“It depends on the boss” – a qualitative study of multi-level interventions aiming at office workers’ movement behaviour and mental health

Figures & data

Figure 1. Overview of the multi-level interventions.

Textbox 1 RCT and intervention design

The multi-level cluster RCT tested two interventions among office workers. 263 office workers from two Swedish companies (73% women, mean age 42 ± 9 years, education 15 ± 2 years) (O’Cathain et al., 2015) were grouped into 22 cluster teams. At both companies, teams were randomized to one of two intervention groups or a wait-list control group. During the 6-month intervention period, one intervention group (iPA) focused on increasing moderate to vigorous physical activity (MVPA) and the other on reducing SED (iSED) by breaking up prolonged bouts of sitting and replacing SED with light-intensity physical activity to improve mental health and cognitive functions. The primary outcomes were accelerometer-measured time spent in MVPA and SED, while mental health and cognitive functions were secondary outcomes. The trial was conducted from 2018 to 2020. Ethical approval was obtained from the Stockholm regional ethic review board (2018/587–32). The intervention design was based on the Ecological model of health behaviour (Ojo et al., 2019,) which suggests that factors on the organizational, environmental, and individual level influence health behaviour. Multiple behaviour change techniques were included to address these different levels, see Figure 1. The design was also informed by a preceding study on perceived barriers and facilitators for reducing SED among office workers at the same companies (Nooijen et al., 2018). The three most reported barriers were sitting is a habit (67%), standing is uncomfortable (29%) and standing is tiring (24%). Standing (33%) or walking meetings (29%) and more possibilities or reminders for breaks (31%) were most frequent suggestions for facilitators. The interventions aimed at changing movement behaviour during work and non-work time. Organizational level: To ensure organizational support, human resource and higher management staff promoted participation in the interventions within their companies. In addition, the RCT aimed at recruiting managers as team leaders to provide manager support by acting as role models and by encouraging respective behaviours throughout the intervention period. They were also asked to promote continued participation in the interventions. Environmental level: Managers functioning as team leaders were expected to implement group activities and access to standing and walking meetings (see Figure 1). In addition, iPA participants received free gym access. Team leaders were invited to one individual and one group meeting prior to intervention start where they received information about their role as team leaders and the importance of PA or SED. Throughout the intervention period, team leaders could contact the responsible researcher for questions or support. Individual level: Both intervention groups received five counselling sessions based on cognitive behavioural therapy (CBT) and motivational interview (MI). Trained health coaches received additional training in applying CBT and MI. A detailed manual was used to standardize each session. Following CBT-based techniques were used: (1) Goal setting tied to internal rewards and value, (2) Identification of the individual’s resources and barriers for making behaviour changes, (3) Functional analysis including antecedents and consequences of undesired and desired behaviour, (4) Acceptance techniques for handling negative emotions, (5) Plan for long-term behaviour change. Between sessions, participants were asked to manually track their PA or SED using a logbook. Participants chose physical activities according to their individual needs and preferences.

Table I. Overview of identified themes for each level of intervention.

Level of intervention	Organizational	Team	Environmental	Individual
Identified themes	Health promoting company culture and leadership	Preconditions for team leaders Impact of peer support	Ambiguity of environmental support	“Life puzzle” Counseling as facilitator for a “mental journey”

Table

Type of participant	Company 1	Company 2	Other
Office workers	17	5
iSED group	6	1
iPA group	11	4
Office workers that were first in the waitlist control group	9	0
Team leaders	4 (out of 13)	4 (out of 8)
iSED group	1	1
iPA group	3	3
Team leaders that were first in the waitlist control group	1	2
Office workers Human Resource (HR) and higher management staff	3 (out of 5 who were contacted)	2 (out of 3 who were contacted)
Health Coaches			3 (out of 6)
TOTAL	38

Table

How did it work with …		How often could you integrate this?
Interruption of prolonged sitting in meetings	Book meetings where you motivate and facilitate standing meetings/interruptions in sitting Breaks every 20 minutes in all meetings (suggestions for break activities can be found in video XY) At least 3 times/month during the intervention period
Walking meetings	Encourage employees to have at least 1 walking meeting At least 1 time during the first 2 months
Standing while working, including standing meetings	Encourage interruptions of sitting during the working day (going to the printer often, talking to colleagues, taking breaks, standing at the desk, etc.). During the entire intervention period
Lead by example	Being a good example by taking regular breaks in prolonged sitting, working while standing parts of the working time

Table

How did it work with …		How often could you integrate this?
Exercise during the workday	Organize 1 joint training session (lead by the gym) during working hours, for example during lunch for the entire work group including team leader Around week 3
Exercise during the workday	Organize 1 joint brisk lunch walk (entire work group including team leader) 2 times around week 5 and 15
Exercise during the workday and outside working hours, including active commuting	Encourage exercise during work and non-work time, including commuting (walking/cycling/jogging) to and from work During the entire intervention period
Lead by example	Being a good example by exercising during the workday and by actively commuting

Other

Is there anything else you would like to say?

Table

Topic	Item No.	Guide Questions/Description	Reported on Page No.
Domain 1: Research team and reflexivity
Personal characteristics
Interviewer/facilitator	1	Which author/s conducted the interview or focus group?	6
Credentials	2	What were the researcher’s credentials? e.g., PhD, MD	6
Occupation	3	What was their occupation at the time of the study?	6
Gender	4	Was the researcher male or female?	1
Experience and training	5	What experience or training did the researcher have?	6
Relationship with participants
Relationship established	6	Was a relationship established prior to study commencement?	5
Participant knowledge of the interviewer	7	What did the participants know about the researcher? e.g., personal goals, reasons for doing the research	5
			6
Interviewer characteristics	8	What characteristics were reported about the inter viewer/facilitator?
e.g. Bias, assumptions, reasons and interests in the research topic
Domain 2: Study design
Theoretical framework
Methodological orientation and Theory content analysis	9	What methodological orientation was stated to underpin the study? e.g. grounded theory, discourse analysis, ethnography, phenomenology,	6
Participant selection
Sampling	10	How were participants selected? e.g., purposive, convenience, consecutive, snowball	5
Method of approach	11	How were participants approached? e.g., face-to-face, telephone, mail,	5
Sample size	12	email	5
		How many participants were in the study?
Non-participation	13	How many people refused to participate or dropped out? Reasons?	5
Setting
Setting of data collection	14	Where was the data collected? e.g., home, clinic, workplace	5
Presence of non-participants	15	Was anyone else present besides the participants and researchers?	5
Description of sample data, date	16	What are the important characteristics of the sample? e.g., demographic	Appendix 1
Data collection
Interview guide	17	Were questions, prompts, guides provided by the authors? Was it pilot tested?	6, Appendix 2
Repeat interviews	18	Were repeat inter views carried out? If yes, how many?	No
Audio/visual recording	19	Did the research use audio or visual recording to collect the data?	6
Field notes	20	Were field notes made during and/or after the inter view or focus group?	6
Duration	21	What was the duration of the inter views or focus group?
			4
Data saturation	22	Was data saturation discussed?
Transcripts returned	23	Were transcripts returned to participants for comment and/or correction?	6
Domain 3: analysis and findings
Data analysis
Number of data coders	24	How many data coders coded the data?	6
Description of the coding tree	25	Did authors provide a description of the coding tree?	Appendix 3
Derivation of themes	26	Were themes identified in advance or derived from the data?	6
Software	27	What software, if applicable, was used to manage the data?	6
Participant checking	28	Did participants provide feedback on the findings?
Reporting
Quotations presented	29	Were participant quotations presented to illustrate the themes/findings? Was each quotation identified? e.g., participant number	8–16
Data and findings consistent	30	Was there consistency between the data presented and the findings?	17, 18
Clarity of major themes	31	Were major themes clearly presented in the findings?	7
Clarity of minor themes	32	Is there a description of diverse cases or discussion of minor themes?	8–16

Developed from: Tong A, Sainsbury P, Craig J.Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focusgroups. International Journal for Quality in Health Care. 2007. Volume 19, Number 6: pp. 349–357

Once you have completed this checklist, please save a copy and upload it as part of your submission. DO NOTinclude this checklist as part ofthe main manuscript document. It must be uploaded as a separate file.

O’Cathain, A., Hoddinott, P., Lewin, S., Thomas, K. J., Young, B., Adamson, J., Jansen, Y. J., Mills, N., Moore, G., & Donovan, J. L. (2015). Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: Guidance for researchers. Pilot and Feasibility Studies, 1(1), 1–13. https://doi.org/10.1186/s40814-015-0026-y

 PubMedGoogle Scholar

Ojo, S. O., Bailey, D. P., Brierley, M. L., Hewson, D. J., & Chater, A. M. (2019). Breaking barriers: Using the behavior change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time. BMC Public Health, 19(1), 1–17. https://doi.org/10.1186/s12889-019-7468-8

 PubMed Web of Science ®Google Scholar

Nooijen, C. F. J., Kallings, L. V., Blom, V., Ekblom, O., Forsell, Y., & Ekblom, M. M. (2018). Common perceived barriers and facilitators for reducing sedentary behaviour among office workers.Pdf. Journal of Environmental Research and Public Health, 15, 792. https://doi.org/10.3390/ijerph15040792

 PubMed Web of Science ®Google Scholar