Background
Methods
Step 1: Define the problem in behavioural terms
Step 2 and Step 3: Select and 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
Focus groups
Job type/grade | Sample size (n) | Manager/Executive level N (%) | Age (range) | Gender (women) N (%) | White ethnicity N (%) | Education at degree level N (%) | Self-reported sitting time hours at work per day (n (%))a | Device trial N (%) | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2–3 h | 3–4 h | 4–5 h | 5–6 h | 6–7 h | > 7 h | ||||||||
Hospital site 1 | 24 | 5 (21.0) | 20–59 | 19 (83.3) | 18 (75.0) | 15 (62.5) | 0 (0.0) | 1 (4.2) | 3 (12.5) | 2 (8.3) | 5 (20.8) | 6 (25.0) | 21 (87.5) |
Hospital site 2 | 8 | 2 (25.0) | 30–69 | 5 (62.5) | 7 (87.5) | 8 (50.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 5 (62.5) | 3 (37.5) | 5 (62.5) |
Hospital site 3 | 7 | 1 (14.3) | 30–59 | 6 (85.7) | 7 (100) | 7 (100) | 1 (14.3) | 0 (0.0) | 3 (42.9) | 2 (28.6) | 0 (0.0) | 1 (14.3) | 5 (71.3) |
Total | 39 | 8 (20.5) | 20–59 | 30 (77.0) | 32 (82.1) | 30 (77.0) | 1 (2.6) | 1 (2.6) | 6 (15.4) | 4 (10.3) | 10 (25.6) | 10 (25.6) | 31 (79.5) |
Readiness-to-change
Analysis and intervention development
Device testing
Results
Step 1: Define the problem in behavioural terms
Steps 2 and 3: Select and specify the target behaviour
What target behaviour? | Reduce sitting time at work throughout the day for 12 months |
Where does the behaviour occur? | Work desks of support-staff workers across NHS sites of three Leicester hospitals |
Who is involved in performing the behaviour? | Desk-bound office workers in any department employed at the sites above |
Step 4: Identify what needs to change
Dimension | Score* | Level |
---|---|---|
Knowledge of efforts | 3 | Vague awareness |
Leadership | 3 | Vague awareness |
Climate | 5 | Preparation |
Knowledge of the issue | 5 | Preparation |
Resources | 2 | Denial/Resistance |
Readiness Score | 3.6 | Vague awareness |
Behavioural analysis using COM-B – barriers and enablers for breaking up prolonged sitting time (step 4) | TDF domains linking to COM-B components (step 4a) | Intervention functions (step 5) | Behaviour Change techniques (BCT v1) (step 7) | Description of intervention strategies | |
---|---|---|---|---|---|
CAPABILITY |
Psychological Capability:
Limited knowledge about the health risks of high levels of sitting (barrier) |
Knowledge
Develop scientific knowledge of the health risks of high levels of sitting and the benefits of reducing sitting time; knowing how to reduce sitting time | Education, Training | Education: Information about health consequences; feedback on behaviour; feedback on outcome(s) of behaviour; prompts/cues; self-monitoring of behaviour | Education, Training, Modelling & Enablement: An educational seminar at the start of intervention, posters at different stages, goal setting diary with educational messages, demonstration given by researchers on how to use the desk, instruction booklet provided Environmental Restructuring: Darma cushion which provides prompts to stand |
Need to notice and remember to stand more |
Memory, Attention & Decision Processes
Know how and when to stand and for how long; and make decisions over tasks that can be conducted whilst standing | Education, Training, Environmental Restructuring, Modelling, Enablement | Training: Demonstration of the behaviour; instruction on how to perform a behaviour; self-monitoring of behaviour | ||
Limited understanding on how to manage or change own behaviour (goals, self-monitoring) (barrier) |
Behavioural Regulation
Develop skills of goal-setting, action-planning, self-monitoring and breaking prolonged sitting habit | Education, Training, Enablement | Environmental Restructuring: Prompts/Cues Modelling: Demonstration of the behaviour | ||
Enablement: Goal setting (behaviour); goal setting (outcome); self-monitoring of behaviour; action planning | |||||
OPPORTUNITY |
Social Opportunity
Perceptions that social norms make it difficult to stand at a desk and work (barrier) |
Social Influences
To provide opportunity to observe colleagues in using a sit stand desk and regularly breaking up their sitting time (i.e. positive role models) by randomising participants by office clusters | Modelling, Enablement | Modelling: Demonstration of the behaviour Enablement: Social support (unspecified) | Modelling: Demonstration by researchers on desk use, clusters using their desks in the same office Enablement: Posters updated every three months with motivational quotes from intervention participants |
Physical Opportunity
To have a height adjustable desk (enabler) |
Environmental Context & Resources
Being able to break up prolonged sitting time at work by having a height-adjustable sit-stand desk | Environmental Restructuring, Enablement | Environmental Restructuring and Enablement: Restructuring the physical environment; adding objects to the environment | Provide height-adjustable workstations (choice of desktop or full desk) | |
MOTIVATION |
Automatic Motivation
Staff need simple automatic reinforcement to change habit (enabler) |
Reinforcement
Reinforce routines and habits | Training, Environmental Restructuring; Incentivisation | Training: self-reward; habit formation Environmental Restructuring: Prompts/ cues Incentivisation: Self-monitoring of behaviour; remove aversive stimuli | Sit-stand desk use supported by a paper diary to record daily sitting and standing time, to set short/long-term goals. This is reinforced by the Darma cushion and its App. |
Reflective Motivation
Beliefs about positive consequences of standing are low (barrier), but beliefs about negative consequences of prolonged sitting is high (enabler). |
Social/Professional Role & Identity
Create individual and group identity that sitting and standing regularly is part of daily work | Persuasion, Modelling, | Persuasion: Information about social and environmental consequences; feedback on behaviour; feedback on outcome(s) of behaviour; identification of self as role model; social comparison; Modelling: Demonstration of the behaviour | Persuasion: seminar, diary, Darma cushion, leaflets/posters, ActivPAL feedback (data from accelerometer provided at individual and group level); coaching sessions | |
Beliefs about Capabilities
Believing that regularly standing at work is achievable will require improved cognitive and self-regulations skills | Incentivisation | ||||
Intentions
Develop intentions to sit and stand regularly when working at desk | Education, Enablement | Incentivisation: Feedback on behaviour; feedback on outcome(s) of the behaviour | Incentivisation & Enablement: Darma cushion feedback via phone app, ActivPAL feedback via researcher; goal setting via diary, coaching sessions Education: seminar, posters/leaflets, coaching sessions | ||
Goals
Develop goals to break up prolonged sitting by regularly standing when working at desk | Education, Persuasion, Enablement | Enablement: goal setting (behaviour); goal setting (outcome); action planning; review behaviour goals; review outcome goals | |||
Beliefs about Consequences
Believing that regularly standing at work is beneficial | Education | Education: Information about health consequences |
Perceptions on high levels of sitting on health
‘When you are sat there for a couple of hours and you look at this, and you, you just slouch, and you start to, your posture goes… and it’s the whole thing’ (participant 2, focus group 9)
Observations on high levels of sitting in the workplace
‘They will say you must take breaks every 20 minutes but if you’ve got work, you are not going to get up every 20 minutes and walk around the office for no good reason’ Participant 1, focus group 6)
‘They just expect you to sit until you basically go home’ (participant 4, focus group 6)
‘It’s just normal to sit down for such long periods of time. Your body is just not really meant to do that’ (participant 5, focus group 6).
Perceptions of the barriers to reduce sitting at work
‘I think quite often you get sort of sucked into what you’re doing, and you know it’s just a case of you want to crack on because you’ve got too much work’ (participant 1, focus group 9.)
‘There would be an awful lot of mickey taking…’ (participant 2, focus group 9)
Capability, Opportunity and Motivation to reduce sitting at work
Capability
‘There are a lot of people who are completely ignorant of the fact that when you’re sitting for prolonged periods, there’s bad effects on your health….. so yes, increasing awareness would certainly help’ (participant 4, focus group 4. TDF: Knowledge)
‘Because you’re so engrossed in work, you’re not thinking about what time it is or anything else, so yes, you definitely need something to say its time [to stand]’ (participant 1, focus group 2. TDF: Memory, Attention and Decision Processes)
“Because you don’t realise actually, you think you are having enough breaks but at the end of the day when you see it….’ (participant 4, focus group 6. TDF: Behavioural Regulation)
Opportunity
‘We don’t have a bin each in our room….the nearest recycling point is downstairs on the first floor [so] it has already happened … it’s kind of the way I’m already working’ (participant 1, focus group 3. TDF: Environmental Context and Resources)
Motivation
They talk about taking breaks from your computer but do we do it, no….[having a prompt] would encourage me more as a goal. Well yes, that seems more as a driver for me (participant 1, focus group 3. TDF: reinforcement)
‘And the thing is if it was happening to everybody and everybody was doing that thing it would become normal. So, for people to jump up and down would be normal. Whereas, if it was just one person doing it, they’d say oh’ (participant 4, focus group 4. TDF: Social/Professional Role and Identity; Social Influences).
I suppose I could perhaps not fill up my water bottle every day, just go the kitchen and get water as and when’ (participant 2, focus group 5. TDF: Intentions)
‘In our office, one of two of us had maybe, musculoskeletal issues so those people are the ones that I’d say are more aware of [the risks of] sitting …but some people don’t and will have their lunch at their desk. They’d be sitting at their desk all morning and then they will sit at their desk all afternoon’ (participant 4, focus group 7. TDF: Beliefs about Capabilities)
‘I think if you think about it more, then you’ll think more about your health. There are probably things you could do. But I think until you’ve got the high surface to it then you’re not going to do it’ (participant 2, focus group 5. TDF: Beliefs about Capabilities)
Device testing
Questions | Darma cushion | Jawbone UP24 | LumoBack | Polar Loop |
---|---|---|---|---|
Battery life | 4.5 | 4.1 | 4.6 | 4.0 |
Ease of charging | 4.6 | 3.8 | 4.6 | 4.1 |
Syncing data from device to web/app | 3.7 | 3.9 | 3.4 | 3.6 |
Presentation of feedback on web/app | 4.1 | 4.3 | 3.6 | 3.8 |
Navigation of feedback on web/app | 4.3 | 4.2 | 3.6 | 3.6 |
Understanding feedback on web/app | 4.1 | 4.3 | 3.6 | 3.6 |
Overall, how easy would you say the device has been to use? | 4.3 | 4.5 | 3.7 | 4.1 |
How obtrusive has the device been to your daily activities? | 3.7 | 3.8 | 2.3 | 3.9 |
Do you agree that the device has been useful for monitoring your sitting behaviour? | 4.2 | 3.8 | 3.4 | 3.3 |
Do you agree that the device has encouraged you to reduce your sitting behaviour? | 3.8 | 3.8 | 3 | 3.4 |