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Healing Nature ANIMATION FOR HEALTH AND WELL-BEING IN CHILDREN HOSPITAL ENVIRONMENTS

TABLE OF CONTENTS

5 ABOUT THE PROJECT Healing Nature – Animation for Health and Well-being in Children Hospital Environments Melinda Šefčić PhD Lea Vidaković, PhD 9 PRESENTATION OF PROJECT ACTIVITIES BY COUNTRY 10 BULGARIA Vessela Dantcheva – Bogdanova Sevina Ivanova, PhD 28 CROATIA Melinda Šefčić PhD Lea Vidaković, PhD 42 PORTUGAL Natalie Woolf, PhD 57 PRESENTATION OF RESEARCH RESULTS 58 Eye Tracking Component of the Healing Nature Project Evgeniya Hristova, PhD 64 Impact Survey Research Findings and Analysis Ana Beato, PhD

81 PROJECT DISSEMINATION 82 First Press Conference in Sofia, Bulgaria, 27.05.2026 84 Press Conference in Zagreb, Croatia, 15.06.2026 86 Press Conference in Lisbon, Portugal, 17.07.2026 88 Second Press Conference in Sofia, Bulgaria, 19.10.2026

ABOUT THE PROJECT

Healing Nature – Animation for Health and Well-being in Children Hospital Environments Melinda Šefčić PhD Lea Vidaković, PhD

The project Healing Nature – Animation for Health and Well-being in Children Hospital Environments is an international interdisciplinary project that connects contemporary art, animation, new technologies, research, and the healthcare system with the aim of creating more humane, aesthetically sensitive, and emotionally supportive hospital environments for children, parents, healthcare professionals, and the wider hospital community. The project was implemented from 2024 to 2026 under the leadership of the Croatian Association of Visual Artists (HDLU), in partnership with Universidade Lusófona / COFAC from Portugal and New Bulgarian University from Bulgaria, with co-financing from the European Union through the Creative Europe programme. The total value of the project amounted to EUR 248,986.62, of which EUR 199,189.30 was co-financed by European Union funds through the Creative Europe programme. The financial structure of the project enabled the implementation of international cooperation, the realization of three original mural designs and their animated components, the development of innovative digital content, the implementation of workshops with children, research activities, international knowledge exchange, and the communication and dissemination activities of the project. In this way, Healing Nature brought together artistic production, technological innovation,

participatory work, research, and international interdisciplinary cooperation within a sustainable implementation model in public hospital environments. Healing Nature emerged as a continuation of the long-standing artistic and research work of Melinda Šefčić in the field of the rehumanization and re-aestheticization of hospital environments through art, as well as a multi-year collaboration with Lea Vidaković on the development of experimental models of animation and expanded artistic formats within hospital environments. The project builds upon the pilot projects Digital Flora and Fauna: Digital Aestheticization of Hospital Space (2021/2022) and Animated Forest World in Hospital Space (2023), implemented at the Zagreb University Hospital Centre, which for the first time within the Croatian hospital system connected mural painting, animation, and digital technologies in the service of mental health and positive distraction for patients. At its core, Healing Nature explores the possibilities of contemporary art to function as a form of emotional support, visual therapy, and positive distraction within a space often marked by stress, uncertainty, fear, and feelings of isolation. The project is based on the fact that hospital environments, particularly paediatric wards and waiting rooms, are often aesthetically and emotionally neglected, focused primarily on functionality and medical efficiency, while the

psychological and emotional aspects of the hospital experience are insufficiently taken into account. Children in hospitals often spend hours waiting for examinations, therapies, or procedures in spaces marked by monotony, tension, and a feeling of insecurity. It is precisely for this reason that Healing Nature is based on the idea that art can become an important tool for supporting mental health, creating a sense of safety, and providing emotional distance from illness and everyday hospital life. The project does not view art as a decorative addition to space, but rather as an active element of humane and emotionally sensitive healthcare infrastructure. Numerous international studies over recent decades confirm that art in healthcare institutions can significantly contribute to reducing stress, anxiety, and feelings of discomfort among patients, while also positively affecting hospital staff and the overall atmosphere of the environment. Particular emphasis is placed on the importance of natural motifs, organic forms, light, colour, and visual elements that create a sense of safety, calmness, and emotional connection with the surrounding environment. For this reason, Healing Nature uses motifs of forests, plants, animals, water, natural micro-worlds, and imaginative landscapes as the foundation of the project’s visual language, relying on the principles of biophilic

design and neuroaesthetics. Nature appears in the project not merely as a decorative motif, but as a universal symbol of calmness, safety, connectedness, and emotional balance. In sterile and emotionally demanding hospital environments, natural motifs have the potential to create feelings of comfort, gentleness, and psychological distance from the medical environment.

The project introduces an innovative use of Augmented Reality that integrates hand held screens with real world situation, a form of interaction that does not use conventional screens, large projections, or digital installations that dominate space, but instead connects the physical mural with hidden digital layers through augmented reality (AR). Using a mobile device, visitors can activate animated sequences within the mural, causing the hospital walls to literally “come to life.” Animals begin to move, plants grow, and hidden micro-stories, and animated details appear, encouraging children to explore, play, communicate, and use their imagination. It is important to emphasize that the goal of the project is not to further increase passive consumption of content through screens, but quite the opposite — to encourage children to respond to the space around them, to move, explore, communicate with one another, and, through interaction with the artwork, develop a sense of curios-

ity, play, and emotional presence within the environment. Technology here is not an isolating tool that separates the child from their surroundings, but rather a means that reconnects them with the space, encourages exploration, and connects them with other people. The child must approach the wall, explore the details of the mural, observe the surrounding environment, and communicate with other children in order to discover the hidden animated layers of the work. In this way, the project seeks to transform the experience of waiting into an experience of play, interaction, and imagination. A particular value of the project lies in the combination of traditional hand-crafted artistic techniques with contemporary digital technologies. The murals were digitally prepared in such a way that they retain the sensorial, texture, and poetic quality of classical visual art, while the combination of traditional animation and AR expands them into a new layer of experience. Technology is not used here as an end in itself, but as a tool that deepens the emotional and spatial experience of the artwork. One of the important innovations of the project is precisely the combination of the physical mural and the digital animated layer. Printed murals represent the first layer of the aesthetic transformation of the hospital environment, while AR elements open additional hidden worlds, characters, sounds, and narratives. Through inter-

action, children enter imaginary spaces that separate them from everyday hospital life and create moments of play, curiosity, and emotional distance from illness. The project had several key objectives: to aesthetically and emotionally improve hospital environments, reduce stress and anxiety among children and parents during waiting periods, develop new models of art in the service of health, encourage children’s social interaction and imagination, enable access to contemporary art for a wider audience, connect art, research, technology, and the healthcare system, develop international interdisciplinary cooperation, and investigate the impact of animated and interactive content on mental health and the perception of space. A particular value of the project lies in its strong social and participatory dimension. The project was not conceived as a closed artistic process, but as a collaborative platform in which children become active participants in the creation of artistic content. In Croatia, Bulgaria, and Portugal, workshops were organized with children from different social groups and backgrounds, including children without adequate parental care, children with developmental difficulties, and children from hospital and educational systems. Their drawings of animals, fantastic creatures, plants, and natural motifs became an integral part of the murals and animations. In Portu-

gal the workshops were used to build a legacy of understanding of use and play. Staff and long-term patients took part in demonstrations of the AR tool, integrating the viewer into the mural scenes, and also how to use low-tech shadow play and character designs that worked on top of the murals encouraging playful personal storytelling. In this way, the project develops the principle “from child to child,” whereby children, through their creative contribution, create content that will later be viewed by other children in hospital environments. In this way, feelings of belonging, empathy, solidarity, and social connectedness are further developed, while art becomes a tool of inclusion and empowerment. The artistic process becomes a space of collaboration, dialogue, and collective creation, and the hospital environment ceases to be merely a place of treatment and becomes a place of experience, participation, and human contact. The project included the realization of three original mural designs and their animated AR layers: the Croatian work Forest of Little Wonders by Melinda Šefčić, the Bulgarian work Lilies and the White Pond by Lydia Tsvetkova, and the Portuguese work Spring Breeze by Natalie Woolf. The Bulgarian project was developed under the artistic supervision of Vessela Dantcheva – Bogdanova, Sevina Ivanova, Kalina Hristova.

All three works were implemented in hospitals in Zagreb, Sofia, and Lisbon, making each hospital environment a meeting place for different European artistic poetics and cultural approaches. In this way, the project not only connected institutions and artists from different countries, but also opened a space for the exchange of knowledge, experience, and interdisciplinary approaches within the fields of art and health. The animation segment of the project was developed by international teams of artists, animators, designers, researchers, and students from the fields of animation, film, sound, and new media. In Croatia, Lea Vidaković, Katrin Novaković, João Miguel Real, and Matea Kovač developed animations incorporating children’s drawings, 2D animation, and puppet animation. Under the mentorship of the animator Sevina Ivanova, the Bulgarian team of animators—Boryana Angelova, Nelina Petkova, Daria Ruseva, Lyudmil Vasilev, and Evgeniya Stoitseva—focused on expressive drawn animation with unexpected narrative twists, while the Portuguese team consisting of Pedro Serrazina, Catarina Gil, Daniela Tietzen, Ana Cortes, and Paulo Simão employed the poetics of watercolour, drawing, and fluid atmospheric animation. One of the important aspects of the project was also its research component. The project included the evaluation of the impact of artistic in-

terventions through survey questionnaires collected before and after the installation of the visual interventions. The aim of the research was to analyse how artistic interventions affect stress and anxiety levels, children’s emotional state, perception of waiting time, feelings of comfort and safety, children’s behaviour and engagement within the space, and the perception of the hospital environment by staff and parents. The survey design and data collation was the responsibility of the Lisbon Team, integrating the CICANT creative team with the HEI-Lab psychology research groups both based Universidade at Lusófona. A special research segment of the project was carried out in Bulgaria through an eye-tracking study, which analysed which parts of the murals attracted the greatest attention from viewers, how long they maintained their gaze, and how they responded to particular visual compositions. The research results showed that certain elements—especially animals, colour contrasts, and organic forms—significantly attract attention and maintain viewers’ interest, opening new possibilities for the development of artistic interventions based on scientific insights into the perception of space. In this way, the project contributes to the development of the European field of arts & health, that is, the study of the relationship between art, health, and social well-being. At the same time, it opens new questions

about the role of contemporary art in public space and the possibilities for developing artistic practices that actively participate in shaping a higher-quality and more humane social environment. Healing Nature also makes a strong contribution to European cultural and social priorities through innovation and digital transition, social inclusion, accessibility of contemporary art to a broad audience, interdisciplinary cooperation, sustainability and environmentally conscious approaches, as well as the promotion of mental health and well-being among children and communities. The project builds upon contemporary European initiatives such as CultureForHealth, Arts on Prescription, the New European Bauhaus initiative, and the recommendations of WHO Europe on arts and health. It is particularly significant that the Healing Nature project has been recognised and included as an example of good practice in the European strategic document Culture and Health: Time to Act, developed within the OMC (Open Method of Coordination) Working Group of the European Commission on Culture and Health. The inclusion of the project in this document confirms its relevance within contemporary European discussions on the role of art in the fields of mental health, social well-being, and the humanisation of healthcare systems, and positions the project among relevant

European examples of interdisciplinary cooperation between art, technology, and healthcare. A strong emphasis was also placed on the sustainability of the project. The combined installation model—printed mural foils together with AR animations activated by scanning parts of the mural using a mobile application—enables relatively low implementation and maintenance costs, as well as easy adaptation and replication of content in other hospitals and countries. The animations can be upgraded, modified, and expanded with new content, seasons, stories, and future artistic collaborations. The project therefore does not end with the implementation of the murals, but opens the possibility for the long-term development of an international network of artists, researchers, hospitals, and cultural institutions that will continue to develop new models of art in the service of health. Healing Nature demonstrates that contemporary art can play an active social role in creating a more humane, empathetic, and emotionally sensitive society. The project opens a new perspective on understanding hospital environments—not only as places for healing the body, but also as spaces of psychological support, imagination, hope, play, and humanity. Art appears here not merely as visual content within a space, but as an active participant in the process of cre-

ating a higher-quality, more dignified, and more humane experience of being in healthcare institutions.

Presentation of Project Activities by Country 9

Bulgaria 10

BULGARIA

Vessela Dantcheva – Bogdanova Sevina Ivanova, PhD

The Bulgarian component of the Healing Nature – Animation for Health and Well-being in Children Hospital Environments project was developed as a collaborative artistic, educational, and research process bringing together students, faculty members, artists, psychologists, healthcare professionals, and children. Unlike the other two murals, created by established artists, the Bulgarian mural was conceived as a collaborative artistic project within an academic environment at New Bulgarian University (NBU). Through an open competition for visual interpretations of the theme Nature in the Children’s Hospital, the project created a platform for young artists to explore how nature, art, animation, and technology could contribute to more welcoming and emotionally supportive hospital environments. The competition received 26 proposals, of which 10 were selected for further development. The winning proposal, The Lilies and the Little White Pond by Lydia Tsvetkova, offered a delicate and luminous interpretation of the project theme. The process brought together students from seven bachelor’s and master’s programmes at NBU, alongside tutors, academic staff, project partners, and healthcare professionals, demonstrating how collaboration between education, art, and healthcare can contribute to the transformation of hospital environments. As part of the artistic and psychological research leading up to the

creation of the murals, two workshops were organised in Bulgaria: one with children deprived of parental care at Atelier Hug Me, and another with children with special needs from the Winnie the Pooh Speech Therapy and Education Centre. The children were introduced to the concept of re-creating hospital environments, shown examples of good practices, and encouraged to contribute ideas to the development of the mural and its animated elements. Under the guidance of an interdisciplinary team of visual arts and animation students, mentors, a psychologist, and speech therapists, the children created drawings inspired by animals from different natural habitats and discussed short scenarios for possible interactive situations. The workshops encouraged imagination and individual expression while also supporting attention, memory, fine motor skills, self-esteem, communication, emotional expression, and social interaction. Selected drawings and ideas were later incorporated into the animations as motifs that reflected the children’s imagination while remaining consistent with the visual language of the mural. The process of preparing and training the participating artists began with the open call for visual interpretations of the theme Nature in the Children’s Hospital. An international jury consisting of Melinda Šefčić, Lea Vidaković, Vessela Dantcheva, Kalina Hristova, and Sevina Ivanova assessed

the 26 proposals according to criteria including originality, artistic style, contemporary approaches, potential for augmented reality (AR), and suitability for adaptation as a mural, selecting 10 finalists. From the end of March to the end of June 2025, the selected participants developed their proposals through meetings, consultations, and site visits under the mentorship of Vessela Dantcheva, Sevina Ivanova, and Kalina Hristova. Melinda Šefčić also held an online session with the students, sharing her professional experience, providing individual feedback, and helping the artists further align their proposals with the objectives of Healing Nature. The process was intended not only to identify a suitable artistic concept, but also to provide young artists with professional guidance and experience in developing their work within an international and interdisciplinary project. The ten final concepts were presented to the public in an exhibition entitled NBU Artists for Children’s Smiles, organised to mark International Children’s Day. The exhibition included a public vote for the Best Audience Choice, while an independent jury selected the design to be implemented as the project mural. The winning proposal was The Lilies and the White Pond by Lydia Tsvetkova, a student in the BA Animated Cinema programme at NBU. The concept for The Lilies and the White Pond emerged from Lydia

Tsvetkova’s personal memories of being in hospital as a child. She recalled the reflection of sunlight on a hospital wall and translated this memory of silence, peace, and gentle reflection into the image of a small pond surrounded by large lily leaves. Under the artistic guidance of the project mentors, the original concept was developed into an adaptive mural designed to respond to the dimensions and characteristics of the hospital walls while preserving its quiet and almost living atmosphere. Animals were carefully integrated into the natural surroundings, while rays of sunlight filtering through the leaves introduced a subtle sense of movement. The soft colour palette was also adapted to meet the technical requirements of augmented reality, requiring stronger contrasts and clearer details in the areas intended to trigger animation. Additional details and textures were developed by Evgeniya Stoitseva, a BA Visual Arts student at NBU, adding greater visual depth to the final mural. The storyboard was developed in accordance with the calm and contemplative atmosphere of the mural. The team chose a naturalistic animation approach, allowing the animals to behave in ways inspired by their movements and interactions in the wild, while introducing subtle playful elements and moments of imagination. The storyboard also expanded the world of the mural by introducing hidden animals, including a lizard and

a ladybird. These less immediately visible characters create small moments of discovery and surprise, encouraging children and other visitors to look more closely at the mural and explore its animated layers. The animation was developed by a team of students working under the guidance of animation mentor Sevina Ivanova. Hand-drawn digital animation was selected as the most appropriate technique for bringing the mural and its inhabitants to life while preserving the visual character of the original artwork. The mural was divided into seven interactive animated zones. Evgeniya Stoitseva was responsible for the colour design of the characters, while Daria Ruseva, Lyudmil Vasilev, Boryana Angelova, and Nelina Petkova worked on the detailed frame-byframe animation of the characters and environmental elements. To ensure visual continuity between the physical mural and the animated sequences, Lydia Tsvetkova developed character sheets that served as a reference for the animators, helping them preserve the volume, shape, proportions, and visual presence of the original characters. The final artwork combines the physical mural with a series of animated sequences activated through augmented reality. When viewed through a mobile device, selected areas of the mural come to life, allowing the animals and elements of the natural environment to move, interact, and ex-

pand the visual narrative beyond the physical artwork. The AR experience creates an additional layer between mural painting and animation, inviting visitors to explore the artwork actively and discover animated elements that are not visible in the mural itself. In this way, the technology supports a playful and exploratory encounter with the hospital environment. The laboratory eye-tracking study conducted at the Department of Cognitive Science and Psychology at New Bulgarian University provided an analytical basis for the development of the Healing Nature project. Digitised versions of the three project murals were presented to a diverse group of participants while a Tobii TX300 eye-tracking device recorded their gaze patterns. The study analysed specific areas of interest, including how frequently, how quickly, and for how long participants looked at particular elements of the murals. This provided objective data on the ability of different visual elements to attract and maintain attention. The research contributed to a more evidence-based understanding of how the trigger zones for the AR animations could be organised within the murals, supporting the development of an experience in which the animated sequences could be activated in relation to viewers’ visual attention and interaction with the artwork. The Bulgarian installation reached an important public mile-

stone on 27 May 2026, when The Lilies and the White Pond was officially unveiled at the University Hospital Tsaritsa Yoanna – ISUL in Sofia as part of the Healing Nature project. Vessela Dantcheva, the Bulgarian project leader from NBU, together with members of the creative team, representatives of the hospital, project colleagues, and partners from Flip.bg, presented the project to journalists, students, and members of the public. The Ministry of Health highlighted the project in its congratulatory message as an example of the integration of art, technology, and paediatric care. The event received national media attention, including coverage by BNT, bTV, and Nova. The Bulgarian team was subsequently featured on Nova’s morning programme Zdravei, Bulgaria, where the project and its initial findings were presented to a wider audience. Through the combination of artistic education, participatory workshops, mural art, animation, augmented reality, and eye-tracking research, the Bulgarian implementation of Healing Nature demonstrates how collaboration between young artists, academic institutions, healthcare professionals, and children can contribute to the transformation of hospital environments and create new ways of engaging with art in healthcare settings.

Open Call for Visual Concepts for Mural Designs

Artist Training / Education

Exhibition of Competition Works

New Bulgarian University, 30.05.–08.06.2025

Mural Creation

Mural Artist: Lydia Tsvetkova Collaborators in the Realization of the Mural Artwork: Evgeniya Stoitseva

Workshops

Partners in Implementation of Children’s Workshops: “Hug Me” Gallery, “Winnie the Pooh” Speech Therapy and Educational Center” Kid’s Workshops Expert: Ekaterina Todorova Locations and Dates: “Hug me” Gallery, Sofia, Bulgaria, 17 May 2025 “Winnie the Pooh” Speech Therapy Centre, Sofia, Bulgaria, 30 August 2025

Animation Development

Animation and AR Mentor: Sevina Ivanova Animaton, Design and AR Team: Evgeniya Stoitseva, Daria Ruseva, Nelina Petkova, Boryana Angelova, Lyudmil Vasilev and Lydia Tsvetkova Additional Experts on Design and Animation: Ivaylo Saraliyski, Ivan Bogdanov Expert on Mural Adaptation: Iliya Kozhuharov

Augmented Reality (AR)

Croatia 28

CROATIA

Melinda Šefčić PhD Lea Vidaković, PhD

The Croatian component of the Healing Nature – Animation for Health and Well-being in Children Hospital Environments project was implemented by the Croatian Association of Fine Artists (HDLU) through a series of artistic, educational, research, and participatory activities that brought together children, artists, animators, healthcare institutions, and the wider community. The activities were designed to create more humane, aesthetically stimulating, and emotionally supportive hospital environments for children and their families. A central element of the Croatian implementation was a series of creative workshops held with children from diverse social and educational backgrounds, including children without adequate parental care. The workshops were organised in collaboration with SOS Children’s Village Lekenik, the House of St. Francis for Children without Adequate Parental Care in Vugrovec (Caritas of the Archdiocese of Zagreb), Ivan Gundulić Primary School, and Krijesnice Kindergarten. Led by Melinda Šefčić, the workshops encouraged children to explore themes of nature, endangered animal species, plants, and fantasy worlds through drawing, storytelling, and creative play. The resulting artworks became an important source of inspiration for the development of the mural, storyboards, and animated content. The children’s drawings were directly incorporated into both the mural design

and the animations, creating a strong connection between the participants and the final artworks. The Croatian artistic intervention, the mural Forest of Little Wonders by Melinda Šefčić, was implemented in two healthcare institutions in Zagreb. One mural was installed at the Sestre milosrdnice University Hospital Center – Department of Pediatric Oncology and Hematology “Dr. Mladen Ćepulić” – leased by the Zagreb Children’s Hospital, while the Children’s Hospital Zagreb became the home of all three project murals—from Croatia, Bulgaria, and Portugal—bringing together artworks from the three participating countries within a shared hospital environment. Inspired by forests, wildlife, and hidden natural micro-worlds, the murals transform hospital spaces into imaginative environments inhabited by animals, plants, insects, and magical details. Developed according to the principles of neuroaesthetics and biophilic design, the artworks aim to provide positive distraction, emotional comfort, and a sense of safety for children, parents, and healthcare professionals. The animation segment of the Croatian project, led by Lea Vidaković, began with the development of storyboards, in which children’s drawings and ideas were transformed into visual narratives and animated sequences. These storyboards served as the foundation for a series of short animated

stories centred on curiosity, exploration, playfulness, and interaction with nature. Lea Vidaković designed and created all the puppets for the stop-motion animation, drawing inspiration from both the mural motifs and the children’s drawings. She also designed and constructed all the stop-motion sets, including the blackand-white forest environment, rigged all the puppets, and developed the lighting with the assistance of Ricardo Mata. In addition, she served as the director of photography for every stop-motion animation sequence. The animation segment of the Croatian project was developed by Lea Vidaković, Katrin Novaković, João Miguel Real, and Matea Kovač. Together, they created a series of animations combining children’s drawings, 2D animation, and puppet stop-motion animation. The animated content expanded the mural beyond its physical form, introducing additional layers of storytelling, imagination, and interaction. A distinctive feature of the Croatian intervention is the integration of Augmented Reality (AR). By scanning selected parts of the mural with a mobile device, visitors can activate seven hidden animated sequences in which animals begin to move, plants grow, and new stories emerge directly from the artwork. This innovative approach encourages children to explore the physical environment, interact with

one another, and actively engage with the artwork rather than passively consuming digital content. The Croatian project activities also included the evaluation of the artistic intervention through surveys conducted before and after the installation of the mural. The research provided valuable insights into perceptions of the hospital environment, emotional responses, and the potential impact of art on the experiences of children, parents, and healthcare professionals. An important aspect of the Croatian implementation was the dissemination of project results through conferences, presentations, and public events. The final press conference presenting the project and its outcomes was held on 15 June 2026 at the Children’s Hospital Zagreb. The event brought together project partners, healthcare professionals, media representatives, and members of the public, highlighting the role of art, animation, and innovative technologies in supporting children’s well-being within healthcare environments. It also contributed to raising awareness of the importance of Arts & Health initiatives in contemporary healthcare systems. Through the combination of mural art, animation, augmented reality, participatory workshops, research activities, and interdisciplinary collaboration, the Croatian implementation of Healing Nature demonstrates how

contemporary art can contribute to the humanisation of healthcare environments and support the mental well-being of children and their families during hospital visits and treatment.

Workshops

Partners in Implementation of Children’s Workshops: House of St. Francis – Caritas of the Archdiocese of Zagreb in Vugrovec, SOS Children’s Village Lekenik Location and Dates: the House of St. Francis – Caritas of the Archdiocese of Zagreb in Vugrovec, February 24, 2025 SOS Children’s Village Lekenik, March 18, 2025

Mural Creation

Puppet Making

Animation Development

Storyboard, Stop motion Animation and Puppets: Lea Vidaković Animators: Katrin Novaković, João Miguel Real Lighting: Ricardo Mata

Augmented Reality (AR)

Augmented Reality (AR): Matea Kovač

Portugal 42

“I am certain that everyone benefits from initiatives such as this. The children and their families benefit, as they find pleasant and stimulating spaces here. The staff benefit, as they too enjoy the transformation of their workplace. And the organisation benefits, as it reinforces its mission to look beyond illness and to innovate in care.” Dr. Eduardo Castela, Executive member of the Board of Directors of the Unidade Local de Saúde (ULS) de São José, E.P.E.

PORTUGAL

Natalie Woolf, PhD

The Portuguese strand of Healing Nature began when Lisbon-based CICANT researchers Pedro Serrazina and Natalie Woolf met the Croatian project creators, Melinda Šefčić and Lea Vidaković, who were seeking partners across Europe to test whether animated images of nature help reduce stress for children and young adults in hospital waiting spaces. Together, the team secured funding for an animation pilot project through ILiND at Universidade Lusófona to identify the most suitable styles and techniques for the Portuguese context. Working with psychologists from HEI-Lab (Digital Human-Environment Interaction Lab), animated and still imagery was tested with children across a range of ages, assessing abstraction, realism, colour, speed, and movement. As a watercolour style emerged as a suitable approach, a further session was held with CBIOS (Research Centre for Biosciences and Health Technologies). Here, watercolour paintings and animated sequences containing more abstract elements were viewed by researchers trained in cancer cell biology, who found some of the marks strikingly similar to microscopic cellular forms — a resemblance that made the team aware of how easily abstract imagery could read as unsettling in a hospital context. Handled carefully, though, and combined with the mural’s overall design and animation, these material traces of painting add a haptic dimension to viewing rather

than a triggering one. On this foundation, together with the Croatian pilot projects, the three partners successfully secured Creative Europe (CREA) funding. The Portuguese mural, Spring Breeze, was then developed, led by researcher and artist Natalie Woolf assisted by Ana Cortes and installed in the Blood Analysis Clinic waiting room at Hospital Dona Estefânia, Lisbon - a space serving the whole hospital. Painted as a watercolour meadow seen from close to the ground, the mural gives an immersive, giant-jungle feel to plants that are usually small or unremarkable. It was built from hundreds of individually painted layers, then digitally reassembled so each element could be animated without losing the handmade quality of the original marks. Many of the plants are common across Europe rather than uniquely Portuguese: research into the everyday, marginal landscapes around Lisbon, cross-referenced with folk and herbal medicine traditions, showed that these familiar wayside flowers are recognised throughout the continent. This shared familiarity was used deliberately, drawing an urban audience’s attention back to the surrounding but maybe overlooked nature. A similar approach was taken when selecting the characters, in particular the swallow, a long-standing motif in Portuguese visual culture, chosen to give the mural a local resonance for Lisbon audiences while still carrying a flavour

of the Portuguese landscape to visitors from the partner countries. The storyboard was developed character by character - swallow, mouse, ladybird, dandelion, caterpillar, pine marten, butterfly, and frog - each sequence choreographed to overlap and loop rather than play as a single narrative, allowing each viewing to unfold differently. Animation, directed by Pedro Serrazina with production by Catarina Gil and animation by Ana Cortes, Daniela Tietzen, and Paulo Simão, stays close to the original watercolour in style, and the design deliberately balances busy, detailed passages with quieter, more open ones. Intuitively it was thought that calmer, more distanced views would also support the intention of the installation, and the Bulgarian-led eye-tracking study later confirmed that viewers were drawn to these quieter areas just as strongly as to the intended focal points. Viewing the animations is achieved through a mobile phone scanning a QR code to activate the Artivive app. Various triggers hidden within the mural activate the characters individually or in combination. Animated elements are composited with the real space in front of the mural, so a butterfly can appear, through the screen, to land on a visitor’s hand - a surprising effect that added real emotional depth and which visitors can record and share through the app. The team challenged and tested the app

repeatedly to find the best integration for this specific context, always aiming for the most convincing mixed-reality experience. Alongside this our psychology team: Ana Beato, Ana Loureiro, Isabel Santos and Bernardo Cruz from HEI-Lab developed impact surveys for the waiting-rooms before and after installation for use across all three partner hospitals. Early indications point to calmer, more positive responses from children and parents alike. Having the Lisbon researchers on site also allowed an additional survey to be conducted at Hospital Dona Estefânia – ULS de São José, giving greater insight into the site-specific effects before installation, after mural installation, and after interaction with the AR animations. Full findings will be published at the end of the research period. Unlike the other partner projects, the Lisbon workshops were deliberately scheduled after the mural and AR installation were complete. Their purpose was not to create the artwork but to explore how it could be used within the hospital, introducing patients, families, and staff to the project’s intent and to the AR experience itself. Two workshop sessions, The Living Mural – Spring Breeze, were led by Hugo Barata and João Cabral with support from lead researcher Natalie Woolf and MA volunteers Jessica Frade and Paulo Simão. Simple analogue tools such as shadow-play projectors allowed children to design

and physically move their own characters across the mural and surrounding walls, demonstrating how the same playful, collaborative spirit could carry over into the AR experience. The AR, though experienced through a single phone screen, was shown in practice to become a communal tool — something to explore together in the waiting room. Beyond the hospital itself, dissemination continues through the project websites (healingnature.ulusofona.pt and healingnature.hdlu.hr) and Instagram (@healingnature.project), while the Artivive app allows visitors to record and share their own augmented-reality encounters. Mobile phones are often blamed for isolating children rather than connecting them to what surrounds them. Here, the aim was the opposite: to make the phone a source of shared, playful distraction in the waiting room. Treatment will always come first in a hospital, but we hope that a calmer environment and a more settled patient can contribute something real to the experience of care for patients, families, and staff alike, as part of a genuinely holistic approach to healthcare.

Mural Creation

Mural Design and Production: Ana Cortes, Daniela Tietzen, Natalie Woolf Supported by Carolina Torres, Maria Feitinha and Daniela Salvador

Animation Development

Animation Director: Pedro Serrazina Production Director and Assistant Animation Director: Catarina Calvinho Gil Animators: Ana Cortes, Daniela Tietzen, Paulo Diogo Simão

Augmented Reality (AR)

Workshops

Workshop Team: Hugo Barata, João Cabral, Natalie Woolf Assisted by Paulo Diogo Simão, and Jessica Fraude.

Presentation of Research Results 57

EYE TRACKING COMPONENT OF THE HEALING NATURE PROJECT 58

Evgeniya Hristova, PhD

EYE TRACKING RESEARCH FINDINGS AND ANALYSIS 1. Research context

As part of the Healing Nature project, an eye-tracking study was conducted to examine how participants visually explored the three nature-based murals developed for paediatric hospital environments in Croatia, Bulgaria, and Portugal. While the Impact Survey examined participants’ subjective perceptions, emotional responses, and experiences of the hospital environment, the eye-tracking study provides an additional behavioural perspective by measuring where participants looked, how long they looked at specific visual elements, and how quickly different elements attracted their attention. The eye-tracking study therefore complements the questionnaire-based research by providing objective measures of visual attention. This is particularly relevant for Healing Nature because the project places visual art, nature-based imagery, animation, and interaction at the centre of its approach to creating more welcoming and engaging hospital environments. The study examined digitised versions of the Bulgarian, Portuguese, and Croatian murals. Each mural was presented for 10 seconds in a randomised order for each participant. A practice image was presented at the

beginning of the procedure and was not included in the analysis. Between stimuli, participants viewed a central fixation cross for 300 milliseconds before the next mural was presented. 2. Research aim The eye-tracking study aimed to understand how visual attention was distributed across the different elements of the three murals. More specifically, the analysis examined: •

•

which visual elements attracted attention most consistently across participants; how much visual attention participants allocated to different areas of each mural; and how quickly different areas attracted participants’ gaze.

For this purpose, specific Areas of Interest (AOIs) were defined for each mural. Three eye-tracking measures were analysed: the proportion of participants who fixated each AOI, the total duration of fixations, and the time to first fixation (TTFF). Because not every participant fixated every AOI, TTFF was interpreted together with the proportion of participants who fixated the relevant area. 3. Participants and procedure A total of 31 participants took part in

the eye-tracking study. Due to recording problems, one participant was excluded, resulting in a final sample of 30 participants. The sample consisted of 26 female and 4 male participants, aged between 19 and 41 years, with a mean age of 23 years. Eye movements were recorded at the Decision Lab – Decision and Behavioral Science Lab at New Bulgarian University between 5 and 13 March 2026. A Tobii TX300 remote eye tracker was used, with a 23-inch monitor and a display resolution of 1920 × 1080 pixels. The system recorded gaze data from both eyes at a sampling rate of 300 Hz, while stimulus presentation and eye-movement recording were conducted using Tobii ProLab software. Because each mural was preceded by a centrally presented fixation cross, the first 300 milliseconds of viewing time were excluded from the analyses in order to reduce the influence of the initial central fixation. 4. Results 4.1 Bulgarian mural The Bulgarian mural was analysed using seven Areas of Interest (AOIs). The distribution of gaze across the mural shows that some visual elements attracted attention from almost all participants, while others were viewed by a smaller proportion of the sample. BG_2 and BG_5 were fixated by all participants (100%). BG_3, BG_4 and

BG_6 were fixated by 29 participants (96.7%). BG_1 was fixated by 26 participants (86.7%), while BG_7 was fixated by 23 participants (76.7%). These results indicate that BG_2 and BG_5 had the broadest reach in terms of the number of participants who looked at them. The duration of visual attention also differed significantly between the AOIs. A repeated-measures ANOVA showed a significant effect of AOI on total fixation duration, F(3.84, 111.31) = 5.72, p < .001. Post hoc comparisons showed that BG_2 was viewed significantly longer than BG_3 and BG_7, while BG_4 was viewed significantly longer than BG_3. Overall, BG_2 received the longest mean fixation duration (1.47 seconds), followed by other areas, while BG_3 (0.55 seconds) and BG_7 (0.69 seconds) received the shortest viewing times. The results therefore indicate that BG_2 attracted particularly sustained visual attention. The analysis of time to first fixation also revealed significant differences between AOIs, F(3.63, 72.61) = 8.72, p < .001. BG_2 and BG_4 attracted gaze relatively early, with mean TTFF values of 1.11 and 1.30 seconds respectively. By comparison, BG_3 and BG_7 were fixated later, at 3.71 and 4.65 seconds respectively. Taken together, the Bulgarian mural shows a relatively clear concentration of visual attention around BG_2. This area was not only viewed by all

participants, but was also viewed for the longest period and attracted gaze earlier than several other AOIs. 4.2 Portuguese mural The Portuguese mural was analysed using eight Areas of Interest. The results show a high overall level of visual exploration, with most AOIs being fixated by the large majority of participants. PT_3 and PT_8 were fixated by all 30 participants (100%). PT_7 was fixated by 29 participants (96.7%), while PT_1 and PT_6 were each fixated by 28 participants (93.3%). PT_4 was fixated by 27 participants (90.0%), PT_2 by 26 participants (86.7%), and PT_5 by 24 participants (80.0%). Thus, PT_3 and PT_8 attracted the broadest visual attention across the sample. Fixation duration differed significantly between the AOIs, with a repeated-measures ANOVA showing a significant effect of AOI, F(4.15, 120.35) = 9.78, p < .001. PT_8 and PT_3 received the longest mean fixation durations, at 1.50 and 1.47 seconds respectively. In contrast, PT_5 and PT_6 received substantially shorter viewing times, at 0.25 and 0.52 seconds. The time-to-first-fixation analysis also revealed a significant effect of AOI, although the differences were more limited than for fixation duration, F(3.32, 53.10) = 2.77, p = .046. PT_1 and PT_4 attracted attention relatively quickly, with mean TTFF values of 1.39

and 1.58 seconds. PT_5 and PT_6 were fixated later, with mean values of 3.94 and 3.81 seconds. Overall, the Portuguese mural generated broad visual engagement across its different elements. PT_3 and PT_8 were particularly prominent in terms of sustained attention, while PT_1 and PT_4 were among the elements that attracted gaze relatively quickly. 4.3 Croatian mural The Croatian mural was also divided into eight Areas of Interest. In contrast to the Bulgarian and Portuguese murals, the results show greater variation in the proportion of participants who looked at the different areas. HR_2 and HR_8 attracted attention from 29 of the 30 participants (96.7%). HR_3 was fixated by 26 participants (86.7%), followed by HR_5 with 24 participants (80.0%). HR_4 was fixated by 22 participants (73.3%), while HR_1 was fixated by 21 participants (70.0%). The two least frequently fixated areas were HR_6 and HR_7, which attracted the attention of 13 (43.3%) and 12 participants (40.0%) respectively. The duration of visual attention differed significantly across the AOIs, F(4.33, 125.57) = 14.01, p < .001. HR_8 received the longest mean fixation duration (1.29 seconds), followed by HR_2 (1.02 seconds). HR_7 and HR_6 received the shortest viewing times, at 0.17 and 0.20 seconds respectively.

Post hoc comparisons showed that HR_8 was viewed significantly longer than HR_1, HR_3, HR_4, HR_6 and HR_7. HR_2 was also viewed significantly longer than HR_1, HR_6 and HR_7. HR_6 and HR_7 were therefore among the areas receiving comparatively limited sustained attention. The TTFF analysis for the Croatian mural was more restricted because complete valid data were available only for five AOIs: HR_2, HR_3, HR_4, HR_5 and HR_8. Among the 17 participants with valid data for all five AOIs, the repeated-measures ANOVA did not identify a significant difference in time to first fixation, F(2.43, 38.79) = 0.48, p = .656. This means that, for the selected AOIs, there was no statistically significant evidence that one area consistently attracted gaze earlier than another. Overall, the Croatian mural shows a particularly strong concentration of sustained attention around HR_8 and HR_2, while HR_6 and HR_7 attracted substantially less visual attention. 5. Integrated interpretation of the eye-tracking findings

Taken together, the eye-tracking results demonstrate that visual attention was not distributed evenly across the murals. In all three cases, specific visual elements attracted more sustained attention than others, indicating that participants naturally concentrat-

ed their gaze on particular components of the compositions. The Bulgarian mural showed a particularly clear focal pattern around BG_2. This AOI was fixated by all participants, received the longest mean fixation duration, and attracted gaze earlier than several other areas. The Portuguese mural similarly showed strong engagement with PT_3 and PT_8, both of which were fixated by all participants and received the longest viewing times. The Croatian mural showed strong attention to HR_2 and HR_8, both in terms of the number of participants who fixated them and the duration of those fixations. These findings provide behavioural evidence that the murals contain visual elements capable of attracting and sustaining attention. This is relevant to the wider Healing Nature research because the questionnaire findings indicate that children particularly valued the visual elements of the murals, with animals, plants, landscapes, and other visual characteristics frequently mentioned in relation to what they remembered and liked. The eye-tracking results complement this subjective evidence by showing that participants’ gaze was indeed concentrated on particular visual areas of the murals. The two types of evidence therefore address different aspects of the same experience. The survey findings describe what participants reported noticing, remembering, and liking, while eye tracking records their

visual behaviour during exposure to the mural. Together, they provide a more comprehensive picture of how nature-based visual interventions can engage viewers. At the same time, the eye-tracking results should not be interpreted as evidence that particular visual elements are inherently more appealing, calming, or beneficial without considering the specific composition and characteristics of each mural. The study measures visual attention rather than emotional response or well-being directly. 6. Conclusions The eye-tracking study provides objective evidence of differentiated visual attention across the three Healing Nature murals. Participants did not look equally at all parts of the images; instead, particular Areas of Interest consistently attracted broader or more sustained attention. Across the Bulgarian mural, BG_2 emerged as a particularly prominent area of visual attention. In the Portuguese mural, PT_3 and PT_8 received the longest viewing times and were fixated by all participants. In the Croatian mural, HR_2 and HR_8 attracted the broadest and most sustained attention, while HR_6 and HR_7 received comparatively limited attention. The findings complement the Impact Survey results, in which children frequently identified visual elements as

important aspects of what they remembered and liked about the murals. In particular, visual elements such as animals, plants, and landscape accounted for the largest category of remembered mural components, while visual elements were also the most frequently reported aspects that children liked. The eye-tracking study therefore strengthens the overall research component of Healing Nature by adding a behavioural measure of visual engagement to the self-reported questionnaire data. Rather than relying exclusively on what participants say they noticed or liked, the study also demonstrates how gaze was distributed while the murals were being viewed. The results support the relevance of visual composition and the strategic placement of engaging elements within nature-based murals. At the same time, eye tracking measures attention and should therefore be considered alongside the emotional, perceptual, and qualitative findings of the wider Healing Nature research when interpreting the potential contribution of the murals to more engaging and supportive hospital environments. 7. Limitations and data-quality considerations

Several methodological considerations should be taken into account when interpreting the findings. First, the final eye-tracking sample

consisted of 30 participants, with a predominantly female composition (26 female and 4 male participants). The participants were aged 19–41 years, with a mean age of 23, meaning that the eye-tracking sample was not composed of the children and adolescents who are the primary target group of the Healing Nature hospital intervention. Second, the murals were presented as digitised images for 10 seconds each. Consequently, the eye-tracking task examined visual attention to representations of the murals rather than gaze behaviour in the actual hospital environments. Third, TTFF analyses were based on smaller subsets of participants with valid data for all relevant AOIs. For the Bulgarian mural, 21 participants had valid TTFF data for all seven AOIs; for the Portuguese mural, 17 participants had valid data for all eight AOIs. For the Croatian mural, only five AOIs had sufficient valid data, with 17 participants included in the corresponding analysis. Finally, visual attention should not be equated directly with positive emotional impact. Longer fixation duration or earlier fixation indicates patterns of visual attention, but does not by itself establish that an element was perceived as more beautiful, calming, entertaining, or beneficial. The strongest interpretation therefore comes from considering the eye-tracking findings together

with the Impact Survey and the broader qualitative responses collected within the Healing Nature research.

IMPACT SURVEY RESEARCH FINDINGS AND ANALYSIS 64

Ana Beato, PhD

Project Team: Ana Beato, Ana Loureiro, Bernardo Cruz, Isabel Santos User testing at the Research Centre for Biosciences and Health Technologies CBIOS facilitated by Ana Sofia Fernandes and Nuno Saraiva.

1. Healing Nature: project context Healing Nature incorporates the power of images of nature as reassuring environmental elements into hospital spaces, using art, animation, and augmented reality (AR) to support health and well-being. The project responds to the limited presence of contemporary interactive art and animation in children’s hospital waiting areas. Its central aim is to create welcoming, calming, and engaging environments in which children are not only passive viewers but are encouraged to explore, imagine, and interact with the space. The project combines handmade or printed murals with animated digital elements activated through AR. This creates a layered, screenless interactive experience that brings real-world visual elements and animation together. The project also includes workshops with children, whose creative contributions can inform or become part of the artworks, thereby linking artistic production, participation, technology, and social inclusion. Healing Nature includes three murals and three AR experiences in paediatric hospital settings in Croatia, Bulgaria, and Portugal, six workshops with children, a research study evaluating the impact of the interventions, a digital booklet presenting the results, and dissemination activities including press conferences.

2. Research rationale and continuity with previous work The research component of Healing Nature was informed by the methodological experience of previous mural-based projects, including the Colours of Reality project in Croatia. In Colours of Reality, the research examined perceptions of institutional spaces before and after artistic interventions, with questionnaires for users and staff and a combination of descriptive analysis and chi-square testing. The reported findings indicated a more positive perception of the environment after mural implementation, together with perceived benefits for comfort, atmosphere, and stress. Healing Nature adapts this general pre–post logic to a paediatric healthcare context. Rather than focusing on prison environments, the present study examines children’s and accompanying adults’ experiences of hospital waiting areas, with particular attention to emotional states, perceptions of the physical environment, and reactions to nature-based murals and AR animation. This continuity is important because the value of the intervention is considered not only in aesthetic terms, but also in relation to how people experience the space. The Healing Nature study, therefore, places emotional experience and environmental perception at the centre of the evaluation.

3. Research aim The research aims to understand whether contact with nature through art, animation, and digital interaction can contribute to more positive, engaging, and emotionally supportive hospital settings. More specifically, it examines children’s emotional experiences, perceptions of waiting-room environments, and their responses to the murals and AR experiences, alongside parents’ and caregivers’ perceptions of the intervention. 4. Participants and procedure Participants were children and adolescents aged 4-17 years attending the participating paediatric hospitals, together with one accompanying parent or caregiver. The overall sample pool comprised approximately 300 participants recruited in hospital waiting rooms. The study used a multicentre pre–post intervention design involving paediatric hospitals in Portugal, Croatia, and Bulgaria. Three waiting areas in each participating hospital were evaluated, with each area receiving a different nature-based mural with AR animation. Baseline assessment was conducted before mural installation, while the post-intervention assessment was conducted approximately three months after installation, allowing the evaluation to include both immediate perceptions of the inter-

vention and users’ experiences after a period of exposure. Four questionnaires were developed: a baseline questionnaire for children, a baseline questionnaire for parents/caregivers, a post-intervention questionnaire for children, and a post-intervention questionnaire for parents/caregivers. The questionnaires were translated into Portuguese, Croatian, and Bulgarian. They covered perceptions of the hospital environment, children’s responses to the murals and AR experiences, parents’ perceptions of children’s emotional states, and sociodemographic information. 5. Data processing and interpretation

The available results document presents quantitative and qualitative information, including descriptive comparisons between the baseline and post-intervention stages and comparisons across countries. SPSS for Windows v27 is identified as the statistical software used. However, the current results document does not report the chi-square statistics, degrees of freedom, or p-values. Accordingly, the findings below are presented as descriptive patterns rather than as evidence of statistically significant change. A further reporting point concerns the denominators of the categorical response graphs. Several graphs present numbers of respons-

es rather than percentages, and the available document does not consistently state whether categories were mutually exclusive or whether participants could provide more than one response. The interpretations, therefore, retain the original response counts and percentages shown in the graphs and avoid converting them into unsupported population estimates. 6. Results 6.1 General emotional experience and perception of the waiting environment Parents’ reported boredom was lower after the intervention than at baseline, indicating a descriptive reduction in boredom during the waiting experience. Following the intervention, parents tended to describe the wait-

ing environment as warmer, brighter, and more colourful. At the same time, perceptions of the space as dark and empty decreased. The perception of the space as small also showed a slight decrease. Overall, the pattern points towards a more positively characterised physical environment after the intervention. Children’s responses show a positive descriptive shift: feeling entertained increased, while frightened, bored, and anxious responses decreased after the intervention. This pattern is consistent with the project’s objective of providing positive distraction and reducing negative emotional experiences during waiting. Children also perceived the waiting environment more positively after the intervention. Ratings associated with the space being warm, bright, and colourful increased, where-

Boredom

Before

After

1,5

Graph 1. Parents’ boredom before and after the intervention.

2,5

Warm

Bright

Colourful

Dark

Empty

Small

1,5

2 Before

2,5

After

Graph 2. Parents’ perceptions of the waiting-room environment before and after the intervention.

Entertained

Frightened

Bored

Anxious

1,5 Before

2 After

Graph 3. Children’s emotional states before and after the intervention.

2,5

as perceptions of the space as dark and empty decreased. The perception of the space as small also declined slightly.

Cold

Colourful

6.2 Cross-country patterns

Dark

1,5

Before

2,5

After

Graph 4. Children’s perceptions of the waiting-room environment before and after the intervention.

Happy

Frightened

Curious

Distracted

Bored

Sad

Exausted

1,5 Bulgaria

2 Croatia

Portugal

Graph 5. Children’s perceptions of the waiting-room environment by stage.

2,5

This graph is labelled as children’s emotions in the original document, but its variables (cold, colourful, and dark) correspond to perceptions of the physical environment. The descriptive pattern shows a decrease in the perception of the space as cold and dark and an increase in the perception of the space as colourful after the intervention. This graph is labelled as waiting-room perceptions in the original document, but its variables (happy, frightened, curious, distracted, bored, sad, and exhausted) are emotional states. The country profiles differ in magnitude, but the graph shows meaningful variation in children’s emotional experiences across Bulgaria, Croatia, and Portugal. These differences should be interpreted as descriptive because inferential statistics are not reported in the current document. Parents’ emotional profiles varied across countries and between baseline and post-intervention assessment. The country-specific bars indicate that the intervention was experienced differently in the three settings, while the overall results should be read alongside the aggregate de-

crease in boredom. Country-specific results show variation in the magnitude of change, but several positive environmental descriptors-particularly warm, bright, full, and colourful-show higher post-intervention values in the overall pattern. Descriptors such as cold, dark, and empty tend to be lower after the intervention. Children’s emotional responses also show country-specific variation. The graphs suggest that the direction and magnitude of change were not identical across countries, reinforcing the importance of considering local context when interpreting a multicentre environmental intervention. The perception of the physical environment differs across countries, but several positive descriptors - especially bright, full, and colourful - show higher post-intervention values in the displayed profiles. The results, therefore, suggest an overall shift towards a more positively experienced environment, while retaining cross-country heterogeneity.

Warm

Bright

Full

Colourful

Empty Small 1

1,5 Bulgaria

2 Croatia

2,5

Portugal

Graph 6. Children’s emotional states by country.

Parents’ Emotions by Country and Moment 2,5

1.5

Before After Before After Before After Before After Before After Before After Before After Before After Happy

Entertained

Distracted

Bulgaria

Bored

Croatia

Anxious

Portugal

Frightened

Sad

Sign

Graph 7. Parents’ emotional states by country and assessment stage.

Overwhelmed

Parents’ Emotions by Country and Moment 3

2,5

1.5

1 Before After

Before After

Warm

Bright

Full

Big

Colourful

Cold

Dark

Empty

Small

Bulgaria

Croatia

Portugal

Sign

Graph 8. Parents’ perceptions of the physical space by country and assessment stage. Children’s Emotions by Country and Moment 3

2,5

1.5

1 Before After

Before After

Happy

Entertained

Distracted

Bored

Anxious

Frightened

Sad

Overwhelmed

Croatia

Portugal

Sign

Bulgaria

Graph 9. Children’s emotional states by country and assessment stage.

Children’s Perception of the Space by country and Moment 3

2,5

1.5

1 Before After

Before After

Warm

Bright

Full

Big

Colourful

Cold

Dark

Empty

Small

Bulgaria

Croatia

Portugal

Sign

Graph 10. Children’s perceptions of the physical space by country and assessment stage.

Children’s Perception of the Hospital Spaces Before the Mural

6.3 Children’s direct responses to the mural

14 Number of children

Before the mural, the most frequent responses were the absence of entertainment (15 responses) and negative perceptions of the space, including references to it being small, noisy, crowded, or old (15 responses). A further 11 responses identified a need for space decoration through colours or pictures. Only 9 responses reflected a positive perception of the space. After the mural, positive perceptions of the mural were the dominant response, with 36 children describing it positively, particularly as

10 8 6

2 0 Entertainment missing (toys, games)

Negative Need for space perception of decoration the space (smell, (colours, pictures) noise, crowded, old)

Positive perception of the space

Small comments

Graph 11. Children’s perception of the hospital spaces before the mural.

Other

Children’s Perception of the Hospital Spaces After the Mural 40

35 Number of children

interesting or distracting. Negative perceptions of the mural were reported by 12 children. Five children asked for more distractions, such as pictures or colours, while five mentioned complaints concerning staff or infrastructure; eight responses were classified as other. The most common association with nature pictures concerned their appearance: 37.4% of responses described them as beautiful or colourful. A further 25.3% referred to stimulation, such as being interesting, realistic, or prompting memories. Emotional associations, such as calming or distracting, accounted for 17.6%, while 14.3% represented general liking. Suggestions and other responses were comparatively uncommon (3.3% and 2.2%, respectively).

30 25 20 15

5 0

Positive perception Negative perception Need for more Hospital complaints of the mural of the mural (anxious, decorations (colours, (staff, infrastructure) (interesting, bored) pictures) distracting)

Other

Graph 12. Children’s perception of the hospital spaces after the mural.

Children’s thoughts of the nature pictures on the wall

3.30%

2.20%

•

Appearance (beautiful, colourful)

•

Perceived stimulation (interesting, memories, realistic)

•

Emotional association (calming, distracting)

•

General liking

•

Suggestions

14.30%

37.40% 17.60%

25,30%

Graph 13. Children’s thoughts about the nature pictures on the wall.

Half of the responses (50%) linked the mural to nature through natural elements such as animals, plants, and colours. Perceived qualities of the images - including detail, realism, and immersion - accounted for 17.6%, while 11.8% referred to memory stimulation. Cartoon or media references represented 5.9%, with 14.7% classified as other. Visual elements such as animals, plants, and landscape were the most frequently remembered component (35%). Interactivity and perceived associations each accounted for 19%, while general positive perceptions represented 14.3%. Other responses accounted for 12.7%. Visual elements were the most liked component (32.6%). Interactivity and general positive perceptions each accounted for 19%. Associations represented 11.6%, layout characteristics such as size, detail, and realism 10.5%, and other responses 7.4%. A strong majority of responses (70%) indicated that children did not dislike anything about the intervention. Contextual issues such as noise, positioning, or visibility accounted for 11.6%, technical issues such as the animation being too short or fading quickly for 9.3%, and content-related issues for 7%. Other responses accounted for 2.3%. The largest category concerned mural content (24%), including references to animals, flowers, water, and other creatures. This was followed

In what way children associate the pictures on the wall with nature

14.70% 5.90%

•

Natural elements (animals, plants, colours)

•

Perceived quality (details, realism, immersion)

•

Memory stimulation (personal, moment or place)

•

Cartoon or media reference

•

Other

50% 11.80%

17.60%

Graph 14. Children’s associations between the mural and nature.

Which part children remember the most

•

Visual elements (animals, plants, landscape)

•

Interactivity (movements)

•

Perceived associations (memories, family, cartoons)

•

General positive perceptions (interest, fun)

•

Other

12.70%

14.30%

35%

19% 19%

Graph 15. Part of the mural that children remember most.

Which part children like the most about the pictures

7.40% •

Visual elements (animals, plants, landscape)

•

Interactivity (movements)

•

General positiv perceptions (interest, fun)

•

Associations (memories, family)

•

Layout (size, details, realism)

10.50%

11.60%

32.60%

19%

Graph 16. Part that children liked most about the pictures.

Was there anything children didn’t like

2.30%

7% 9.30%

11.60% 70%

•

Nothing

•

Contextual issue (noise, positioning, visibility)

•

Technical issues (too short, fades quickly)

•

Content issue (boring, strange, more variety)

•

Other

Graph 17. Was there anything children did not like?

by children who indicated that they would change nothing (23%), requests for greater interactivity, such as sound or increased realism (18.3%), unrelated requests (16.9%), suggestions to expand the mural to other locations (12.7%), and ‘don’t know’ responses (5.6%). Overall, these responses suggest that while many children were satisfied with the mural as it was, others expressed interest in enriching the experience through additional content, greater interactivity, or expansion to other spaces.

What would children change on the mural

5.60%

12.70%

24%

16.90%

•

Content (animals, flowers, water, creatures)

•

Nothing

•

Interactivity (sound, realism)

•

Unrelated requests (bring home, paint themselves)

•

Expansion (mural locations)

•

Don’t know

23%

18.30%

6.4 Parents’ direct responses to the mural

Graph 18. What would children change on the mural?

Parents’ Perceptions of the Hospital Spaces Before the Mural

30 Number of parents

Before the mural, negative perceptions of the hospital spaces were the most frequent category, with 28 responses referring to noise, discomfort, or darkness. Positive perceptions of comfort or cleanliness accounted for 13 responses. Entertainment was reported as missing in 8 responses, while information and staff/waiting-time issues accounted for 7. Satisfaction and other responses were less frequent. After the mural, 16 responses remained negative, primarily referring to crowding. Eight responses expressed a positive perception of the mural. One response identified a need for additional murals, and one was classified as other. The results suggest that the mural was positively noticed, although broader characteristics of the hospital environment - particular-

25 20 13

Satisfaction

Other

0 Negative perception of the spaces (noisy, discomfort, dark)

Positive perception (comfort, cleanliness)

Entertainment missing (toys, games)

Information and staff (waiting time)

Graph 19. Parents’ perception of the hospital spaces before the mural.

Parents’ Perceptions of the Hospital Spaces After the Mural 18 16

Number of parents

14 12 10

8 6 4

Need for expansion (murals)

Other

2 0 Negative perception of the spaces (crowding)

Positive perception of the mural

Graph 20. Parents’ perception of the hospital spaces after the mural.

Parents’ Suggestions to improve hospital Spaces Before the Mural 35

Number of parents

25 20 15

5 0 Entertainmet missing (toys, games)

Better spaces and infrastructures

Space decoration

General satisfaction

Other

Graph 21. Parents’ suggestions for improving hospital spaces before the mural.

ly crowding - continued to shape parents’ perceptions. Before the mural, parents most frequently identified missing entertainment such as toys and games (30 responses) and the need for better spaces and infrastructure (28). Space decoration was mentioned in 11 responses, while 7 expressed general satisfaction and 3 were classified as other. These responses indicate that parents’ expectations extended beyond visual decoration to broader environmental and functional improvements. After the mural, negative perceptions of the remaining hospital environment were still the most frequent category (27 responses). Positive perceptions of the mural accounted for 18 responses, while 14 responses requested greater interactivity, such as music or games. A further 11 responses suggested expanding murals to other areas, and 1 response was classified as other. The findings indicate that the intervention was positively received but also generated expectations for broader and more interactive improvements.

Parents’ Suggestions to improve hospital Spaces After the Mural

Number of parents

7. Integrated interpretation of the findings

10 5

0 Negative perception (spaces)

Positive perception of the mural

Interactivity (music, games)

Need for expansion (murals)

Other

Graph 22. Parents’ suggestions for improving hospital spaces after the mural.

Taken together, the descriptive results point towards a more positive experience of the hospital waiting environment after the Healing Nature intervention. For children, the clearest pattern is the combination of increased entertainment with reductions in frightened, bored and anxious responses, alongside a perception of the space as warmer, brighter and more colourful. Children’s direct responses further indicate that the mural was experienced primarily through its visual qualities, its capacity to stimulate interest and its association with nature. The intervention was also positively reflected in parents’ perceptions. Parents described the environment more often in positive sensory terms after the intervention, including as warmer, brighter and more colourful, while perceptions of darkness and emptiness decreased. At the same time, parents continued to identify structural and functional aspects of hospital environments - particularly crowding, infrastructure, entertainment, and waiting conditions - as areas requiring attention. The qualitative and categorical responses strengthen this interpretation. Before implementation, children and parents frequently described a lack of entertainment and negative features of the waiting environment. After implementation, the

mural itself became a prominent positive feature, with children particularly valuing visual elements and most children reporting that there was nothing they disliked. The results also suggest that visual intervention can be a starting point for further engagement: requests for sound, games, greater interactivity and additional murals indicate an appetite for extending the experience beyond static decoration. Cross-country graphs show that the magnitude of these patterns is not identical across Portugal, Croatia and Bulgaria. This heterogeneity is important and should not be interpreted as inconsistency: the intervention was implemented in different hospital settings and cultural contexts. The current report supports describing these differences, but it does not provide sufficient inferential statistics to determine whether country differences or pre–post changes are statistically significant. 8. Conclusions

The Healing Nature research provides preliminary descriptive evidence that nature-based murals combined with interactive AR animation can contribute to a more engaging and positively perceived waiting-room experience for children and accompanying adults. The findings are aligned with the project’s core objectives of improving the aesthetic quality of hospital environments, providing positive distraction,

stimulating imagination and engagement, and exploring the potential contribution of moving images and interactive art to well-being. The results also underline that artistic interventions should be understood as one component of a broader child-friendly healthcare environment. Parents’ responses show that decoration does not replace the need for adequate space, infrastructure, information, entertainment and comfortable waiting conditions. The strongest implication is therefore not simply that murals improve a room, but that carefully designed visual and interactive environments may become meaningful elements within a wider strategy for making paediatric healthcare settings more welcoming and emotionally supportive. 9. Limitations and data-quality considerations • The data-processing description has been aligned with the Healing Nature paediatric hospital study. • The available document does not report chi-square statistics or p-values. Therefore, this report deliberately uses descriptive language such as ‘increase’, ‘decrease’, ‘pattern’ and ‘suggests’, rather than claiming statistically significant effects. • If available, the final consortium version should report the exact sample

size at each assessment point, missing-data information, response denominators for categorical graphs, and inferential test results.

Project Dissemination 81

First Press Conference in Sofia, Bulgaria 27.05.2026

Press Conference in Zagreb, Croatia 15.06.2026

Press Conference in Lisbon, Portugal 17.07.2026

Second Press Conference in Sofia, Bulgaria 19.10.2026

IMPRESSUM

PROJECT IMPRESSUM Project Lead: Croatian Association of Fine Artists (HDLU) Project Partners: New Bulgarian University (NBU), Lusófona University Project Creative Director: Melinda Šefčić Animation Creative Director: Lea Vidaković

CROATIAN ASSOCIATION OF FINE ARTISTS (HDLU)

Accounting: Vlatka Ružić

Mural Artist: Melinda Šefčić

Project Assistant: Miran Jurić

Partners: Zagreb Children´s Hospital, Sestre milosrdnice University Hospital Center – Department of Pediatric Oncology and Hematology “Dr. Mladen Ćepulić” – leased by the Zagreb Children’s Hospital

Public Relations: Martina Miholić

Web Design: Gerilla Agency

Partners in the Implementation of Children’s Workshops: SOS Children’s Village Lekenik, House of St. Francis – Caritas of the Archdiocese of Zagreb in Vugrovec, Ivan Gundulić Primary School, Krijesnice Kindergarten

Project video: Petra Blašković, Matea Kovač, Zlatko Zlatković

Storyboard, Stop motion Animation and Puppets: Lea Vidaković

Project Visual Identity: Duje Medić

Technician: Sven Jozić Video: Zlatko Zlatković Photography: Juraj Vuglač Special thanks to our Hospital partners, the patients, nurses and doctors that took part in our events, and in particular to Anita Znaor, dipl. med. techn., the Director of Nursing

LUSÓFONA UNIVERSITY Animators: Katrin Novaković, João Miguel Real Lighting: Ricardo Mata Augmented Reality (AR): Matea Kovač

Project Coordinator: Nika Šimičić

Lisbon Principal Investigator and Artistic Director: Natalie Woolf Mural Design and Production: Ana Cortes, Daniela Tietzen, Natalie Woolf supported by Carolina Torres, Maria Feitinha and Daniela Salvador Hospital Partner: ULS São José - Hospital Dona Estefânia

Workshop Team: Hugo Barata, João Cabral, Natalie Woolf, assisted by Paulo Diogo Simão, and Jessica Fraude. Animation Director: Pedro Serrazina Production Director and Assistant Animation Director: Catarina Calvinho Gil Animators: Ana Cortes, Daniela Tietzen, Paulo Diogo Simão Social Media and AR Manager: Paulo Diogo Simão Psychology Research Team (Impact surveys): Ana Beato, Ana Loureiro, Bernardo Cruz, Isabel Santos. Pilot Project user group testing and Waiting Space Impact Survey Study. User testing at the Research Centre for Biosciences and Health Technologies CBIOS facilitated by Ana Sofia Fernandes and Nuno Saraiva. Project Coordinator: Inês Castaño Public Relations: Francisco Assis 91

Photography, Video Recording/Editing:

Zlatko Zlatkovic, Paulo Diogo Simão, Pedro Serrazina.

Expert Kid’s Workshops: Ekaterina Todorova

Special thanks to our Hospital partners at Hospital Dona Estefânia, the patients, nurses and doctors that took part in our events, and in particular to Ana Oliveira HDE Deputy Director of Nursing.

Partners in Implementation of Children’s Workshops: Milena Neyova “Hug Me” Gallery, Boryana Murgina “Winnie the Pooh” Speech Therapy and Educational Center”

NEW BULGARIAN UNIVERSITY (NBU) Artistic Director: Vessela Dantcheva – Bogdanova Mural Artist: Lydia Tsvetkova Collaborators in the Realization of the Mural artwork: Evgenia Stoitseva Bulgaria Project Partners: New Bulgarian University, National Culture Fund, Monika Nikolova, ISUL “Queen Joanna” University Hospital, Sofia Animation and AR Director: Sevina Ivanova Animaton, Design and AR Team: Evgeniya Stoitseva, Daria Ruseva, Nelina Petkova, Boryana Angelova, Lyudmil Vasilev and Lydia Tsvetkova

Additional Experts on Design and Animation: Ivaylo Saraliyski, Ivan Bogdanov Expert on mural adaptation: Iliya Kozhuharov Expert Eye Tracking Research: Evgeniya Hristova Project Coordinator: Vessela Dantcheva – Bogdanova Administrative Coordinator: Liliya Kolova Designer: Filip Rashev Photography, Video Recording: Yosif Kokonchev, Kosio Hadgigenchev Accounting: Vera Mitova, Diana Krustanova PR and Marketing: Elena Gurova, Dessislava Boshnakova, Desislava Dankova

PUBLICATION CREDITS Publisher: Croatian Association of Fine Artists (HDLU), Trg žrtava fašizma 16, 10000 Zagreb, Croatia, hdlu@hdlu.hr, www.hdlu.hr For the Publisher: Ida Blažičko, President of HDLU

Text Authors: Ana Beato, Vessela Dantcheva, Evgeniya Hristova Sevina Ivanova, Melinda Šefčić, Lea Vidaković, Natalie Woolf

Director: Ivana Andabaka Vujičić

Design: Duje Medić

Supported by:

Partners:

Editors: Nika Šimičić, Melinda Šefčić, Lea Vidaković

ISBN: 978-953-8098-76-5 The CIP record is available in the online catalogue of the National and University Library in Zagreb under record: 991006071236409366 Zagreb, 2026

Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them. Project No. 101173267 The views expressed in this publication are the sole responsibility of the Croatian Association of Fine Artists (HDLU) and do not necessarily reflect the views of the Government Office for Cooperation with NGOs of the Republic of Croatia.