Measure, monitor, and reduce sitting time in the workplace

Occupational sedentary behaviour is a growing health concern with occupational sitting accounting for almost half of overall sedentary behaviour. Workers undertaking jobs that require minimal standing or physical activity are at higher risk of accumulating larger amounts of sedentary behaviour compared to blue-collar workers, which highlights the need to reduce sedentary behaviour in predominantly desk-based roles. The explicit use of theoretical frameworks to guide sedentary behaviour change interventions is limited; additionally, followup of multi-component sedentary behaviour interventions is rare thus producing a gap in sedentary behaviour research. A mixed-method embedded intervention design was implemented in order to investigate occupational sedentary behaviour. The first aspect of the thesis was to explore the perceptions of office-based workers prior to a sedentary behaviour change intervention (Chapter 2 & Chapter 3). Based on the initial findings, qualitative and quantitative data were collected to explore the outcomes of a low-cost, multi-component, theory-informed, individually-tailored, six week intervention to reduce occupational sitting time (Chapter 4). Finally, a six month follow-up including quantitative and qualitative data were incorporated to evaluate the long-term effectiveness of the intervention (Chapter 5). The first study (Chapter 2) aimed to explore office workers' perceptions of sedentary behaviour, identify potential behavioural strategies to reduce sedentary behaviour in the workplace, and identify barriers which may hamper behaviour change. Office-based workers from a higher education institution were recruited for the study. The perceptions were explored via an online survey and focus groups which were thematically analysed. One hundred and forty office workers were recruited and surveyed from the same workplace. Following the survey, 12 employees also participated in focus groups. One hundred employees perceived a negative association between sitting time and their health. The most prominent theme identified was musculoskeletal complaints, followed by poor general health, and weight gain. The focus groups identified that interventions (behaviour change strategies) targeting reducing sitting time should include education, supportive and knowledgeable managers. These behaviour change strategies should all be offered to address individual preferences and barriers. The second study (Chapter 3) aimed to explore the perceptions of office-based workers who have successfully modified their occupational sedentary behaviour without a formal intervention. In particular, the study explored the employees' stage of change, strategies used to reduce sedentary behaviour in the workplace, and barriers, which prevented behaviour change from occurring. A qualitative in-depth interview design was used for this study. Participants who regularly undertook office-based tasks during work hours were recruited from a higher education institution. Participants were invited to participate in a semi-structured interview if they currently self-identified as modifying their occupational sedentary behaviour in any way. The interviews were audio recorded, transcribed verbatim and were thematically analysed to identify key themes. Nine participants volunteered for the study and all participants were in the action or maintenance stage of the Transtheoretical Model with two recent replases. A variety of strategies were used by the participants to reduce occupational sedentary behaviour such as having access to a sit-to-stand workstation, developing specific strategies around how the workstation was used, purposeful walking, and peer and managerial support. The participants identified barriers to success such as soreness, fatigue and illness; attending seated meetings, not enough desk space when using the workstation, and the need to be seated to complete work tasks which required high levels of concentration. Following study one and study two, the key findings suggested there was a negative perception regarding sitting time and health, indicating that increased sitting time was a problematic behaviour. Additionally, employees suggested that barriers were likely to occur when attempting to change sedentary behaviour and that a variety of strategies would be useful to reduce these barriers, thus changing occupational sedentary behaviour. This exploratory phase of the research informed the design and implementation of the intervention. The third study (Chapter 4) aimed to evaluate the effectiveness of a low-cost, theoryinformed, multi-component, individually-tailored, six week intervention for the reduction of occupational sedentary behaviour of office workers. Full-time office-based workers from a higher education institution were invited to participate in the study. Participants were asked to complete the online survey from study one to explore their perception of sedentary behaviour. Following this, pre-intervention behaviour patterns were collected for five days via an ActivPAL™ activity monitoring device and a self-report workbook. The Theory of Planned Behaviour (TPB), the Transtheoretical Model (TTM), and the Social Cognitive Theory (SCT) guided the development and implementation of the intervention. The first stage of the intervention included a face-to-face meeting between the participant and the investigator to discuss information identified from the online survey including the key themes, which were negatively associated with sitting time and health, and the individual ActivPAL™ and selfreport data, which relates to consciousness raising of the TTM, self-reflection and selfregulation of the SCT. During this meeting, participants set goals for the six week intervention, signed a commitment contract, and were asked about their stage of change and their selfefficacy to change behaviour which relates to self-regulation of the SCT, self-liberation of the TTM, and perceived behavioural control of the TPB. Participants were provided with another self-report workbook which included their goals for the six week intervention which relates to the self-regulation of the SCT. Participants received a weekly follow up from the investigator, which relates to verbal persuasion of the SCT, and helping relationships of the TTM. During the final week of the intervention, participants wore an ActivPAL™ and were invited to participate in a follow-up semi-structured interview. Open-ended responses from the online survey, the individual weekly goals, and the post intervention interviews were transcribed verbatim and were thematically analysed. Pre and post intervention ActivPAL™ data, selfreported workbook sitting time and self-efficacy were analysed via paired samples t-tests. Forty-nine participants volunteered for the study however 27 office-based workers had sufficient data to be included in the analysis. Occupational sitting time was reduced by an average of 45.2 ± 60.7 min/work day (p = .001) based on ActivPAL™ data. Self-efficacy towards goal achievement increased post intervention (pre: 69 ± 21%; post: 82 ± 16%; p = .002). The follow-up interviews indicated that the intervention increased awareness of occupational sedentary behaviour and identified the key behaviour change strategies utilised in the intervention. The fourth study (Chapter 5) aimed to explore participant experiences six months post intervention to evaluate the long-term effectiveness of the intervention. Participants who completed the intervention were contacted via email and invited to participate in a six month follow-up data collection phase. Participants were provided with an ActivPAL™ and instructed to wear it for five days during work hours. Following the ActivPAL™ data collection, participants were invited to complete a semi-structured interview conducted by the principal investigator which explored successful behaviour change strategies, barriers to changing sedentary behaviour, self-efficacy towards goal achievement, and stage of change in relation to current sedentary behaviour patterns. The open-ended responses from the follow up interviews were transcribed verbatim and were thematically analysed. The six month follow up ActivPAL™ and self-efficacy data were compared to the pre-and post-intervention data and analysed via paired samples t-tests. A total of 25 out of 27 eligible participants volunteered to participate in the follow up study. Occupational sitting time was reduced by an average of 40.6 ± 76.1 min/work day (p = .018) based on ActivPAL™ data for 23 participants who had sufficient data. Twenty-three participants indicated that they had continued with their occupational sedentary behaviour change in some form. Self-efficacy towards goal achievement remained high at the six month follow-up (post: 83 ± 15%; six month: 81 ± 19%). The most prominent goal identified by the participants to reduce occupational sedentary behaviour was walking. This included walking at lunchtime, walking to visit colleagues, and walking further to the bathroom, to fill their water bottle, or to empty their rubbish. The reduction in occupational sitting time was likely the result of the multi-component and individually-tailored aspects of the intervention which matched the level of willingness of the participants. Including participants in the planning stages may have enhanced their perceived behavioural control over their own sedentary behaviour change. The participants identified that attending seated meetings, perceived workloads or work tasks, and work environments were the key barriers to reducing occupational sitting time. To overcome some of these barriers, a variety of strategies were suggested including changing the work environment by installing sit-to-stand workstations or creating a standing space, and providing prompts by installing computer software, having campaigns or competitions especially with the support from management. At the six month follow-up, 13 participants were in the action stage of change as they continued to work towards their goals. Seven participants had moved to the maintenance stage as they indicated that they were able to successfully reduce their occupational sedentary behaviour for six months or longer. Five participants had relapses and returned to the contemplation or preparation stages as they were not regularly attempting to change their behaviour. In conclusion, the theory-informed, low-cost, individually-tailored, multi-component six week intervention resulted in reduced occupational sedentary behaviour, increased awareness of sedentary behaviours and an increase in self-efficacy to change sedentary behaviour patterns. As expected, there were barriers identified by the participants, which included long or numerous meetings, increased workloads, and poorly planned workstations. These barriers are the likely cause of the relapses identified during the interviews. The findings of the current study suggest short-term sedentary behaviour change is possible with appropriate theory-informed strategies, and further research could explore strategies to overcome barriers which may impact long-term adherence to sedentary behaviour change