Enrollment Strategies, Barriers to Participation, and Reach of a Workplace Intervention Targeting Sedentary Behavior

Maintenance effects of a multilevel workplace intervention to reduce sedentary time: twenty-four-month follow-up of the group randomized clinical trial 'Stand and Move at Work'

BACKGROUND

The long-term impact of multilevel workplace sedentary behavior interventions has not been established beyond 12-months. We conducted a 2-arm group randomized trial examining the 24-month efficacy of a multilevel workplace intervention with sit-stand workstations (SSW) relative to the same multilevel intervention with delayed SSW implementation until 12-months.

METHODS

Worksites (N = 24 worksites, N = 630 employees) were randomized to participate in Stand and Move at Work and received: (a) STAND + , a 12-month multilevel behavioral intervention targeting reductions in sedentary time and increases in light physical activity (LPA) with SSW delivery during the 12-months or (b) MOVE + , the same multilevel intervention, however with SSW delivery at the end of the 12-month primary assessment period. We present maintenance endpoints (24-month follow-up) of objectively measured sedentary behavior variables as well as cardiometabolic biomarkers of the total sample and an at-risk exploratory dysglycemic (prediabetes or diabetes) subgroup per study arm.

RESULTS

All worksites (N = 24; from academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) were retained and participated in 24-month follow-up data collection. A total of 464 participants (248 STAND + , 216 MOVE + ; 19 ± 6 per worksite; 45.8 ± 10.6 years of age, 73% female) completed the 24-month assessment. At 24 months, the adjusted within-arm difference in sitting was -37.3 (CI:-51.9, -22.7) min per 8 h workday for STAND + and -23.4 (-39.7, -7.0) min per 8 h workday for MOVE + . Findings at 12-months were reproduced at 24-months, in which the majority of reductions in sitting translated to increasing standing with minimal change in LPA. There were no significant changes in cardiometabolic risk within the total sample, while there were some significant changes in triglycerides and blood pressure for the dysglycemic participants.

CONCLUSIONS

Multilevel workplace interventions incorporating SSWs have the potential to sustain reductions in workplace sedentary time through 24-months. Further, delayed introduction of SSWs following a 12-month multilevel workplace intervention seem to produce similar sitting time reductions relative to immediate introduction. SSWs are a robust environmental stimulus within multilevel interventions targeting workplace sedentary behavior. A larger sample size is needed to detect concomitant impact on cardiometabolic health.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317. Registered on 2 October 2015, the first participant enrolled 11 January 2016. https://clinicaltrials.gov/ct2/show/NCT02566317 . See Consort checklist.

Identifying recruitment strategies to improve the reach of evidence-based health promotion, disease prevention, and disease self-management interventions: a scoping review

Introduction

Improving the reach of existing lifestyle interventions focused on health promotion, disease prevention, and self-management delivered in community or clinical settings has the potential to increase the public health impact of these interventions. However, little is known about the overall success of recruitment strategies or the specification of strategy components including the details of how, through which channel, and by whom the recruitment strategies are enacted.

Methods

We conducted a scoping review with guidance from the JBI Manual for Evidence Synthesis. For transparency and reproducibility, we adhered to the PRISMA-S and PRISMA-ScR guidelines for reporting literature searches and scoping reviews. Our eligibility criteria included studies that reported recruitment strategies to improve reach (enrollment number, participation rate, and representativeness of participants) of health promotion, disease prevention, and self-management lifestyle interventions for children or adults worldwide. Recruitment strategies for non-lifestyle interventions, such as pharmaceutical trials, were excluded. Databases included Medline (Ovid), Embase (embase.com), CINAHL Complete (Ebscohost), APA PsycINFO (Ebscohost), and Dissertation and Theses Global (ProQuest). Database search results were retrieved on March 2-3, 2023.

Results

From a total of 9,712 references, 98 studies were included. Eight studies compared recruitment strategies using a randomized controlled trial and 90 studies were evaluations/quasi-experiments that reported on reach. There was a wide variety of recruitment strategies used, with 32% of the studies utilizing more than one recruitment strategy. The average reach, operationalized as participation rate, of the primary strategy (n = 15 defined strategies) being tested ranged from 3 to 41%. Further, participation rates ranged across studies that focused on children (43%), adults (25%), and older adults (16%). Most included studies did not report (1) strategy timing and dose, (2) theoretical basis, or (3) potential mechanisms of improved reach. Finally, differences in how the denominator was operationalized reduced confidence in comparing across strategies.

Discussion

More clarity is needed when reporting on specific recruitment strategies used to improve the reach of lifestyle interventions. Suggestions include guidance on how to consistently define a denominator of eligible participants exposed to recruitment strategies. Furthermore, the use of theoretical approaches and testing of potential mechanisms of effect are needed in future studies to advance the science of improving lifestyle intervention reach.

Systematic review registration

The unique identifier for our scoping review is 3g68b it can be found at this url: https://doi.org/10.17605/OSF.IO/3G68B.

National implementation trial of BeUpstanding™: an online initiative for workers to sit less and move more

BACKGROUND

The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding.

METHODS

Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described.

RESULTS

Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program.

CONCLUSIONS

BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability.

TRIAL REGISTRATION

ACTRN12617000682347.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation

BACKGROUND

There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH.

METHODS

This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation.

RESULTS

Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation.

CONCLUSIONS

As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

Efficacy of the 'Stand and Move at Work' multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial

Background

Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk.

Methods

Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months.

Results

Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was − 59.2 (CI: − 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (− 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat.

Conclusions

Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized.

Trial registration

ClinicalTrials.gov Identifier: NCT02566317. Registered 2 October 2015, first participant enrolled 11 January 2016.

The "Best of 2019 List" of Health Promotion Researchers

Each year, the editorial team of the American Journal of Health Promotion selects our "Best of List" of health promotion science from the prior year. This editorial features the Editor's picks, the Editor in Chief's favorites, and other award categories for the research and writing published in 2019 in this journal. Our criteria for selection include such factors as: whether the study addresses a topic of timely importance in health promotion, the research question is clearly stated and the methodologies used are well executed, whether the paper is often cited and downloaded, whether the study findings offer a unique contribution to the literature, and whether the paper is well written and enjoyable to read. Awardees in 2019 shared study findings that demonstrated the vital role of health policies in affecting behaviors and offered new insights into how to engage voices from communities, how intervention dose and reach impact outcomes, and how to better engage the most difficult to reach.