"Oh-oh, the others are standing up... I better do the same". Mixed-method evaluation of the implementation process of 'Take a Stand!' - a cluster randomized controlled trial of a multicomponent intervention to reduce sitting time among office workers.

BACKGROUND: Multicomponent workplace-based interventions aimed at reducing sitting time among office workers are becoming increasingly popular. 'Take a Stand!' was such an intervention, reducing sitting time by 71 min after 1 month and 48 min after 3 months. However, it is unclear how the implementation process of 'Take a Stand!' affected these results. The present study explored how individual factors and organizational context influenced implementation and effect in 'Take a Stand!' METHODS: This was a mixed-methods study, combining data from interviews, questionnaires and accelerometers. Directed content analysis was used for analysing interviews with participants, ambassadors and managers from the 10 intervention offices in the 'Take a Stand!' STUDY: Categories for analysis were taken from Framework for Evaluating Organizational-level Interventions. Interview data were combined with questionnaire and activity data, and multilevel analysis was undertaken to assess how changes in sitting time varied depending on the assessed factors. In addition, interview data were used to underpin results from the multilevel analysis. RESULTS: Concurrent institutional changes were found to be a barrier for the intervention by ambassadors, while participants and managers did not find it to be an issue. Management support was consistently highlighted as very important. Participants evaluated ambassadors as being generally adequately active but also, that the role had a greater potential. The motivational and social aspects of the intervention were considered important for the effect. This was supported by regression analyses, which showed that a strong desire to change sitting time habits, strong motivation towards the project, and a high sense of collective engagement were associated to less sitting time at 3 months of about 30 min/8 h working day compared to participants with low scores. Influence from other participants (e.g. seeing others raise their tables) and the use of humour were continuously highlighted by participants as positive for implementation. Finally, the intervention was found to influence the social climate at the workplace positively. CONCLUSION: Individual motivation was related to the sitting time effect of 'Take a Stand!', but the organizational culture was relevant both to the implementation and effect within the office community. The organizational culture included among others to ensure general participation, to uphold management and peer-support, and maintain a positive environment during the intervention period. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01996176 . Prospectively registered 21 November 2013.

Standing Meetings Are Feasible and Effective in Reducing Sitting Time among Office Workers-Walking Meetings Are Not: Mixed-Methods Results on the Feasibility and Effectiveness of Active Meetings Based on Data from the "Take a Stand!" Study.

Active meetings (standing or walking) have the potential to reduce sitting time among office workers. The aim of the present study was to explore the feasibility and effectiveness of standing and walking meetings. The "Take a Stand!" study was a cluster-randomized trial, consisting of multiple components including the possibility of active meetings. Analyses were based on the 173 participants in the intervention group. Feasibility was evaluated by questionnaire and interview data from participants, ambassadors and leaders. Effectiveness was assessed as the change in objectively measured sitting time from baseline to 3 months follow-up. Regular standing meetings were implemented at all offices and were generally popular, as they were perceived as more effective and focused. In contrast, only a few walking meetings were completed, and these were generally associated with several barriers and perceived as ineffective. Participants who participated in standing meetings on a regular basis had 59 min less sitting per 8 h workday (95%CI -101;-17) compared to participants who did not participate in standing meetings at all. Walking meeting participation was not significantly associated with changes in sitting time, likely due to the low number of employees who used this option. This explorative study concludes that standing meetings in office workplaces were feasible and well-liked by the employees, and having frequent standing meetings was associated with reduced sitting time. In contrast, walking meetings were unfeasible and less liked, and thus had no effect on sitting time.

Does It Work for Everyone? The Effect of the Take a Stand! Sitting-Intervention in Subgroups Defined by Socio-Demographic, Health-Related, Work-Related, and Psychosocial Factors.

OBJECTIVE: Take a Stand! was a multicomponent workplace-based intervention reducing sitting among office-workers. This study tested whether the effect of Take a Stand! differed across subgroups. METHODS: A cluster-randomized controlled trial with objectively measured sitting-time as primary outcome evaluated Take a Stand! Main analysis was reanalyzed in strata defined by four levels of preselected factors: socio-demographic (eg, sex); health-related (eg, smoking); work-related (eg, workhours); and psychosocial (eg, motivation to change sitting). RESULTS: No notable differences in the effect were observed: across all assessed subgroups sitting time was ∼60 minutes less after 1 month and ∼40 minutes less after 3 months in intervention as compared with control group. CONCLUSION: There was no differential effect of Take a Stand! indicating that the intervention was effective in all groups. This knowledge is advantageous when disseminating similar interventions to different populations of office workers.