Application of ecological momentary assessment in workplace health evaluation

Workplace Productivity, Health and Wellbeing: Findings From a Cluster Randomised Controlled Trial of a Workplace Intervention to Reduce Sitting in Office Workers

OBJECTIVE

The aim of the study was to evaluate the feasibility and potential effects of a workplace intervention to reduce and break up sitting.

METHODS

Office workers were randomized in clusters to intervention ( n = 22) or control ( n = 22). The intervention included a height-adjustable workstation, education, computer prompt software, and line manager support. Outcomes included device-measured workplace sitting and ecological momentary assessed workplace productivity. Recruitment, retention, and data completion rates were assessed.

RESULTS

Recruitment ( N = 44), retention (91%), and workplace sitting measurement rates demonstrated study feasibility. At 8 weeks, workplace sitting was 11% lower (95% CI: -20.71, -1.30) in the intervention group compared with control participants. Intervention participants were also more engaged, motivated, and productive while sitting ( P ≤ 0.016).

CONCLUSIONS

It was feasible to implement and evaluate this office workplace intervention, with potential benefits on workplace sitting and ecological momentary assessed productivity.

Exploring Work-Time Affective States Through Ecological Momentary Assessment in an Office-Based Intervention to Reduce Occupational Sitting

BACKGROUND

The aim of this study was to examine whether a low-cost standing desk intervention that reduced occupational sitting was associated with changes in work-time cognitive-affective states in real time using ecological momentary assessments at the start and end of the trial.

METHODS

Forty-one office employees (91.7% female, mean age = 39.8 [10.1] y) were randomized to receive a low-cost standing desk or a waitlist control. Participants received 5 surveys each day for 5 workdays via smartphone application prior to randomization and at trial's end. Ecological momentary assessment assessed current work-time psychological states (valence and arousal, stress, fatigue, and perceived productivity). Multilevel models assessed whether changes in work-time outcomes over the course of the intervention were significantly different between treatment groups.

RESULTS

There were no significant differences in outcomes between the groups except for fatigue, with the control group reporting a significant decrease in daily fatigue following the intervention (P < .001). The intervention group reported no significant changes in any of the work-time outcomes across the study period (P > .05).

CONCLUSIONS

A low-cost standing desk intervention to reduce occupational sedentary behavior did not negatively impact work-time outcomes such as productivity and fatigue in the short term.

Two decades of workplace ecological behaviour: a systematic literature review

Purpose

This research offered a systematic and comprehensive literature review in analysing current studies on employee ecological behaviour (EEB) strategies and settings to determine various emphasised workplace ecological behaviour areas and contribute a precise mapping for future research.

Design/methodology/approach

This systematic literature review method involved 106 peer-reviewed articles published in reputable academic journals (between 2000 and the first quarter of 2021). This study was confined to a review of empirical papers derived from digital databases encompassing the terms ‘Employee green behaviour’, ‘Green behaviour at workplace’, ‘Employee ecological behaviour’, ‘Employee Pro-environmental behaviour’ and ‘Pro-environmental behaviour at workplace’ in the titles.

Findings

This study identified relevant journal articles (classified as EEB at work) from the current body of knowledge. Notably, much emphasis was identified on EEB over the past two decades. Overall, most studies employing quantitative approaches in both developed and emerging nations. Notably, ecological behaviour application garnered the most significant attention from scholars among the four focus areas in the literature review: (i) EEB concepts, models, or reviews, (ii) EEB application, (iii) EEB determinants and (iv) EEB outcomes.

Practical implications

Significant literature gaps indicate this field to be a relatively novel phenomenon. Thus, rigorous research on the topic proves necessary to develop a holistic understanding of the subject area.

Originality/value

This study expands the current body of knowledge by providing the first comprehensive systematic review on EEB themes, methods, applications, determinants, contextual focus, outcomes and recommending future research agenda.

An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic

Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic's first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.

Preliminary effectiveness of an evidence-based mobile application to promote resilience among working adults in Singapore and Hong Kong: Intensive longitudinal study

Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application ('Intellect'); and (b) if daily engagement of 'Intellect' would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong (Mage = 32.4, SDage = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = -0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = -0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = -0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) (Mage = 32.2, SDage = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039-0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004-0.032), higher physical activity (β = 0.079; 95% CI 0.032-0.126), and mood levels (β = 0.020; 95% CI 0.012-0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.

Development of an integrated fatigue measurement system for construction workers: a feasibility study

Background

Construction workers working in physically and mentally challenging environments experience high levels of occupational fatigue, which is the primary cause of industrial accidents and illnesses. Therefore, it is very important to measure fatigue in real time to manage the safety and health of construction workers. This study presents a novel approach for simultaneously measuring the subjective and objective fatigue of construction workers using ecological momentary assessment (EMA) and smartwatches. Due to the complexity and diversity of construction site environments, it is necessary to examine whether data collection using smartwatches is suitable in actual construction sites. This study aims to examine the feasibility of the integrated fatigue measurement method.

Methods

This study comprised two phases: (1) development of an integrated fatigue measurement system for construction workers, and (2) a validation study to evaluate the method’s feasibility based on sensor data acquisition, EMA compliance, and feedback from construction workers in the field (N = 80). Three days of biometric data were collected through sensors embedded in the smartwatches for objective fatigue measurement, including heart rate, accelerometer, and gyroscope data. Two types of self-reported data regarding each worker’s fatigue were collected through a researcher-developed EMA application. The acceptability and usability of this system were examined based on the researchers’ observations and unstructured interviews.

Results

Based on the standardized self-report questionnaire scores, participants were classified into high (n = 35, 43.75%) and low (n = 45, 56.25%) fatigue groups for comparison. The quantitative outcomes did not show a statistically significant difference between the two fatigue groups. Both groups experienced positive emotions and were able to recognize their health condition at the time of self-reporting, but stated that responding to this measurement system could be burdensome.

Conclusions

This feasibility study provides a unique understanding of the applications of EMA and smartwatches for safety management in the construction workforce. The developed measurement system shows potential for monitoring fatigue based on the real-time collection of relevant data. It is expected that by expanding this integrated system through further research and onsite application, the health and safety of construction workers can be improved.

Workplace Intervention for Reducing Sitting Time in Sedentary Workers: Protocol for a Pilot Study Using the Behavior Change Wheel

The workplace is a major contributor to excessive sitting in office workers. There are a wide array of adverse effects of high volumes of sitting time, including an increased risk of type 2 diabetes and depression. Active workstations can be used in effective interventions to decrease workplace sitting. However, there are a lack of interventions that have been developed using a systematic process that is informed by participant needs and a framework for identifying the most appropriate content for the intervention. Applying these methods could increase adherence and potential effectiveness of the intervention. Therefore, the purpose of this pilot study is to examine the feasibility, acceptability, and efficacy of a tailored workplace intervention to reduce and break up sitting in office workers that has been developed using the Behavior Change Wheel and the APEASE (Acceptability, Practicability, Effectiveness/cost-effectiveness, Affordability, Safety/side-effects, Equity) criteria. This article reports the protocol for this study that is currently ongoing. Participants will be cluster-randomized (by offices) to control and intervention groups. The evaluation of the intervention includes determining feasibility by assessing participant recruitment, retention and data completion rates. Adherence to the intervention will be assessed based on daily sitting and standing time relative to guidelines provided to participants as part of the intervention. Outcome measures also include productivity measured using Ecological Momentary Assessment, absenteeism, presenteeism, cardiometabolic risk markers, and wellbeing. The findings of this study will inform the effective design and implementation of interventions for reducing and breaking up sitting in office workers.

Understanding Worker Well-Being Relative to High-Workload and Recovery Activities across a Whole Day: Pilot Testing an Ecological Momentary Assessment Technique

Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5-6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.

A Cluster-Randomised Crossover Pilot Feasibility Study of a Multicomponent Intervention to Reduce Occupational Sedentary Behaviour in Professional Male Employees

Professional male office employees have been identified as those most at risk of prolonged sedentary time, which is associated with many long-term adverse health conditions. The aim of the study was to assess the acceptability and feasibility of a gender-sensitive multicomponent intervention, guided by the socio-ecological model, to reduce occupational sedentary behaviour by increasing physical activity in professional men. The main elements of the intervention comprised: a Garmin watch with associated web-based platform/smartphone application, an under-desk pedal machine, and management participation and support. A cluster-randomised crossover pilot feasibility trial recruiting professional males was conducted in two workplaces. Mixed methods were used to assess the primary outcomes of recruitment, retention, and acceptability and feasibility of the intervention. Secondary outcomes included objectively measured sedentary behaviour, standing and physical activity. Focus groups were used to explore the acceptability of the intervention in a real-world setting. Twenty-two participants were recruited (mean age 42.9 years (SD 11.0)). Recruitment and retention rates were 73.3% and 95%, respectively. Overall, participants found the intervention acceptable and feasible, and expressed enjoyment of the intervention, however desk set-up issues with the pedal devices were noted. The manual recording of the pedalling bouts was overly burdensome. Preliminary data indicate that the intervention may reduce occupational sedentary behaviour and increase physical activity. This intervention should be further tested in a definitive trial following consideration of the findings of this pilot feasibility trial.

Movement at work: A comparison of real time location system, accelerometer and observational data from an office work environment

Office workers can spend significant periods of time being stationary whilst at work, with potentially serious health consequences. The development of effective health interventions could be aided by a greater understanding of the location and environmental context in which this stationary behaviour occurs. Real time location systems (RTLS) potentially offer the opportunity to gather this much needed information, but they have not been extensively trialled in office workplaces, nor rigorously compared against more familiar devices such as accelerometers. The aim of this paper was to determine whether an RTLS can measure and spatially locate the non-stationary and stationary behaviours of adults working in an office work environment. Data collected from a series of comparison studies undertaken in a commercial office building suggests that RTLS can measure the velocity at which people are moving and locate them, when stationary, with an accuracy of 0.668 m (SD 0.389). This opens up significant opportunities to further understand how people move within buildings, the indoor physical environmental influences on that movement, and the development of effective interventions to help people to move more whilst at work.

Smartphone-Based Ecological Momentary Assessment of Well-Being: A Systematic Review and Recommendations for Future Studies

Feelings of well-being and happiness fluctuate over time and contexts. Ecological Momentary Assessment (EMA) studies can capture fluctuations in momentary behavior, and experiences by assessing these multiple times per day. Traditionally, EMA was performed using pen and paper. Recently, due to technological advances EMA studies can be conducted more easily with smartphones, a device ubiquitous in our society. The goal of this review was to evaluate the literature on smartphone-based EMA in well-being research in healthy subjects. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching PubMed and Web of Science, we identified 53 studies using smartphone-based EMA of well-being. Studies were heterogeneous in designs, context, and measures. The average study duration was 12.8 days, with well-being assessed 2-12 times per day. Half of the studies included objective data (e.g. location). Only 47.2% reported compliance, indicating a mean of 71.6%. Well-being fluctuated daily and weekly, with higher well-being in evenings and weekends. These fluctuations disappeared when location and activity were accounted for. On average, being in nature and physical activity relates to higher well-being. Working relates to lower well-being, but workplace and company do influence well-being. The important advantages of using smartphones instead of other devices to collect EMAs are the easier data collection and flexible designs. Smartphone-based EMA reach far larger maximum sample sizes and more easily add objective data to their designs than palm-top/PDA studies. Smartphone-based EMA research is feasible to gain insight in well-being fluctuations and its determinants and offers the opportunity for parallel objective data collection. Most studies currently focus on group comparisons, while studies on individual differences in well-being patterns and fluctuations are lacking. We provide recommendations for future smartphone-based EMA research regarding measures, objective data and analyses.

Protocol of the STRess at Work (STRAW) Project: How to Disentangle Day-to-Day Occupational Stress among Academics Based on EMA, Physiological Data, and Smartphone Sensor and Usage Data

Several studies have reported on increasing psychosocial stress in academia due to work environment risk factors like job insecurity, work-family conflict, research grant applications, and high workload. The STRAW project adds novel aspects to occupational stress research among academic staff by measuring day-to-day stress in their real-world work environments over 15 working days. Work environment risk factors, stress outcomes, health-related behaviors, and work activities were measured repeatedly via an ecological momentary assessment (EMA), specially developed for this project. These results were combined with continuously tracked physiological stress responses using wearable devices and smartphone sensor and usage data. These data provide information on workplace context using our self-developed Android smartphone app. The data were analyzed using two approaches: 1) multilevel statistical modelling for repeated data to analyze relations between work environment risk factors and stress outcomes on a within- and between-person level, based on EMA results and a baseline screening, and 2) machine-learning focusing on building prediction models to develop and evaluate acute stress detection models, based on physiological data and smartphone sensor and usage data. Linking these data collection and analysis approaches enabled us to disentangle and model sources, outcomes, and contexts of occupational stress in academia.

A theory-based multicomponent intervention to reduce occupational sedentary behaviour in professional male workers: protocol for a cluster randomised crossover pilot feasibility study

BACKGROUND

Prolonged sitting, a significant risk factor for increased morbidity and mortality, is accumulated mostly in the workplace. There is limited research targeting specific at-risk populations to reduce occupational sedentary behaviour. A recent study found that professional males have the longest workplace sitting times. Current evidence supports the use of multi-level interventions developed using participative approaches. This study's primary aims are to test the viability of a future definitive intervention trial using a randomised pilot study, with secondary aims to explore the acceptability and feasibility of a multicomponent intervention to reduce workplace sitting.

METHODS

Two professional companies in Dublin, Ireland, will take part in a cluster randomised crossover pilot study. Office-based males will be recruited and randomised to the control or the intervention arms. The components of the intervention target multiple levels of influence including individual determinants (via mHealth technology to support behaviour change techniques), the physical work environment (via provision of an under-desk pedal machine), and the organisational structures and culture (via management consultation and recruitment to the study). The outcomes measured are recruitment and retention, minutes spent sedentary, and physical activity behaviours, work engagement, and acceptability and feasibility of the workplace intervention.

DISCUSSION

This study will establish the acceptability and feasibility of a workplace intervention which aims to reduce workplace SB and increase PA. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of this intervention in a definitive cluster randomised controlled trial.

Content validity and methodological considerations in ecological momentary assessment studies on physical activity and sedentary behaviour: a systematic review

Background

Ecological momentary assessment (EMA) is a method of collecting real-time data based on repeated measures and observations that take place in participant’s daily environment. EMA has many advantages over more traditional, retrospective questionnaires. However, EMA faces some challenges to reach its full potential. The aims of this systematic review are to (1) investigate whether and how content validity of the items (i.e. the specific questions that are part of a larger EMA questionnaire) used in EMA studies on physical activity and sedentary behaviour was assessed, and (2) provide an overview of important methodological considerations of EMA in measuring physical activity and sedentary behaviour.

Methods

Thirty papers (twenty unique studies) were systematically reviewed and variables were coded and analysed within the following 4 domains: (1) Content validity, (2) Sampling approach, (3) Data input modalities and (4) Degree of EMA completion.

Results

Only about half of the studies reported the specific items (n = 12) and the source of the items (n = 11). None of the studies specifically assessed the content validity of the items used. Only a minority (n = 5) of the studies reported any training, and one tested the comprehensibility of the EMA items. A wide variability was found in the design and methodology of the EMA. A minority of the studies (n = 7) reported a rationale for the used prompt frequency, time selection, and monitoring period. Retrospective assessment periods varied from ‘now’ to ‘in the last 3.5 hours’. In some studies there was a possibility to delay (n = 6) or deactivate (n = 10) the prompt, and some provided reminders after the first prompt (n = 9).

Conclusions

Almost no EMA studies reported the content validation of the items used. We recommend using the COSMIN checklist (COnsensus-based Standards for the selection of health Measurement INstruments) to report on the content validity of EMA items. Furthermore, as often no rationale was provided for several methodological decisions, the following three recommendations are made. First, provide a rationale for choosing the sampling modalities. Second, to ensure assessment ‘in the moment’, think carefully about the retrospective assessment period, reminders, and deactivation of the prompt. Third, as high completion rates are important for representativeness of the data and generalizability of the findings, report completion rates.

Trial registration

This review is registered in PROSPERO, the International prospective register of systematic reviews (registration number: CRD42017077996).

Application of an Ecological Momentary Assessment Protocol in a Workplace Intervention: Assessing Compliance, Criterion Validity, and Reactivity

BACKGROUND

Ecological momentary assessment (EMA) is a method of collecting behavioral data in real time. The purpose of this study was to examine EMA compliance, identify factors predicting compliance, assess criterion validity of, and reactivity to, using EMA in a workplace intervention study.

METHODS

Forty-five adults (91.1% female, 39.7 [9.6] y) were recruited for a workplace standing desk intervention. Participants received 5 surveys each day for 5 workdays via smartphone application. EMA items assessed current position (sitting/standing/stepping). EMA responses were time matched to objectively measured time in each position before and after each prompt. Multilevel logistic regression models estimated factors influencing EMA response. Cohen kappa measured interrater agreement between EMA-reported and device-measured position. Reactivity was assessed by comparing objectively measured sitting/standing/stepping in the 15 minutes before and after each EMA prompt using multilevel repeated-measures models.

RESULTS

Participants answered 81.4% of EMA prompts. Differences in compliance differed by position. There was substantial agreement between EMA-reported and device-measured position (κ = .713; P < .001). Following the EMA prompt, participants sat 0.87 minutes more than before the prompt (P < .01).

CONCLUSION

The use of EMA is a valid assessment of position when used in an intervention to reduce occupational sitting and did not appear to disrupt sitting in favor of the targeted outcome.

Understanding the Office: Using Ecological Momentary Assessment to Measure Activities, Posture, Social Interactions, Mood, and Work Performance at the Workplace

Studying the workplace often involves using observational, self-report recall, or focus group tools, which all have their established advantages and disadvantages. There is, however, a need for a readily available, low-invasive method that can provide longitudinal, repeated, and concurrent in-the-moment information to understand the workplace well. In this study, ecological momentary assessment (EMA) was used to collect 508 real-time responses about activities, posture, work performance, social interactions, and mood in 64 adult office workers in three Australian workplaces. The response rate was 53%, and the time to fill out the survey was 50 seconds on average. On average, the participants were sitting, standing, and walking in 84%, 9%, and 7% of survey instances, respectively. The participants reported they were working alone at their desks in 55% of all reported instances. Reported mood varied up to nine points within one person over the course of the post-occupancy observations. EMA can be used to paint a rich picture of occupants’ experiences and perceptions and to gain invaluable understanding of temporal patterns of the workplace, how the space is used, and how aspects of the workplace interact. This information can be used to make improvements to the physical and social workspaces and enhance occupants’ work performance and mood.