Mixed methods study exploring the impact of the hospital gown on recovery and wellbeing: implications for policy and practice

Background: The importance of personalised and dignified care is increasingly being recognised in healthcare policy and practice. Despite the known impact of clothing on social identity few studies have considered the impact of hospital clothing on patient wellbeing and recovery. Whilst clothing can empower the wearer, it can also induce psychological distress, feelings of disempowerment and lowered self-esteem. Despite recent drives to empower patients with person centred health care provisions, the institutionalised acceptance of the hospital gown persists. Research has yet to explore the impact of wearing the hospital gown on patients' health, wellbeing and recovery. Methods: Two studies were carried out to consider the impact of the hospital gown on wellbeing and recovery among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with lifelong chronic health conditions, which were audio-recorded, transcribed and thematic analysis was used to identify themes from the qualitative data. The second study was a cross-sectional, online survey exploring adults' views (n = 700) and experiences of wearing the hospital gown. Findings: Qualitative analysis identified the following master themes: (1) loss of 'healthy' identity, (2) symbolic embodiment of the 'sick' role, (3) relinquishing control to medical professionals, and (4) vulnerability, disempowerment and embarrassment. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Interpretation: The implications of these findings for public health policy and practice are discussed, emphasising the importance of challenging cultural norms in healthcare since de-humanising aspects of care, as symbolically represented by the hospital gown, may adversely impact on wellbeing and recovery and increase patient distress. Alternatives to the hospital gown are discussed.