Background
Theoretical framework underpinning the intervention design
Method
Step 1: define the problem in behavioural terms
Step 2: select the target behaviour
Step 3: specify the target behaviour
Step 4: identify what needs to change
Step 5 and 6: identify intervention functions and policy categories
Step 7 and 8: identify behaviour change techniques and mode of delivery
Results
Demographics of interview participants
Step 4: identifying what needs to change
Capability
“I’m quite capable and confident of breaking up my sitting time. I do that quite a lot … .” (Participant 15, female, in their 20’s).
With respect to psychological capability, all participants stated that it was important to understand how much sitting is acceptable or excessive, as well as the consequences of prolonged sitting and any benefits of breaking up sitting time. This highlighted knowledge and skills as important TDF domains that should be targeted in an intervention:“I’m sat down to help me improve my back muscles because standing or walking for too long can be detrimental for me” (Participant 24, female, in their 40’s).
Most of the participants reported being engrossed in their work to meet tight deadlines, and this usually leads to them forgetting to take breaks from sitting. However, some participants believed that having a device or an app to remind them would help them to be more conscious, reflecting the TDF domain memory, attention and decision processes. In contrast, some participants said their sitting behaviour would change if they were able to monitor it by themselves, underlining the need for interventions to target the behavioural regulation TDF domain.“If I'm really honest, I don't really know any current advice other than it's not good to sit down for too long … I think it would help if this is properly communicated” (Participant 10, female, in their 40’s).
“It’s just the amount of work, purely the amount of work that’s there. Also, not remembering to, because sometimes you become engrossed in a project, or in a piece of work … , your head is just focused on that piece of work … . It's a case of the workload. Maybe something that flashes up on the computer; that flashes up at me saying: ‘you've been working for this length of time, you know move now’ … .” (Participant 20, male, in their 40’s).
“I think you just forget yourself trying to beat the deadline! Probably if there was something that prompts, like setting an alarm on your phone or receiving a message on your phone to prompt you to move” (Participant 11, female, in their 40’s).
Opportunity
“Again I suppose it would have to come from another person to sort of tell me, that ‘you have got to remember that you need to stand’ I think someone like a fire marshal would get the job done (smiles)” (Participant 2, female, in their 40’s).
However, a popular opportunity amongst the participants was the need for an organisational culture that supports breaking up sitting to reassure employees that they will not be penalised if they stand up or leave their seat for a short while:“If it was a corporate activity, I am more likely to engage with it. If you are on your own, you are less likely to do it. Being encouraged by other people would help a great deal” (Participant 23, female, in their 50’s).
“It's about the whole [organisation] being aware of true key messages, I think it's about promoting positive culture of movement. And that comes through communication, variety of communication strategies, it’s about communicating every opportunity about good practice about healthy movement … . and I guess it's about being given permission” (Participant 19, male, in their 30’s).
Creating the opportunity to influence the TDF domain environmental context and resources if cost was not a concern was highlighted by participants who suggested that a height-adjustable desk would be an important tool that could reduce their sitting in the workplace:“Just knowing that my manager is okay with me getting up every half hour should be enough really. Apart from that, I’m okay but it’s a busy period right now so I have to be on my desk … . I get that, so if my manager is okay with me standing up, going back and forth for two to three minutes then coming back, then it’s fine” (Participant 3, female, in their 20’s).
“I think a raising desk is something that is worth exploring, but I understand that financially that is a huge investment for the [organisation] but there has been a lot of studies into that … . If money was not a problem, you can get raising desks, you can have it raised or seated and I will be happy to try that” (Participant 8, male, in their 30’s).
Motivation
However, laziness and lack of will power was seen as a counter argument that may prevent them from doing so. In response, the participants highlighted they will need to change their mindset for a stronger commitment towards integrating movement and standing into their work life, which corresponds to the intention TDF domain.“On a scale of ‘1’ to ‘10’, with ‘10’ being the most confident; I would say my confidence level [to sit less] is ‘8’” (Participant 16, male, in their 50’s).
Moreover, participants stated that they would respond to set goals if there was an expectation that they would be rewarded at the end, highlighting goals and reinforcement as important TDF domains.“The right mindset! That's what I need to be able to stand up and walk at regular intervals” (Participant 22, female, in their 40’s).
With respect to automatic motivation, the majority of the participants reported mixed perception about the effect of mood on their sitting time. Some participants said mood had no effect on their sitting time, while some thought it did. Either way, emotion appeared to be an important TDF domain that should be targeted.“Well, I'm motivated by having a pound every time I get up, or, or a chocolate every time I get up … It wouldn't necessarily have to be money, it could be a, as I say, a kind of build credits for some sort of treats … ” (Participant 25, female, in their 40’s).
“My job determines my sitting behaviour, but my mood doesn’t – no!” (Participant 10, female, in their 40’s).
Participants who perceived sitting time could be influenced by mood expressed that their optimism and motivation could be improved by having access to empirical evidence regarding the negative consequence of prolonged sitting.“It’s two ways: sometimes when I am happy I tend to be quite chatty, so I move more to talk to people, but when I’m low in mood I can sit all day at my desk or move more keeping to myself” (Participant 6, male, in their 20’s).
Participants also reported that they are likely to overcome the habit of sitting if there was competition among peers or if they were given incentives, underlining reinforcement as an important TDF domain.“Generally, people value research evidence, statistics, so in terms of increasing motivation and hope, informational literature on consequence of excessive sitting I guess will make a difference” (Participant 23, female, in their 50’s ).
“You could develop some sort of challenge type thing. Erm, you know, people like games or competitions or even being given vouchers. People can find that quite motivating from that point of view” (Participant 6, male, in their 20’s).
Steps 5 and 6: identification of intervention functions and policy categories
COM-B Component | TDF | What needs to happen for the target behaviour to occur | Evidence to support the need for change (Quotes from the interviews) | Intervention Functions | Policy Categories | Behaviour Change Techniques (BCTs) |
---|---|---|---|---|---|---|
Psychological Capability | Knowledge | Have access to empirical evidence that supports breaking up sitting time | “Personally, I think I base my decisions on evidence, case studies and ‘big shots’. Therefore, the more information we have about how it’s beneficial to people and exactly what has happened, the intervention provided and the exact result” (Participant 24, female, in their 40's) | Education | Communication/Marketing, Guidelines | 9.1 Credible source 5.1 Information about health consequences 5.3 Information about social and environmental consequences |
Have an awareness of the health consequence of excessive sitting | “I think you need to keep spreading the message that sitting for long periods of time actually isn’t good for you” (Participant 18, aged 59) “I think, for me, possibly having a clearer understanding of the damage and negatives” (Participant 6, male, in their 20's) | Education | Communication/Marketing, Guidelines | 5.1 Information about health consequences | ||
Have an awareness of the benefit of breaking up sitting | “I think it’s about … education, I think it’s about those key communication, and the positive, yes negative is important, but actually promoting the positive or focusing on the benefits rather than … ..” (Participant 19, male, in their 30's) | Education | Communication/Marketing, Guidelines | 5.1 Information about health consequences | ||
Have access to feedback about individual health behaviour | “Erm, somebody from occupational health came out to see me, and pointed that I sit kind of wonky at my desk. I think if we have something or someone that tells us our progress, I’m sure everyone would be inclined to adjust” (Participant 9, female in their 30's) | Education | Guidelines | 2.2 Feedback on behaviour | ||
Know other strategies to break up sitting | “Maybe by reducing use of emails a bit more; instead stand up and talk to people rather than email when they are just there” (Participant 11, female in their 40's) | Education | Communication/Marketing | 8.1 Behavioural practice/rehearsal 8.2 Behaviour substitution 8.3 Habit formation 8.4 Habit reversal | ||
Skills | Understand guidelines on sitting in the workplace | “What do the experts say? Erm to be honest with you, I can’t say I have any particular knowledge or guidance to it. I don’t know what the recommendation is (smile) so I can’t answer that …” (Participant 22, female in their 40's) “I’m not aware of any advice that says ‘Don’t sit for longer than X amount” (Participant 21, female in their 50's) | Training | Guidelines | 4.1 Instruction on how to perform the behaviour | |
Memory, Attention & Decision Processes | Improve ability to remember to take breaks from sitting | “Yea I would do a chair that buzzes or causes electric shock; shaking chair that’s got a pressure pad on it so you know if it’s been sat on it for a long time” (Participant 19, male in their 30's) “I think technology can be used for pop-up on peoples’ computer every now and then, reminding them to get up and move or to get up and work once an hour or so” (Participant 8, male, in their 30's) | Environmental restructuring Enablement | Environmental/Social planning | 7.1 Prompts/cues 12.5 Adding objects to the environment 12.1 Restructuring the physical environment | |
Behavioural Regulation | Identify and develop strategies to break existing habits and for self-monitoring of sitting | If I’ve got something that I can look at and I think ‘oh I should be doing that’. The guilt factor always works … I would be willing to try if I know I’m being monitored (Participant 10, female in their 40's) “Getting drinks, getting water. For example, at the moment I do have a bottle on my desk but I’ve actually decided on getting a small cup to allow me stand up as many times as possible...” (Participant 6, male, in their 20's) | Education Enablement | Communication/Marketing, Environmental/Social planning | 2.3 Self-monitoring of behaviour 2.1 Monitoring of behaviour by others without feedback 2.2 Feedback on behaviour 1.2 Problem solving 1.4 Action planning 7.1 Prompts/cues 12.5 Adding objects to the environment | |
Physical Capability | Skills | Have physical strength to move more and sit less | “Erm, if somebody was ill - I’m not personally, but - if somebody was, if they had a bad back or bad legs and it’s difficult for them to walk around on a regular basis, I think they would benefit a lot from getting help from physio and weight training” (Participant 4, female, in their 50's) | Training Enablement | Environmental/Social planning | 12.6 Body changes |
Social Opportunity | Social influences | Have the enablement to make tea by oneself rather than by colleagues | “Because they (colleagues) make my tea for me (laughs). We share the roles, we’ve got rota for making tea, so the four of us that drink tea take turns to get the drink. They are influencing my sitting time because they are making my drinks, so I’m not actually having to get up and do it myself” (Participant 20, male, in their 40's) | Enablement | Environmental / social planning | 6.3 Information about others’ approval 1.2 Problem solving 1.4 Action planning |
Consider creating a team for peer support and comparison | “I would feel uncomfortable doing it on my own, so I just kind of carry on as I am, but I think if we were doing it as a whole, we would not feel alone and can compare what we are doing with our colleagues’” (Participant 10, female, in their 40's) | Enablement | Environmental / social planning | 6.2 Social comparison 12.2 Restructuring the social environment 3.1 Social support (unspecified) | ||
Identify a time keeper to get people moving | “A possibility depends on whether I can get a Fire Marshall that would jump up and say ‘common people, let’s do stretches’. I think there are people in our office who are well placed to do that kind of thing” (Participant 10, female, in their 40's) | Modelling Enablement | Environmental/Social planning | 3.2 Social support (practical) 6.1 Demonstration of the behaviour | ||
Encourage having walking or standing meetings | “Walking meeting would be nice. You know when you’re just walking around, having a meeting instead of sitting in a place” (Participant 13, female, in their 20's) | Enablement | Environmental/Social planning | 8.1 Behavioural practice/rehearsal 8.2 Behaviour substitution 8.3 Habit formation 8.4 Habit reversal 12.2 Restructuring the social environment | ||
Consider stretching or walking for 5 min every hour | “Go for a walk every hour or do the stretching kind of every half an hour for five mins” (Participant 9, female, in their 30's) | Enablement | Environmental/Social planning | 1.1 Goal setting (behaviour) 1.4 Action planning | ||
Encourage senior management to participate in breaking up sitting to ensure support | “I guess a manager would be appropriate person, so that you don’t feel you are doing something you should not do” (Participant 24, female, in their 40's) | Enablement | Environmental/Social planning | 3.1 Social support (unspecified) 12.2 Restructuring the social environment | ||
Organisational support for moving more and sitting less | “I think there can be some sort of support from management or line managers to make sure that, you are not just sitting there continuously … Cultural change at higher level, maybe via a training section, leaflet or booklet that go around or one of those online courses that we normally do - like fire awareness training, health and safety training …” (Participant 7, male, in their 30's) | Enablement | Environmental/social planning | 3.1 Social support (unspecified) 12.2 Restructuring the social environment | ||
Physical Opportunity | Environmental context and Resources | Provision of computer reminder system | “I think technology can be used for pop-up on peoples’ computer every now and then, reminding them to get up and move or to get up and work once an hour or so” (Participant 8, male, in their 30's) | Enablement | Environmental/Social planning | 7.1 Prompts/cues 12.5 Adding objects to the environment |
Provide height-adjustable desks to ensure employees continue working while standing up | “We probably do need our desks to be adjusted …. you know, at the right height. Well, I’m surprised this place doesn’t have them but I have worked in places where, hmm, where we have actually had height-adjustable desks. This place should have them, full stop” (Participant 4, female, in their 50's) | Environmental restructuring | Environmental/Social planning | 12.1 Restructuring the physical environment 12.5 Add object to the environment | ||
Move printers, water dispensers away from employees’ desks | “Moving photocopiers and water dispenser further away … Same with toilet facilities. We’ve got to walk to them! Also, probably getting rid of all the rest of the printers, and we’ve only got one printer to use” (Participant 20, male, in their 40's) | Environmental restructuring | Environmental/Social planning | 12.1 Restructuring the physical environment | ||
Provide treadmill/ stand up chairs or buzzing chairs | “Yeah I would do a chair that goes up and down or a chair that buzzes or causes electric shock; shaking chair that’s got a pressure pad on it so you know if it’s been sat on it for a long time” (Participant 19, male, in their 30's) “Mind you there are some brilliant chairs around, have you seen some of these new chairs, the stand-up ones, they are like rockers, and you’ve got to keep your stability and your muscles working …. ‘cause your legs are permanently keeping you stable and those flexing which are equivalent of walking, but you’re not stood up” (Participant 8, male, in their 30's) | Environmental restructuring | Environmental/Social planning | 12.1 Restructuring the physical environment 12.5 Adding objects to the environment 7.1 Prompts/cues | ||
Access to a standing hot desk | “Yeah, possibly a hot-desking idea might be a good one, switching from my desk to a higher one. Yeah good use for that!” (Participant 13, female, in their 20's) | Environmental restructuring | Environmental/Social planning | 12.1 Restructuring the physical environment 12.5 Adding objects to the environment | ||
Reflective Motivation | Beliefs about Capabilities | Have a strong will and belief you can break up sitting | “Somewhat confident, not massively … I hardly move until lunch break … I could break it up a little more and but not massively” (Participant 8, male, in their 30's) “I am not making any excuse, but it is difficult for me at the moment to see how I can incorporate exercise into my day …” (Participant 18, female, in their 50's) | Education Persuasion | Communication/Marketing | 15.1 Verbal persuasion about capability 15.2 Mental rehearsal of successful performance 1.4 Action planning |
Acknowledge the need for self-discipline | “If you discipline yourself to do something you can do it, if you have willpower ….” (Participant 3, female, in their 20's) | Education Persuasion | Communication/Marketing | 8.3 Habit formation 4.2 Information about antecedents 8.1 Behavioural practice/rehearsal | ||
Goal | Have breaking up sitting goals with an expectation of reward | “Well I’m motivated by having a pound every time I get up, or, or a chocolate every time I get up … It wouldn’t necessarily have to be money, it could be a kind of build credits for some sort of treat or, I don’t know, half an hour of you know” (Participant 25, female, in their 40's) “I think people could become quite motivated if you could develop some sort of challenge thing. Erm, you know, people like games or competitions, people can find motivation from that point of view” (Participant 6, male, in their 20's) | Incentivisation | Communication/Marketing | 1.1 Goal setting (behaviour) 1.2 Problem solving, 1.4 Action planning 10.1 Material incentive (behaviour) 10.2 Material reward (behaviour) 10.3 Non-specific reward 10.4 Social reward 10.5 Social incentive 10.6 Non-specific incentive 10.9 Self-reward | |
Intention | Move from the state of contemplation to commitment to break up sitting | “I just need to prioritize it really. It’s prioritization, you need that reminder” (Participant 13, female, in their 20's) | Education Persuasion | Communication/Marketing | 1.1 Goal setting 1.4 Action Planning | |
Automatic Motivation | Emotion | Discuss the risk involved in prolonged sitting to reduce the influence of mood | “Because I’m low in mood I sit for a long time. Most times, when I leave I’m tired, lethargic, and drained. I think getting up more would just make me better by the end of the day” (Participant 10, female, in their 40's) | Persuasion | Communication/Marketing | 5.6 Information about emotional consequences 11.2 Reduce negative emotions 2.4 Self-monitoring of outcome(s) of behaviour 4.4 Behavioural experiments |
Reinforcement | Develop goals with incentives and reward to encourage employees to break up their sitting time | “Maybe incentives, but I’m not sure what the incentive would be. Whether you do this and you get a bag of apples at the end of the month” (Participant 10, female, in their 40's) | Incentivisation | Communication/Marketing | 10.8 Incentive (outcome) 10.1 Material incentive (behaviour) 10.2 Material reward (behaviour) 10.3 Non-specific reward 10.6 Non-specific incentive |
Step 7: identification of behaviour change techniques
Step 8: mode of delivery
Discussion
BCT code | Behaviour Change Techniques | Recommendations |
---|---|---|
3.1 | Social support (unspecified) | Participants need to be assured that they have the support of their management and colleagues and that they will not be judged or punished for standing or leaving their desk to perform physical activity. This should increase their confidence to embrace the idea of taking breaks from sitting while at work. |
7.1 | Prompts/cues | On-screen computer prompts could be provided to serve as a reminder to take breaks from sitting. |
1.1 | Goal setting (behaviour) | Set a goal for participants to reduce prolonged sitting. |
5.1 | Information about health consequences | Provide information about the health consequences of prolonged sitting. |
12.1 | Restructuring the physical environment | To make breaking up sitting easier for the participants without necessarily leaving their desk, active workstations, such as height-adjustable desks should be provided to counteract employees’ and employers’ concern of losing productive time while standing up. |
12.5 | Adding an object to the environment | |
6.1 | Demonstration of the behaviour | Give detailed explanations on how to break up sitting time and demonstrate how to use equipment that is being provided, such as a height-adjustable desk or prompts. |
4.1 | Instruction on how to perform the behaviour | |
4.2 | Information about antecedents | Advise to keep a record of sitting and of events taking place before sitting. |
3.2 | Social support (practical) | Appoint someone to support office workers to reduce their sitting and demonstrate different forms of activities that could be done in the workplace. |
8.1 | Behavioural practice/rehearsal | Encourage office workers to replace sitting with walking or standing meetings and consider having face-to-face meetings instead of communicating by emails or intercoms. |
8.2 | Behavioural substitution | |
8.3 | Habit formation | |
8.4 | Habit reversal | |
2.2 | Feedback on behaviour | Feedback on sitting behaviour and progress should be provided to participants during the intervention to increase their motivation. This would enable them to review their action plans and goals. |
12.2 | Restructuring the social environment | Organise into clusters in such a way that participants are not isolated when given interventions to break up sitting. The set-up should be arranged such that they see other colleagues to promote support. |
6.2 | Social comparison | Ensure participants in the same office or cluster can take cues from their colleagues who may be taking regular breaks from sitting and compared changes in sitting time. Create a league table to share sitting data. |
6.3 | Information about others’ approval | Provide information about what others think of taking breaks from sitting. For instance, what they think about getting up by themselves to make a cup of tea instead of asking fellow colleagues to do this for them. |
1.2 | Problem solving | Participants should be encouraged to identify personal barriers to breaking up sitting and develop an action plan to overcome these barriers. For instance, getting up regularly for a drink or tea with a small cup instead of being served by colleagues or getting incentives or rewards for achieving goals. |
1.4 | Action planning | |
10.1 | Material incentive (behaviour) | Encourage participants to reward themselves in the future if they have been able to achieve to their goals. Also inform participants that they will be recognised and verbally congratulate them for achieving their daily sitting goals. Promise to reward participants with vouchers if they reduce their sitting time. |
10.2 | Material reward (behaviour) | |
10.3 | Non-specific reward | |
10.4 | Social reward | |
10.5 | Social incentive | |
10.8 | Non-specific incentive | |
10.9 | Incentive (outcome) Self-reward | |
12.6 | Body changes | Arrange physiotherapy or massage sessions for participants who have aching back or other parts of their body that is preventing them from reducing their sitting. |
2.3 | Self-monitoring of behaviour | Encourage participants to take notes of their daily postures at work or give a monitoring device that allows participants to track their sitting behaviour. |
2.1 | Monitoring of behaviour by others without feedback | Observe and record participants’ sitting behaviour without their knowledge. |
9.1 | Credible source | Present verbal, visual or written information about the consequences of prolonged sitting and benefits of breaking up sitting from researchers, government organisations or international bodies. |
5.3 | Information about social and environmental consequences | Provide information about how breaking up prolonged sitting has benefited office workers and other sets of people and the type of intervention provided. |
5.6 | Information about emotional | Inform the participants that excessive sitting can causes tiredness and lethargy whilst breaking up sitting may re-energise and increases concentration. |
11.2 | Reduce negative emotions | |
2.4 | Self-monitoring of outcome(s) of behaviour | Advise the participants to rate their wellbeing, weight and general health regularly (daily, weekly, every 2 weeks etc) to see the outcomes of reducing sitting time. |
4.4 | Behavioural experiments | The participants can experiment with taking breaks from sitting to see how it impacts their mood, energy, etc. |
15.1 | Verbal persuasion about capability | Boost employees’ morale by assuring them that they are capable of breaking up their sitting and that they should not give room for any self-doubts. |
15.2 | Mental rehearsal of successful performance | Advise employees to imagine taking breaks from sitting at work. |