To explore the role of the urban rooftop garden used by healthcare staff, focus group interviews and photographic documentation of the garden were conducted. The evaluation spanned a full year to capture the use, experience and meaning of the rooftop garden during all seasons and weather conditions of the year. This was significant as Swedish weather offers large seasonal variations, from warm and sunny in summer, to dark and cold in winter.

Two participant groups were created: one with the management team, which was conducted in conjunction with their regular meetings, and a staff group, with the intention of including different professions and work units and thus collecting extensive and comprehensive data.

The Four Zones of Contact with the Outdoors (Bengtsson, 2015; Bengtsson et al., 2025) were used to identify different zones in the garden’s physical environment, for the possibility of making connections between places (including content and qualities), and use, experiences and meaning. The model was furthermore used to note the connection between the different zones, i.e., to consider the impact the zones had on each other in relation to the use, experience and meaning of the rooftop garden.

In 2020, the newly built Memory Clinic opened in central Malmö, southern Sweden. The clinic is a day center for patient evaluation and treatment with a focus on cognitive diseases such as Alzheimer’s (Region Skåne, n.d.). The clinic also conducts research on memory diseases and dementia care (Starkman Ahlstedt, 2021) and is a world leader in, among other things, research and treatment of Alzheimer’s disease (White, 2021). The Memory Clinic building has furthermore been awarded for its ecological sustainability (White, 2021). The clinic has approximately 140 employees and receives around 450 visitors per week (of which about 250 are patients and 200 are accompanying relatives). The rooftop garden (zone 3) is located on the clinic’s top (i.e., 4th) floor and is approximately 500 square meters in size. The garden is mainly used by staff, but it is also open to patients, relatives and other visitors, who occasionally visit the garden to take a walk or to use it as an outdoor waiting room (with the exception of the COVID-19 pandemic, during which no one except staff accessed the garden).

A wide path wraps around the garden, a so-called “walk & talk” loop. There is a large variety of plants in raised beds, a pergola, a water feature and varying ground materials. In addition, there are open seating areas (space with wooden decking), more secluded and private areas (smaller garden rooms), and a winter-proof (i.e., heated) pavilion (zone 2) (equipped as a meeting room). A central lawn, surrounded by hedges, provides space for physical activities such as exercise and stress management. Viewpoints in the garden offer panoramic views of central Malmö: an art gallery square, a large park and urban development. One of the clinic’s conference rooms is located adjacent to the rooftop garden, with large windows and glass doors that open out to the garden. Although the Memory Clinic has many conference rooms, only this one will be mentioned and discussed in the present study and will therefore simply be referred to as “the conference room.” The illustration below shows the layout of the rooftop garden (Figure 2).

A total of 9 staff members participated in this study and 5 focus group interviews were conducted: 3 with a management team (3–4 participants) and 2 with a staff team (4–5 participants). The management team was interviewed 3 times instead of 2, due to a project kick-off meeting with the management team where an initial interview was conducted. The participants represented different professions, such as unit manager, senior physician, nurse, counselor and medical secretary. They also worked in different work units within the clinic, such as in the “Mobile Team” that mainly helped patients in their own homes, the team that met and helped patients at the clinic (e.g., in connection with doctor’s visits), the “Memory Health” focusing on physiotherapy and occupational therapy, as well as the Research Unit (Table 1). Of all the participants, 7 of them had worked at the Memory Clinic before moving into the new building (thus having 3 years of experience in the garden) and 2 had been employed since then (with 0.5–1.5 years of experience in the garden).

Focus group interviews were chosen to encourage dynamic and interactive group discussions (Morgan, 1996), as well as to achieve more elaborate accounts and collective “sense-making” (Wilkinson, 1998; Wibeck et al., 2007). The interviews were conducted in two rounds; the first was held in the spring to discuss the previous months, i.e., the “cold months,” which covered October to March. The second was held in the autumn and covered the “warm months,” i.e., April to September. The interviews were carried out with a visual connection to the rooftop garden throughout, as they were held either in the garden pavilion or in the adjacent conference room, both of which have glass facades facing the rooftop garden. They were audio-recorded and later transcribed.

Both the first and second author were present during the interviews. To facilitate the discussions and stimulate the participants’ memory, a projected presentation was used during the interviews. This presentation showed a large photo of the rooftop garden (taken from above to see the entire design of the garden) as well as bullet points with interview questions. In qualitative research interviews, stimulus material, such as photos, can be used as a tool to stimulate the conversation by encouraging and reminding the interviewees about the topic in question (Törrönen, 2002; Bell, 2022).

The questions asked during the focus group interviews were based on the study’s research questions. The same interview questions were posed to both the management group and the staff group. The same questions were furthermore asked during the two rounds of interviews, with the exception that interviews in the spring focused on the recently experienced colder months, and the interviews in the autumn aimed to capture the recently experienced warmer months. However, additional questions were asked during the final interview, focusing on the use, experience and significance of the rooftop garden during the COVID-19 period, as the pandemic constituted a significant part of the time the garden had been in use. The following questions were asked during the interviews, with follow-up questions when needed for more in-depth responses.

The analysis was carried out with a focus on the physical environment and aspects related to the physical environment, in line with the aim of the study. The development of themes and sub-themes through thematic analysis, as well as the ethical considerations of the study, are described below.

Ethical approval for the study was obtained by the Swedish Ethical Review Authority (reference number 2022-03606-01). The study aimed to investigate the use, experience and significance of the rooftop garden. The focus was not on collecting personal and sensitive information from the staff of the Memory Clinic. However, a conscious effort was made to avoid linking specific statements to a particular profession, as a precaution, to avoid the risk of personal identification. Prior to the interviews, all staff at the Memory Clinic received written information about the study, in which their potential study participation was explained.

All participants were informed that their participation was voluntary and that they could withdraw at any time, without having to give a reason or risking it affecting their work situation in any way. Signed consent forms were collected before the start of the study from the individuals who agreed to participate.

The rooftop garden provided the staff at the Memory Clinic with access to an outdoor space to use during their workday. The garden was used in a variety of ways, ranging from Spontaneous Visits to Organized Activities. These different ways of using the garden were furthermore connected to different features and places (zones) in the environment (Supplementary Tables 1, 2 in Appendix A).

The rooftop garden was experienced as a connection between the clinic and the outside world, through the contact and proximity to nature and surrounding life (the city) that it provided. Additionally, the garden was a place that, despite belonging to the clinic, was experienced as being situated outside of the healthcare facility. This contributed to a feeling of being somewhere else, where one could escape for a while. The theme is thus divided into (a) Contact with Nature and Surrounding Life, and (b) Beyond Hospital Walls. These different ways of experiencing the garden were furthermore connected to different features and places (zones) in the environment (Supplementary Tables 3, 4 in Appendix A).

In addition to the use and experience of the garden described in theme 1 and 2 above, the results also revealed aspects linked to its meaning and significance. These aspects were generally described as either: (a) Positive and rewarding or linked to (b) Temporary wishes and needs for support. Positive and rewarding (a) represent aspects in the garden that generally seem to have a positive and rewarding impact on the staff. Temporary wishes and needs (b), on the other hand, represent aspects in the garden that correspond to the needs and wishes that may arise on certain occasions, such as in particularly stressful situations. Common to these aspects was their combined impact on staff well-being and job satisfaction, and thus also on work life sustainability.

Supplementary Tables 5, 6 in Appendix A indicates a relationship between the three themes by illustrating how the use of the garden (theme 1) and the experience of the garden (theme 2) influenced aspects linked to the meaning and significance of the garden (theme 3). Theme 3 captures what is inherently less tangible and therefore cannot be as easily linked to specific physical features and places in the rooftop garden. However, it highlights what is seen to have a more direct impact on the health and well-being of staff, i.e., what has meaning and significance, such as for example feelings of renewed energy, increased job satisfaction and restoration.

The use of a rooftop garden is strongly influenced by weather and seasons, and thus its geographical location. The variation in the Swedish climate, with both cold and dark, as well as warm and bright months, meant that both weather protection (e.g., for shade) in the rooftop garden, and more sheltered and partially (or fully) indoor environments were a prerequisite for year-round use and experience. This was especially true in relation to organized activities (sub-theme 1b), where the pavilion and conference room offered sheltered spaces but with a strong visual connection to the garden. The need for and importance of a heated greenhouse, pavilion or similar structure to enable health-promoting contact with nature and year-round use has been mentioned previously (Söderback et al., 2004; Davis, 2011; Pálsdóttir, 2014; Bengtsson et al., 2024; Oher et al., 2024). Similarly, but in relation to spontaneous visits (sub-theme 1a), the view appeared to play a crucial role in the use of the garden throughout the year, especially in relation to the colder months when the garden itself was not perceived as attractive. During these months, it was primarily the view of the city, rather than the garden itself, that encouraged staff to go outside and thus access outdoor breaks, fresh air and daylight – aspects of the outdoor environment that have previously been shown to provide positive health and well-being benefits and increased job satisfaction (Terrapin Bright Green, 2012; Jonveaux et al., 2013; Marcus and Sachs, 2013a; Zadeh et al., 2014; Nejati et al., 2016; Jiang et al., 2018b; Evans et al., 2019; O’Hara et al., 2022; Nieberler-Walker et al., 2023). This suggests that a pavilion (or similar garden structure) as well as an interesting and attractive view both constitute significant aspects in connection the use of health-promoting gardens for staff, especially in climates similar to Sweden.

Easy access and proximity can be seen as a prerequisite for connection to a garden, nature and surrounding life (sub-theme 2a). This, in combination with the garden’s visibility from the inside of the hospital, is mentioned in many studies as important design considerations with benefits for both user orientation and time efficiency (Davis, 2011; Nejati et al., 2016; Pouya and Demirel, 2017; Cordoza et al., 2018; Jiang et al., 2018a; Sachs, 2023). However, the present study found that the use of the garden connected to visibility, not only to facilitate orientation but as a reminder to the staff of its existence and as encouragement for them to visit and use the garden. The staff that could see the garden daily from inside the building described how they used the garden to a greater and more spontaneously extent, whereas the staff without visual contact to the garden admitted to forgetting it was there. The visibility between the rooftop garden in relation to staff workstations, break rooms, corridors, the coffee machine or anywhere else staff visit regularly should therefore be carefully considered to optimize garden use.

The staff, a professional group often with experiences of working in bunker-like work environments, particularly appreciated and valued being in contact with the “outside world,” i.e., experiencing seasonal conditions and changes outside the hospital’s walls, during their working day. The current study found that experiencing cyclical properties of nature provided staff with a sense of hope and normality, particularly during the colder and darker months, as well as during the extremely stressful COVID-19 pandemic. Existing research suggests that the living, growing and ever-changing qualities of nature reflect its ability to adapt to the stresses of survival, leading to feelings of safety, hope and life (Stigsdotter and Grahn, 2002; Heerwagen, 2009; Kellert and Calabrese, 2015). This again justifies the need for rooftop gardens that encourage year-round experiences, that is, also during the colder months of the year, for example through appropriate plant selection, attractive views and heated pavilions or greenhouses.

Being beyond the hospital walls (sub-theme 2b) emerged as an important experience of the rooftop garden and shows similarities to the feeling of “being away,” described by the ART theory (Kaplan, 2001). To get away or withdraw from what is experienced as draining, to an environment that is “physically or conceptually different from one’s usual environment” (Kaplan and Kaplan, 1989), has been highlighted as an important aspect of restorative environments (Marcus and Sachs, 2013b) for healthcare staff by providing “…a sense of normality, a different perspective, a break from focusing on the trauma and illness…” (Reeve et al., 2017, p. 54). In the present study, the difference between the clinic and garden was reinforced by sensory experiences (ground material, water feature, plants etc.), the open and far-reaching views, as well as the noticeable contrast between extreme closeness to nature in the garden and the urban environment surrounding it. Opportunities for privacy and seclusion emerged as an important part of the garden, with the sense of enclosure providing a reassuring sense of safety for staff. This is consistent with the quality Shelter, described as “Where the visitor is offered a secluded safe place while maintaining contact with the outside world… usually emerges in smaller, somewhat enclosed spaces, preferably in the protection of vegetation” (Stoltz and Grahn, 2021, p. 26). Exposure to this quality has furthermore been associated with lower stress levels (Grahn and Stigsdotter, 2010). In contrast to the quality just mentioned, open views were also one of the most valued features of the garden. Previous studies have both concluded that open and enjoyable views reduce feelings of confinement (as open views contrasts positively with common hospital interiors) (Naderi and Shin, 2008; Jiang et al., 2018b), and that healthcare gardens should provide feelings of physical enclosure and safety (Marcus and Sachs, 2013b). The fact that seemingly opposite characteristics, such as openness and enclosure, were valued in the rooftop garden suggests that a supportive environment should offer a spectrum of functions in the garden to meet a variety of users’ needs and desires, as has been previously described (Stoltz and Grahn, 2021; Bengtsson et al., 2024).

The sub-themes for the garden as a place of Meaning for Well-Being and Work-Life Sustainability (theme 3): Positive and rewarding (3a) and Temporary wants and needs for support (3b), indicate that the garden has roles that are clearly linked to salutogenic versus pathogenic perspectives (Figure 15).

Positive and rewarding (3a) can be seen to have a salutogenic effect on staff as the garden was experienced as a place of retreat, associated with feelings of freedom and pride, as well as with health-promoting, stress-preventing properties that increased job satisfaction. Positive and rewarding can thus be described as promoting health and well-being by proactively creating, strengthening and improving physical, mental and social well-being (Antonovsky, 1987; Becker et al., 2010; Bengtsson et al., 2018). However, in relation to Temporary wants and needs for support (3b), the garden offered support that was particularly meaningful in stressful situations, by providing a refuge with positive distractions, possibilities for recovery, a sense of normality and hope, as well as a place to breathe (figuratively and literally). This is in line with pathogenesis which describes factors that cause disease, ill health and stress, as well as how to avoid, cure or eliminate them (Antonovsky, 1987; Becker et al., 2010; Bengtsson et al., 2018). The results thus show that an outdoor environment such as a rooftop garden can include both salutogenic and pathogenic strategies and therefore be used to both promote health and prevent ill health for staff, that is, provide conditions for optimal support and promotion of health and well-being, as previously pointed out by Bengtsson et al. (2018). These results highlighting work-life sustainability are considered relevant, especially from a contemporary perspective, since many healthcare professionals today experience poor health, and as we are experiencing an acute shortage of healthcare professionals globally (Cordoza et al., 2018; Scheffler and Arnold, 2019; Rudman et al., 2020; World Health Organization [WHO], 2020, 2025a; Buchan et al., 2022; Ulrich et al., 2022; Gregory et al., 2023; Michaeli et al., 2024).

Salutogenesis and pathogenesis can further be linked to the concepts of retreat and refuge (as exemplified in the text above), as these are not considered synonymous with each other in this context. They both connect to the “garden-as-escape” experience, described by Naderi and Shin (2008) as a connection with the outside world, beyond the work environment, to achieve a desired sense of escape and distance from work-related stress and fatigue, with opportunities for positive physical and mental distractions. However, a retreat, which in everyday language refers to a place that offers rest and relaxation in a calm, pleasant and private environment (Cambridge University Press Dictionary, 2025a; Merriam-Webster Dictionary, 2025a; Oxford University Press Dictionary, 2005a), could arguably have salutogenic benefits by supporting health and well-being (by providing, for example, renewed energy, increased job satisfaction and sense of pride). A refuge, on the other hand, provides a respite and safety from a stressful and/or uncomfortable situations (Cambridge University Press Dictionary, 2025b; Merriam-Webster Dictionary, 2025b; Oxford University Press Dictionary, 2005b), allowing for relief and a chance to recover (by providing, for example, positive distractions, restoration and a sense of normality and hope), and therefore can be seen to have pathogenic properties.

The need to “breathe” in the rooftop garden was mentioned repeatedly in connection with the pandemic and proved to have a double meaning: partly as being able to breathe (figuratively) as the staff were allowed to take off their protective face masks in the garden and thus were able to breathe, see and talk to their colleagues more easily, and partly as an expression of the (metaphorical) feeling of being able to relax, pause and have a chance to recover. In a similar way “fresh air” has previously been highlighted as one of the most beneficial aspects of going outdoors (Marcus and Barnes, 1995; Nejati et al., 2016; Sachs, 2017, 2019) with the suggestion that “fresh air” could have more than one meaning by also symbolizing change, a break, or a sense of escape. The importance of natural outdoor spaces for recovery, especially in relation to stressful situations like a pandemic, is well documented (Lottrup et al., 2013; Nejati et al., 2016; Cordoza et al., 2018; Copeland, 2021; Gola et al., 2021; Iqbal and Abubakar, 2022; Dinu Roman Szabo et al., 2023; Nieberler-Walker et al., 2023) and further confirmed by this study, as the garden functioned as a much-needed refuge for the staff during this time. This justifies the need for supportive outdoor environments in healthcare contexts, where stress and crisis are commonly occurring. Furthermore, as mentioned by Fernemark et al. (2022), the COVID-19 pandemic is probably not the last crisis to impact healthcare organizations and therefore this study constitutes an important addition to the discourse on improving the work environment for healthcare staff now, thereby contributing to improved well-being and a stronger workforce better prepared for the future (Gola et al., 2021; Iqbal and Abubakar, 2022; Sierakowska and Doroszkiewicz, 2022; Gregory et al., 2023; Sachs, 2023).

There was a noticeable connection and relationship between different places, or zones, in the rooftop garden, in accordance with the model. The four zones of contact with the outdoors (Bengtsson, 2015). Figure 16 illustrates the different zones of the rooftop garden, with arrows indicating the connection between the zones.

The visual connection from Zone 1 (the clinic corridors and conference room) to the garden (zone 3) were significant for staff for various reasons; it allowed them to follow the weather and season (i.e., be in contact with the “outside world”), be reminded of the garden’s presence and encouraged to go outside, as well as to enjoy the garden views, daylight and positive distractions.

The pavilion constitutes Zone 2 of the rooftop garden, a transitional zone with extensive visual garden contact, due to the glass facade on two sides of the structure (as well as smaller windows on the third wall). The use of the pavilion meant visits to the garden that might not have otherwise taken place, especially during the colder months of the year. Although the distance from the clinic was short, the walk in between was considered a pleasant break and an opportunity to get some fresh air. This justifies the placement of a Zone 2 structure further out in the garden rather than right next to the healthcare building.

Zone 3 consists of the garden itself, which is influenced by (and itself influences) all its surrounding zones: the clinic (zone 1) and the pavilion (zone 2) whose structures (including materials, location, size, etc.) are a strong part of the overall experience of the outdoor environment, as well as the surrounding environment (zone 4) which contributes views, openness and space. This is consistent with the argument that a hospital garden never exists in isolation (Pangrazio, 2013) but stands in a spatial relationship with the medical buildings (Jiang et al., 2018b) and its surroundings (Bengtsson et al., 2024). An understanding of this relationship can be seen as a prerequisite for a successful outcome and must be considered and planned for already in the design phase.

Zone 4, the surroundings, proved significant for the staff and defining for the rooftop garden. Its open and far-reaching views gave staff the reason they needed to visit the garden during the colder months, when the garden itself was dormant, and provided them with impressions from the world outside as well as positive distractions. Contact between the garden and its surroundings furthermore existed in the opposite direction, as the garden and its greenery could be seen from the street. This was appreciated by the staff as it contributed to a sense of pride when looking up at the rooftop garden on their way to work, or when they heard that others had seen “their” garden from street level.

In addition to confirming the relevance of the zone model, this study has further developed the model to show the 4 zones of a rooftop garden. This developed and type-specific model further highlights the relationship between zone 3 and zone 4, also in the “opposite” direction, which is indicated by an arrow starting in zone 4 and pointing toward zone 3. This is due to the importance of being able to see the rooftop garden (zone 3) from the city outside (zone 4), expressed by the staff in the study. It is likely that green elements in the cityscape, such as visible rooftop gardens, can be appreciated also by the city’s passing residents.

The rooftop garden of the Memory Clinic, an inner-city healthcare environment with significant space constraints that limit ground-level gardens, is a current example of how design can support the development of healing gardens in a dense urban environment. However, the result sparked reflections on whether the garden would have been used and experienced similarly, and held the same meaning for the staff, if it had been a ground-based garden. Rooftop gardens are seen as a good alternative for introducing more green spaces in dense areas where space is a rare commodity, and as a creative way to recover the benefits of lost green spaces in cities (Pouya and Demirel, 2017; O’Hara et al., 2022). Are rooftop gardens therefore seen as a good “plan B,” that is, are rooftop gardens solely better than no garden at all, or are there advantages linked to garden use and experience that are unique to rooftop gardens? The attractive, open and unobstructed view was an important part of the garden’s appeal and a contributing factor to the overall experience of it. The staff enjoyed the central location of the bustling city, while at the same time being able to stand high up in their quiet and private “bubble.” The contrast between the calmness, privacy and proximity to nature that the garden offered, with the urban environment and the impressions and distractions that it provided, was experienced as special and unique, which led to enjoyment and a sense of pride. The results of this study hence indicate that the location of the garden, i.e., being high up instead of at ground level, clearly influenced the overall and positive experience of the environment.

The use of qualitative focus group interviews in combination with photographic documentation provided methodological triangulation and is thus seen to increase the credibility of this study. Spreading the data collection across all seasons is furthermore considered to have strengthened the ecological validity of the results. However, despite the achieved variation among the participants (female and male participants, different professions, tasks, positions and work unit affiliations), the small sample size (n = 9) could have been larger had the recruitment process generated more participants, which would have increased the generalizability of the study. As a result, the findings should be used with some caution.

Recruitment was carried out via email, on repeated occasions, and distributed via management. In retrospect, it might have been more successful to invite the staff directly, for example in connection with a clinic meeting with a large part of the staff present, to further clarify the focus and significance of the study, and to emphasize that everyone’s opinions and experiences were of interest. Although a larger number of participants would have been preferable, it is believed that larger focus groups, and thus more staff engaged at the same time, would have negatively impacted on the clinic’s daily operations. It proved to be a challenge to find interview times that suited the recruited participants due to their busy schedules. The high workload in healthcare can make it difficult to recruit study participants, as previously mentioned by Fernemark et al. (2022). Therefore, it is considered more ideal in this context to plan for several smaller focus groups, rather than larger groups with more participants in each.

Since the interviews were conducted on repeated occasions but with the same focus groups, it gave the participants a chance to reflect on the use, experience and meaning of the rooftop garden between sessions, and to bring their thoughts and recent experiences to the next interview. It also meant an opportunity for management to ask their employees questions that they themselves had been unsure about before the next session. This opportunity to think, reflect, discuss and ask colleagues between interviews can to some extent be seen as compensation for the small sample size and thus partly increase the generalizability of the study. In addition, empirical studies have shown that smaller groups provide greater opportunities for participation, as well as more focused and in-depth conversations, than larger groups (Wilkerson, 1996). Wibeck et al. (2007) argue that a relatively small group is necessary to achieve an atmosphere that supports a range of perspectives, which is desirable in a focus group situation. The interviews generated many engaged, relevant and informative discussions, where a significant amount of interesting data was obtained. By talking to each other, the staff themselves gained insights and came up with ideas and solutions, such as improvements to their garden, which was exciting for both the researchers and the staff to experience. The displayed photograph of the garden was furthermore found to stimulate conversations during the interviews and help participants remember different ways in which the rooftop garden had been used and experienced, which is in line with existing literature (Törrönen, 2002; Bell, 2022).

Finally, dividing managers and staff into two different focus groups proved to work well. Although the management group generously shared their experiences during the interviews, most of the group had a general tendency to explain how things worked and why. The staff group, on the other hand, was to a greater extent able to discuss what worked well and what worked less well in the garden and allowed themselves to express what was missing, as well as how they wished the garden could be used instead. The difference in how the questions were answered in the two groups can be seen as understandable due to the different roles that the participants held. Nevertheless, this is important to highlight in relation to grouping of focus group interviewees. This experience indicates that separating management and staff groups can provide insight into possible differences in perspective, as well as provide opportunities for more unfiltered and exploratory answers.

The timing of the evaluation, 3 years after completion, was strongly influenced by the COVID-19 pandemic, which struck shortly after the clinic opened. The evaluation began after the pandemic, when daily operations had returned to normal and when the garden had been used for what was perceived as a sufficient period. It was important to allow the feeling of novelty to subside before the evaluation, as this can affect how the environment is experienced (Center for Health Design, 2025a; Bulman, 2022). Although the evaluation was carried out later than initially planned, timeframes mentioned in the literature were met. While previous studies suggest that POE assessments of buildings should be conducted somewhere between 6 months and 1 year (Shepley, 2011; Center for Health Design, 2025a) or within 4–24 months of construction (Vischer, 2002), the timeframe mentioned for gardens is within 3–5 years (Naderi and Shin, 2008), or simply after the gardens have “been in use for a reasonable period” of time (Heath and Gifford, 2001, p. 24). Furthermore, it was important for the current study to understand the role of the rooftop garden for staff in all types of weather conditions and seasons, which is why the POE was conducted over a full year, which is different from some previous studies where assessments were conducted during the summer “to capture favorable weather for outdoor breaks” (Cordoza et al., 2018, p. 509).

As the study involved a relatively small number of participants, it is believed that more studies with a similar focus should be conducted, with the potential to increase generalizability of the current findings and contribute to knowledge of how the physical design of rooftop gardens can best meet the needs of healthcare staff. The tables in Supplementary Appendix A could be further developed to serve as knowledge base in the design discussion when planning outdoor environments in healthcare. Another way to increase knowledge in this area could be to focus on (i) different groups of healthcare professionals, (ii) rooftop gardens used for a wider range of activities by both staff, patients and visitors, or (iii) rooftop gardens that are part of the daily operations of the healthcare facility (e.g., for therapeutic activities for patients). Finally, comparisons and investigations of the advantages and disadvantages of urban rooftop gardens compared to ground-based gardens are suggested for future studies.