Employee Physical Activity Promotion

: Bridging the Gap Between Research and Practice through the Development of Wellness@Work; a Co-created Workplace Physical Activity Social Network

Abstract

Globally, physical activity levels have declined sharply and it has been estimated that up to 42% of individuals within developed countries are classified as being physically inactive. Insufficient physical activity is a substantial health risk and has been associated with negative psychophysiological outcomes including cardiovascular disease, diabetes and depression. Whilst there are many contributors to physical inactivity the workplace has been identified as a particularly significant contributor. Consistently high levels of sedentary behaviour have been documented within many modern workplaces, with employees spending up to 81% of working hours seated in white collar roles. Given that approximately 58% of global workforce will spend one third of their adult life at work, the workplace has been identified as a key domain in which researchers can deliver interventions to promote physical activity. Despite this, evidence for the efficacy of workplace physical activity interventions has been mixed. One potential explanation for this is an underutilisation of participatory approaches during intervention design. Within organisational research, concerns have been expressed regarding a widening gap between research and practice. Whilst interventions may be academically robust they may lack sufficient relevancy to the employees that they are intended to support. To address these issues this thesis adopted a pragmatic, participatory stance and drew upon co-creation methodologies to develop a new workplace physical activity intervention that would meet the needs of employees. This was achieved via four research phases. Phase one involved a meta-analytic review of workplace physical activity and sedentary behaviour intervention literature. As noted, evidence for the efficacy of such interventions has been mixed. To add clarity, the meta-analysis included only studies that had objectively measured physical activity and sedentary behaviour after six months; helping to overcome limitations of behavioural overestimation through self-report and novelty effects present within previous reviews. In light of the pragmatic stance of the author, included studies were also coded for the presence of behaviour change techniques (BCTs) and meta-regression and sub-group moderator analysis conducted to determine whether the number and type of BCTs used within interventions were associated with efficacy. This enabled the meta-analysis to identify not only whether interventions worked but also how. Results from phase one indicated that interventions were effective at increasing physical activity and decreasing sedentary behaviour after six months. A significant negative correlation was identified between the number of BCTs used and intervention effect sizes for physical activity interventions but no correlation was identified for sedentary behaviour focused interventions. Intervention effect sizes were larger when the BCTs information about health consequences and adding objects to the physical environment had been used and when the BCTs commitment, self monitoring of behaviour, instruction on how to perform the behaviour, credible source and material reward had not been used. Combined, phase one identified tangible ways in which practitioners could alter published interventions without unduly compromising efficacy. Phase two involved a co-creation workshop designed to gain insight into what employees perceive to be the barriers and facilitators of physical activity within the workplace. 14 employees from a variety of occupational backgrounds completed two activities: the co-creation CUbe (a form of mobile brainstorming) and photovoice. Integrated visual thematic analysis was conducted to synthesise the data. Themes identified through integrated visual thematic analysis spanned intrapersonal, interpersonal, organisational and environmental levels. At the intrapersonal level themes identified that good mental and physical health may act as pre-requisites to intervention engagement. At the interpersonal level colleagues were identified as a source of support by making activity enjoyable and acting as role models. At the organisational level, themes primarily explored the promotion of physical activity and job design. Finally, at the environmental level themes considered the built environment and the distance between working locations. Combined, the themes suggested that workplace physical activity is a complex, and context dependent, behaviour. As such, one-size-fits all interventions are unlikely to be successful. Instead, interventions targeting different barriers and facilitators may be required to capture the needs and requirements of a broader range of employees. Phase three involved a second co-creation workshop where the co-creators were asked to design physical activity interventions. 13 employees, 11 of which returned from phase two, completed a poster presentation activity. Qualitative content analysis was conducted to analyse the data. Consistent with the findings of phase two, interventions spanned the intrapersonal, interpersonal, organisational and environmental levels. The co-created interventions were also coded for the presence of BCTs to determine whether the behaviour change strategies used by employees differ to those used by the authors of the studies included in the meta-analysis of phase one. It was identified that whilst there were commonalities, such as adding objects to the environment, there were also discrepancies. For example, employees utilised the BCT monitoring of emotional consequences whilst this BCT was not present within any of the studies in phase one. Alongside BCTs, qualitative content analysis was used to identify common implementation strategies described by the employees. Again, commonalities were identified between the evaluation strategies used by researchers, such as measuring step counts, but differences were also noted too, such as the co-creators using mental well-being as a measure of intervention effectiveness. Combined, this phase empowered participants to develop interventions relevant to their needs whilst also highlighting specific areas in which a gap between research and practice may exist. In phase four, the co-created solutions were synthesised into a singular intervention, a workplace physical activity website called Wellness@Work, through a process of iterative developments. Wellness@Work contained information collected through the prior research phases. The feasibility of Wellness@Work was assessed by 148 employed participants who watched a video demonstration of the website and completed a modified Unified Technology Acceptance and Use 2 (UTAUT2) questionnaire to determine factors associated with the behavioural intention to use the website. Structural equation modelling was conducted on the collected data, which revealed that 79% of the variance in behavioural intention to use the website could be explained by the UTAUT2 constructs. Performance expectancy and hedonic motivation were positively associated with behavioural intention to use whilst social influence was also positively associated but only for female participants. Findings suggest that Wellness@Work may be a viable intervention that would be used by employees in a variety of occupations. Through the four research phases, the overarching aim of the thesis was met. It was determined that co-creational approaches can be used to successfully to produce tangible interventions that are relevant to employees. In a research area which has historically underutilised participatory and democratic approaches this thesis has contributed both a more nuanced understanding of workplace physical activity and strengthened the voice of employees within the literature. Through BCT coding, researchers and practitioners have also been provided with a tangible list of BCTs that influence intervention effectiveness and are relevant to employees. Such information can help to bridge the gap between research and practice by demonstrating which aspects of interventions should be added and which can be amended to enhance impact for employees.

Date of Award	2021
Original language	English
Awarding Institution	Coventry University
Supervisor	Gemma Pearce (Supervisor), Christine Grant (Supervisor) & Valerie Cox (Supervisor)