"Sit Less at Work": exploring the contextual factors which influence intervention development, implementation and evaluation

Introduction
Prolonged periods of sitting, a common feature of sedentary jobs, are associated with increased morbidity and mortality. Evaluation of interventions to reduce workplace sitting have shown mixed results, suggesting impact also depends on context. This research, therefore, aimed to explore contextual factors that influence the development, implementation and evaluation of interventions to reduce workplace sitting time.

Methods
An integrative systematic review assessed effectiveness of interventions to reduce workplace sitting and explored key considerations for intervention development and implementation. Phase 1 involved a qualitative study to explore how barriers and facilitators to reducing workplace sitting time differed in four organisations of varying size and sector. Phase 2 developed and planned the implementation of organisation-specific interventions using ecological approaches and co-production. Phase 3 comprised a mixed-methods “before and after” study to assess the feasibility of implementation and evaluation and explored contextual barriers and enablers in three of the participating organisations.

Results
The review produced an operational framework which was tested during the three phases and then refined. Phase 1 highlighted barriers and enablers that differed across organisations including: organisational culture, the idea of presenteeism and wider political and economic influences. Phase 2 produced four “Sit Less at Work” interventions which targeted multiple levels of influence. Phase 3 identified no change in workplace sitting time, however, process evaluation determined that interventions were not implemented as intended. Key contextual barriers to implementation included: organisational culture, social norms of sitting, and lack of management buy-in.

Conclusion
Successful development, implementation and evaluation of interventions to reduce workplace sitting time requires careful consideration of contextual factors, particularly organisational culture and ingrained social practices. The evidence-based operational framework developed in this thesis can be used to ensure consideration is given to these factors to develop and deliver more effective interventions.