Background

The importance of personalised and dignified care is increasingly being recognised in health-care policy and practice. Despite the known effect of clothing on social identity, few studies have considered the effect of hospital clothing on patient wellbeing. Although clothing can empower the wearer, it can also induce psychological distress, feelings of disempowerment, and lowered self-esteem. Despite drives to empower patients with person centred health-care provisions, the institutionalised acceptance of the hospital gown persists. Research has yet to explore the effect of wearing the hospital gown on patients’ wellbeing.

Methods

Recruitment for both studies commenced on Nov 1, 2018 and ended on the Aug 31, 2019. Two studies were carried out to consider the effect of the hospital gown on wellbeing of adults with and without chronic health conditions. The first study consisted of doing in-depth, semi-structured interviews with adults living with life-long chronic health conditions, which were audio recorded and 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 and experiences of wearing the hospital gown. Ethical approval was sought and granted from the Psychological Sciences in Health Ethics Committee.

Findings

Ten people participated in the interviews. 928 people completed the survey, aged 18–80 years (mean age 43 [SD 12]). Participants were predominantly female (79%), white, living in the UK (86%), with 46% identifying as having a long-term health condition. Qualitative analysis identified the four master themes: loss of healthy identity; symbolic embodiment of the sick role; relinquishing control to medical professionals; and vulnerability, disempowerment, and embarrassment. Quantitative analysis of the online survey data indicated that 542 (58%) of 928 adults reported wearing the hospital gown despite feeling uncertain that it was a medical necessity. The gown's design was considered to be not fit for purpose, with 573 (61%) of 928 adults reporting that they struggled to put it on or required assistance, and 623 (67%) of 928 reported that they did not think that the gown fitted them. From the 928 adults, 670 reported feeling exposed (72%), 554 (60%) felt self-conscious, and 530 (57%) felt uncomfortable while wearing the hospital gown.

Interpretation

These findings suggest that hospital gowns might contribute towards patients experiencing an increased sense of exposure, discomfort, disempowerment, and embarrassment at a time of potential vulnerability while undergoing medical intervention, emphasising the importance of challenging cultural norms in health care. Dehumanising aspects of care, as symbolically represented by the hospital gown, might adversely affect patient wellbeing and increase distress.