Abstract
Background: Office workers have been identified as being at risk of accumulating high amounts of sedentary time in prolonged events during work hours, which has been associated with increased risk of a number of long-term health conditions. There is some evidence that providing advice to stand at regular intervals during the working day, and using computer-based prompts, can reduce sedentary behaviour in office workers. However, evidence of effectiveness, feasibility, and acceptability for these types of intervention is currently limited. Little is also understood regarding behaviour change theories applicable to occupational sedentary behaviour, and how such theory could inform intervention development and implementation.The aims of this thesis were to develop and test a low-cost education and prompt intervention to reduce and break up the sedentary behaviour of office workers, and to explore whether existing behaviour change theory can explain sedentary behaviour in the workplace.
Methods: The Medical Research Council’s framework for design and evaluation of complex interventions, was used as a basis for developing the intervention which was initially tested in a 2-arm, parallel group, cluster-randomised feasibility trial with office workers in a commercial bank (n=21). Participants were assigned to a control or intervention group. Both groups received education on reducing and breaking up sitting at work, and the intervention group also received hourly prompts, delivered by Microsoft Outlook over a period of 10 weeks, reminding them to stand. Objective measurements of sedentary behaviour were made using activPAL monitors worn at 3 measurement points: baseline; in the last 2 weeks of the intervention period, and 12 weeks after the intervention. Focus groups were conducted to explore the acceptability of the intervention and the motivations and barriers to changing sedentary behaviour.
The education and prompt intervention was subsequently tested in a pilot study of office workers in a large pharmaceutical company (n= 29). In order to address some of the limitations of the feasibility study, the method used in the pilot study was altered slightly to include: minimising information given on study aims prior to baseline; incorporating feedback on baseline activity into the education session; non-clustering of participants; an additional measurement period during the first 2 weeks of the intervention; measures of stage of change and the constructs of social cognitive theory.
Results: The feasibility study demonstrated that randomly generated, customised prompts, delivered by Microsoft Outlook, with messages about breaking up sitting, were a feasible and acceptable way of delivering prompts to office workers. Small, short-term reductions from baseline levels were made to sedentary behaviour outcomes, which were not maintained at follow-up, in participants from both the intervention and control groups. Similar results were obtained in the pilot study, with reductions in sedentary behaviour outcomes in both groups made early in the intervention period not being maintained by late intervention measurement, or at follow up. Analysis of time taken to stand following delivery of a prompt, in both studies, suggested the intervention groups did not react immediately to prompts, and any increase in standing was made at unrelated times.
Five key constructs, in line with Social Cognitive Theory, surrounding motivation for sedentary behaviour at work, were identified: i) situation/environment, ii) outcome expectations, iii) self-efficacy, iv) self-regulation, v) observational learning. The education session seemed to increase outcome expectations of the benefits of changing sedentary behaviour, and promote self-regulation of behaviour in some participants. However, low self-efficacy and a desire to conform to cultural norms were barriers to changing behaviour. Measures of readiness to change sedentary behaviour at work increased in both groups in the pilot study.
Conclusions: Prompts delivered by Microsoft Outlook were a feasible, low cost way of prompting office workers to break up their sedentary behaviour, although further research is needed to determine whether this has an additional impact on sedentary behaviour, to education alone. Social Cognitive Theory provides a useful framework for understanding the barriers and facilitators that influence occupational sedentary behaviour. Future research would benefit from developing this further to include the influence of social and cultural norms, and perceived behavioural control in order to develop a theoretical underpinning for the design and implementation of interventions to improve sedentary behaviour patterns in the workplace.
| Date of Award | 2017 |
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| Original language | English |
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| Supervisor | Philippa Dall (Supervisor), Margaret Grant (Supervisor) & Maggie Lawrence (Supervisor) |