of stairs in public buildings such as those on university campuses.

The observed deviations in the dimensions of risers and treads point to a lack of strict compliance with standard specifications in the design and construction of stairs. Apart from engaging skilled artisans, and intensifying supervision in stair construction, development control authorities in Ghana need to strengthen inspection of stairs during construction to ensure and enforce compliance.

Findings of the study provide insight into stairway design, as well as stair safety and usability in a developing world context, and allows for a more comprehensive study of stair-related accidents and discomfort associated with stairs in public buildings as a basis for the review of standards and codes in Ghana and other developing countries.

Knowing and understanding the spatial needs of users is imperative for the design of livable and sustainable houses. However, the practical and theoretical difficulties associated with this, especially in social housing, create a shortfall in design knowledge known as user needs gap. To bridge this gap, design researchers over the years, have sought to provide feedback for design decision-making through post-occupancy evaluation studies using preferences and residential satisfaction as constructs. In view of their limitations, this study aims to explore residential adaptations as residents’ tacit means of communicating their spatial needs, and a pathway to understanding residents’ housing requirements.

The study was exploratory in nature and a case study by design using a convergent parallel design within the mixed methods tradition. Activity Theory as used as a conceptual framework. The study involved three strands of research as follows: estimation of the floor areas of the rooms and spaces of the case study designs using the International Standards Organisation intramuros method; a survey of households and their activities using questionnaires; and observation of residents’ adaptations captured photographs and drawings. In all, 43 households out of the 66 apartments in the two case designs were surveyed.

The study found that while the units were theoretically large, they were practically inadequate when average household sizes were taken into account in a space per person analysis. In response, particularly to sleeping requirements of children, residents make different forms of adaptations – normative, such as house sharing, compositional and organizational, as well as add-ins and add-ons including and illegal alterations.

The paper presents residential adaptations as an empirically grounded, contextually embedded and practically useful means of exploring and understanding users’ spatial needs in housing design. Residential adaptations provide a means through which residents communicate their housing needs, albeit tacitly – a means for self-expression, self-extension and self-determination. To theory, the study shows that residential adaptations can be useful as a construct for understanding residents’ spatial needs, though fuzzy. It also helps understand how the tensions in an activity system, may result from contradictions produced by the lurking effect of contextual factors. This makes contextual knowledge, particularly cultural knowledge, critical to the design.