An intervention to promote positive homeworker health and wellbeing through effective home-working practices: a feasibility and acceptability study.

BACKGROUND: In the wake of Covid-19, the prevalence of working from home ('home-working') is expected to rise. Yet, working from home can have negative health and wellbeing impacts. Interventions are needed to promote effective ways of working that also protect workers' health and wellbeing. This study explored the feasibility and acceptability of an intervention intended to promote home-working practices that would protect and promote health behaviour and wellbeing. METHODS: An uncontrolled, single-arm mixed-methods trial design was employed. Forty-two normally-office-based UK workers, working from home between January-February 2021 (during the Covid pandemic), consented to receive the intervention. The intervention: a digital document offering evidence-based recommendations for home-working in ways conducive to health behaviour and wellbeing. Feasibility and acceptability were quantitatively indexed by: expressions of interest within 1 week (target threshold ≥ 35); attrition across the one-week study period (threshold ≤ 20%); and the absence of any apparent detriments in self-reported physical activity, sedentary behaviour, snacking, and work-related wellbeing prior to and one week after receiving the intervention. Qualitative think-aloud data, obtained while participants read through the intervention, and analysed using reflexive thematic analysis, explored acceptability. Semi-structured interviews conducted one week after intervention exposure were content-analysed to identify whether and which behaviour changes were adopted. RESULTS: Two feasibility criteria were met: 85 expressions of interest indicated satisfactory intervention demand, and no detriments were observed in health behaviours or wellbeing. Forty-two participants (i.e., maximum capacity for the study; 26 females, 16 males, aged 22-63) consented to take part. 31% dropped out over the one-week study period leaving a final sample of 29 (18 females, 11 males, aged 22-63), exceeding identified attrition thresholds. Think-aloud data showed that participants concurred with intervention guidance, but felt it lacked novelty and practicality. Follow-up interviews produced 18 (62%) participant reports of intervention adherence, where nine recommendations reportedly prompted behaviour change in at least one participant. CONCLUSIONS: Mixed evidence was found for intervention feasibility and acceptability. Whilst the information was deemed relevant and of value, further development is required to increase its novelty. It may also be more fruitful to provide this information via employers, to encourage and emphasise employer endorsement.

Working From Home: Experiences of Home-Working, Health Behavior and Well-Being During the 2020 UK COVID-19 Lockdown.

OBJECTIVE: The Spring 2020 UK COVID-19 lockdown required normally office-based workers to modify their work-related practices to work at home. This study explored workers' experiences of adapting to home working, health behaviors and well-being. METHODS: Twenty-seven home working employees (19 women; aged 23-57 years), from various industry sectors, gave individual semi-structured interviews. Topics focused on home working experiences, routine adaptations, and changes in health behaviors and well-being. RESULTS: Four themes were extracted: changes to the work interface; adaptations to a new workspace; changes to work-life balance; and adjustments to a new social context. Notably, participants reported greater reliance on computer-based interactions, which they felt discouraged physical activity and increased sitting. Working in a domestic environment reportedly challenged work-home boundaries. CONCLUSIONS: Work practices can incidentally detrimentally impact health-related behaviors and well-being. Organizations should develop policies and procedures to promote health-conducive home working.

Operationalizing resilient healthcare concepts through a serious video game for clinicians.

Resilient healthcare emphasises the importance of adaptive capacity in quality healthcare. This theory has had extensive theoretical development, but comparatively limited translation for clinicians in practice. This study is the first to present resilient healthcare principles in a serious video game. Serious games are an effective tool for engaging users, sharing ideas and eliciting reflections. The aim of this study was to communicate principles from resilient healthcare to clinicians through a serious video game, and to evaluate the game's feasibility as a prompt to reflect on practice. The game, Resilience Challenge, is scenario-based and requires players to resolve dilemmas in clinical practice. It was disseminated online, and was played 1949 times during the four-month study. The game was evaluated using an immediate cross-sectional survey, which included both Likert-style and free text responses. Participants reported that the game was engaging (93%) and that they would recommend it to others (89%). Fewer participants reported learning about resilient healthcare concepts (64%). Resilience Challenge is a promising way to prompt reflections about clinical work, and demonstrates mixed outcomes in communicating resilient healthcare principles to clinicians.

Process evaluation of a tailored workplace intervention designed to promote sustainable working in a rapidly changing world.

Increasing numbers of people are employed in sedentary occupations, spending large amounts of time sitting at work which is detrimental to health and wellbeing. Evidence-based guidance is required to intervene to reduce sedentary behaviour, encourage physical activity and promote sustainable working. This article presents a process evaluation of a successful workplace intervention Walking Works Wonders, shown to be effective in improving health, job satisfaction and motivation (Haslam et al. 2018). In this qualitative process evaluation employees reported an increased awareness of their sedentary time and they particularly valued the monitoring of activity using pedometers. They described changes to their working and leisure time activity to accumulate more steps. Participants reported improved physiological and psychological health outcomes, improved working relations with colleagues, changes in dietary behaviour and involving their families in physical activity. The results highlight elements of the intervention that encouraged healthy and more sustainable working practices.Practitioner summary: This study provides the employees' perspective on the effective elements of a workplace intervention which encouraged physical activity and reduced sitting time. The results offer valuable insights for practitioners aiming to develop interventions to improve health and facilitate more sustainable working practices in a rapidly changing world of work.Abbreviations: BMI: body mass index; PDF: portable document format.

Sedentary behaviour and health at work: an investigation of industrial sector, job role, gender and geographical differences.

This article presents baseline data from 1120 employees across 10 worksites enrolled in a workplace physical activity intervention. The study provides new data on physical activity, sedentary behaviour, and health and highlights gender, geographical, job type and industrial sector differences. Sitting at work accounted for more than 60% of participants' total daily sitting time on work days. Weekly and monthly hours worked, body mass index (BMI) and waist circumference were significantly higher for workers in the private sector compared to the public sector. Employees in sales and customer services had significantly higher BMI scores and significantly lower scores for workability index (WAI), job satisfaction, organisational commitment and job motivation, compared to other groups. This study provides further evidence that work is a major contributor to sedentary behaviour and supports the pressing need for interventions particularly targeting private sector industries and sales and customer service sectors. Practitioner Summary: Work accounts for more than 60% of the daily sitting time. Private sector employees had higher BMIs than those in the public sector and employees in sales and customer services had higher BMIs and poorer health compared to other occupations, suggesting that these groups should be targeted in workplace interventions.

Walking Works Wonders: a tailored workplace intervention evaluated over 24 months.

This article presents longitudinal data from 1120 participants across 10 worksites enrolled in Walking Works Wonders, a tailored intervention designed to increase physical activity and reduce sedentary behaviour. The intervention was evaluated over 2 years, using a quasi-experimental design comprising 3 conditions: tailored information; standard information and control. This study explored the impact of the intervention on objective measures (BMI, %Fat, waist circumference, blood pressure and heart rate) and self-reported measures of physical activity, sedentary behaviour, physical and psychological health. Interventions tailored to employees' stage of change significantly reduced BMI and waist circumference compared to standard and control conditions. Employees who received either a standard or tailored intervention demonstrated significantly higher work ability, organizational commitment, job motivation, job satisfaction and a reduction in intention to quit the organization. The results suggest that adopting a tailored approach to interventions is particularly effective in terms of improving health in the workplace. Practitioner Summary: This study describes Walking Works Wonders, a tailored intervention, which aims to encourage physical activity in the workplace. The study evaluated Walking Works Wonders over a 2 year period and demonstrated that interventions are more effective in improving health outcomes where the information is tailored to employees' stage of change.

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

STUDY OBJECTIVE: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. METHODS: This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). RESULTS: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). CONCLUSION: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.

A qualitative investigation of Foundation Year 2 doctors' views on the European Working Time Directive.

PURPOSE - The purpose of this paper is to examine the personal views and experiences of Foundation Year 2 doctors operating under the European Working Time Directive (EWTD). DESIGN/METHODOLOGY/APPROACH - In total, 36 Foundation Year 2 doctors from a single UK-based Deanery participated in this semistructured interview study. FINDINGS - Findings indicated that Foundation doctors typically welcomed a regulation of working hours, but reported frustration at the manner in which the Directive had been implemented. Participants reported concerns at reducing hours by removing out-of-hours working in order to meet EWTD requirements. Out-of-hours shifts were highly valued owing to their increased opportunities for autonomous clinical decision making. By contrast, day-shifts were regarded as heavily administrative in nature and were perceived as service provision. Foundation doctors discussed the unique nature of the out-of-hours working period which appeared to provide specific learning opportunities as doctors draw on time management and prioritisation skills. ORIGINALITY/VALUE - Given the challenges the EWTD presents, careful rota planning is essential. First, the authors would encourage the restructuring of day-shift work to provide a greater emphasis on hands-on skills experience in a supportive, supervised environment. Second, where possible, Foundation doctors might benefit from the opportunity to engage in some out-of-hours working, such as with multi-professional "Hospital at Night" teams. Third, the authors would encourage junior doctor involvement in rota design and planning which may increase their perceived autonomy and therefore buy-in of working practices.