Steps 1-3 have been described in the methods above. This research has generated new qualitative data from Steps 4-8 as described below.
Demographics of interview participants
The average age of the individuals who participated in the interviews was 40.9±10.8 years, of which 68% were women, 56% White British, 68% university employees, and with an overall average body mass index of 25.7±3.5 kgm-2.
Step 4: Identifying what needs to change
Responses from the interviews have been categorised into capability, opportunity and motivation in line with the COM-B model and includes links to the TDF domains within the text.
Capability
The majority of participants said they are physically capable of breaking up their sitting time, although some highlighted that walking and standing trigger back problems.
“I’m quite capable and confident of breaking up my sitting time. I do that quite a lot….” (Participant 15, female, in their 20’s).
“I’m sat down to help me improve my back muscles because standing or walking for too long can be detrimental for me” (Participant 24, female, in their 40’s).
With respect to psychological capability, all participants stated that it was important to understand how much sitting is acceptable or excessive, as well as the consequences of prolonged sitting and any benefits of breaking up sitting time. This highlighted knowledge and skills as important TDF domains that should be targeted in an intervention:
“If I'm really honest, I don't really know any current advice other than it's not good to sit down for too long… I think it would help if this is properly communicated” (Participant 10, female, in their 40’s).
Most of the participants reported being engrossed in their work to meet tight deadlines, and this usually leads to them forgetting to take breaks from sitting. However, some participants believed that having a device or an app to remind them would help them to be more conscious, reflecting the TDF domain memory, attention and decision processes. In contrast, some participants said their sitting behaviour would change if they were able to monitor it by themselves, underlining the need for interventions to target the behavioural regulation TDF domain.
“It’s just the amount of work, purely the amount of work that’s there. Also, not remembering to, because sometimes you become engrossed in a project, or in a piece of work …, your head is just focused on that piece of work…. It's a case of the workload. Maybe something that flashes up on the computer; that flashes up at me saying: ‘you've been working for this length of time, you know move now’….” (Participant 20, male, in their 40’s).
“I think you just forget yourself trying to beat the deadline! Probably if there was something that prompts, like setting an alarm on your phone or receiving a message on your phone to prompt you to move” (Participant 11, female, in their 40’s).
Opportunity
The participants identified some social opportunities that come from the TDF domain social influences, including restricting their colleagues from making tea for them to encourage them to get up more often to do it themselves, being part of a team to provide collective support and ensure a collective target is set, appointing someone like a fire marshal to remind people, or having walking and standing meetings.
“Again I suppose it would have to come from another person to sort of tell me, that ‘you have got to remember that you need to stand’ I think someone like a fire marshal would get the job done (smiles)” (Participant 2, female, in their 40’s).
“If it was a corporate activity, I am more likely to engage with it. If you are on your own, you are less likely to do it. Being encouraged by other people would help a great deal” (Participant 23, female, in their 50’s).
However, a popular opportunity amongst the participants was the need for an organisational culture that supports breaking up sitting to assure employees that they will not be penalised if they stand up or leave their seat for a short while:
“It's about the whole [organisation] being aware of true key messages, I think it's about promoting positive culture of movement. And that comes through communication, variety of communication strategies, it’s about communicating every opportunity about good practice about healthy movement…. and I guess it's about being given permission” (Participant 19, male, in their 30’s).
“Just knowing that my manager is okay with me getting up every half hour should be enough really. Apart from that, I’m okay but it’s a busy period right now so I have to be on my desk …. I get that, so if my manager is okay with me standing up, going back and forth for two to three minutes then coming back, then it’s fine” (Participant 3, female, in their 20’s).
Creating the opportunity to influence the TDF domain environmental context and resources if cost was not a concern was highlighted by participants who suggested that a height-adjustable desk would be an important tool that could reduce their sitting in the workplace:
“I think a raising desk is something that is worth exploring, but I understand that financially that is a huge investment for the [organisation] but there has been a lot of studies into that…. If money was not a problem, you can get raising desks, you can have it raised or seated and I will be happy to try that” (Participant 8, male, in their 30’s).
Motivation
Participants stated that the intervention should target both reflective and automatic motivation for behaviour change to take place. With regards to reflective motivation, around half of the participants reported that they felt in control of breaking up their sitting time, reflecting self-efficacy beliefs within the beliefs about capabilities TDF domain. For instance:
“On a scale of ‘1’ to ‘10’, with ‘10’ being the most confident; I would say my confidence level [to sit less] is ‘8’” (Participant 16, male, in their 50’s).
However, laziness and lack of will power was seen as a counter argument that may prevent them from doing so. In response, the participants highlighted they will need to change their mindset for a stronger commitment towards integrating movement and standing into their work life, which corresponds to the intention TDF domain.
“The right mindset! That's what I need to be able to stand up and walk at regular intervals” (Participant 22, female, in their 40’s).
Moreover, participants stated that they would respond to set goals if there was an expectation that they would be rewarded at the end, highlighting goals and reinforcement as important TDF domains.
“Well, I'm motivated by having a pound every time I get up, or, or a chocolate every time I get up… It wouldn't necessarily have to be money, it could be a, as I say, a kind of build credits for some sort of treats…” (Participant 25, female, in their 40’s).
With respect to automatic motivation, the majority of the participants reported mixed perception about the effect of mood on their sitting time. Some participants said mood had no effect on their sitting time, while some thought it did. Either way, emotion appeared to be an important TDF domain that should be targeted.
“My job determines my sitting behaviour, but my mood doesn’t – no!” (Participant 10, female, in their 40’s).
“It’s two ways: sometimes when I am happy I tend to be quite chatty, so I move more to talk to people, but when I’m low in mood I can sit all day at my desk or move more keeping to myself” (Participant 6, male, in their 20’s).
Participants who perceived sitting time could be influenced by mood expressed that their optimism and motivation could be improved by having access to empirical evidence regarding the negative consequence of prolonged sitting.
“Generally, people value research evidence, statistics, so in terms of increasing motivation and hope, informational literature on consequence of excessive sitting I guess will make a difference” (Participant 23, female, in their 50’s ).
Participants also reported that they are likely to overcome the habit of sitting if there was competition among peers or if they were given incentives, underlining Reinforcement as an important TDF domain.
“You could develop some sort of challenge type thing. Erm, you know, people like games or competitions or even being given vouchers. People can find that quite motivating from that point of view” (Participant 6, male, in their 20’s).
Steps 5 and 6: Identification of intervention functions and policy categories
Seven out of nine intervention functions described in the BCW guide (37) were identified as relevant based on the outcomes of the semi-structured interviews, mapped from COM-B shown in Table 1. These intervention functions are; Education (defined as increasing knowledge and understanding), Training (defined as imparting skills), Persuasion (defined as a way of using communication to stimulating positive or negative feeling or action), Environmental restructuring (defined as changing the physical or social context), Enablement (defined as increasing means and reducing barriers to increase capability), Incentivisation (defined as creating an expectation of reward), and Modelling (defined as providing an example for imitation).
With respect to policy categories, only three out of the seven categories highlighted in the BCW guide (37) were identified. These included Communication/marketing (for instance, using verbal, electronic communication or flyers to create awareness of benefits of breaking up sitting and health consequences of prolonged sitting), Guidelines (examples of which include informing employees of sitting time guidelines), and Environmental/social planning (e.g, designing and controlling the logistics of height-adjustable desks within the office setting/office culture).
Step 7: Identification of behaviour change techniques
BCTs are considered as ‘active components’ when designing an intervention. In total, 39 out of the 93 BCTs in the BCT Taxonomy Version 1 (47) were identified from the interview data (Table 1). The list of BCTs identified include: ‘Instruction on how to perform the behaviour’, ‘Credible source’, ‘Information about health consequences’, ‘Information about social and environmental consequences’, ‘Feedback on behaviour’, ‘Behavioural practice/rehearsal’, ‘Behaviour substitution’, ‘Habit formation’, ‘Habit reversal’,’ Prompts/cues’, ‘Adding objects to the environment’, ‘Restructuring the physical environment’, ‘Self-monitoring of behaviour’, ‘Monitoring of behaviour by others without feedback’, ’ Problem solving’, ‘Action planning’, ‘Body changes’, ‘Information about others’ approval’, ‘Social comparison’, ‘Restructuring the social environment’, ‘Social support (unspecified)’, ‘Social support (practical)’, ‘Demonstration of the behaviour’, ‘Goal setting’, ‘Verbal persuasion about capability’, ‘Mental rehearsal of successful performance’, ‘Material incentive (behaviour)’, ‘Material reward (behaviour)’, ‘Non-specific reward’, ‘Social reward’, Social incentive’, ‘Non-specific incentive’, ‘Self-reward’, ‘Information about emotional consequences’, ‘Reduce negative emotions’, ‘Self-monitoring of outcome(s) of behaviour’, ‘Behavioural experiments’, ‘Information about antecedents’ and ‘Incentive (outcome)’.
Intervention designers will need to select BCTs that are most appropriate for the population and location where the intervention will be conducted. This can be achieved by considering the APEASE criteria or by first choosing BCTs that were most frequently used within relevant intervention functions before those that were less frequently used as described in the BCW guide (37).
Step 8: Mode of delivery
The appropriateness of mode of delivery depends on the target behaviour, target population and setting. Details on taxonomy of modes of delivery can be found in the BCW guide (37). APEASE criteria should be used in selecting mode of delivery of choice. This could be either face-to-face or distance depending on setting. Where employees are spread over different offices and different locations, interventions could be delivered face-to-face, in clusters or individually. This can be achieved by giving out leaflets with detailed information about breaking up sitting, sitting guidelines for office workers and demonstrated using digital media.