Reducing sedentary time in adults at risk of type 2 diabetes: process evaluation of the STAND (Sedentary Time ANd Diabetes) RCT

ObjectivesTo evaluate the impact of a multicomponent intervention (Stand More AT (SMArT) Work) designed to reduce sitting time on short (three months), medium (six months), and longer term (12 months) changes in occupational, daily, and prolonged sitting, standing, and physical activity, and physical, psychological, and work related health.DesignCluster two arm randomised controlled trial.SettingNational Health Service trust, England.Participants37 office clusters (146 participants) of desk based workers: 19 clusters (77 participants) were randomised to the intervention and 18 (69 participants) to control.InterventionsThe intervention group received a height adjustable workstation, a brief seminar with supporting leaflet, workstation instructions with sitting and standing targets, feedback on sitting and physical activity at three time points, posters, action planning and goal setting booklet, self monitoring and prompt tool, and coaching sessions (month 1 and every three months thereafter). The control group continued with usual practice.Main outcome measuresThe primary outcome was occupational sitting time (thigh worn accelerometer). Secondary outcomes were objectively measured daily sitting, prolonged sitting (≥30 minutes), and standing time, physical activity, musculoskeletal problems, self reported work related health (job performance, job satisfaction, work engagement, occupational fatigue, sickness presenteeism, and sickness absenteeism), cognitive function, and self reported psychological measures (mood and affective states, quality of life) assessed at 3, 6, and 12 months. Data were analysed using generalised estimating equation models, accounting for clustering.ResultsA significant difference between groups (in favour of the intervention group) was found in occupational sitting time at 12 months (−83.28 min/workday, 95% confidence interval −116.57 to −49.98, P=0.001). Differences between groups (in favour of the intervention group compared with control) were observed for occupational sitting time at three months (−50.62 min/workday, −78.71 to −22.54, P<0.001) and six months (−64.40 min/workday, −97.31 to −31.50, P<0.001) and daily sitting time at six months (−59.32 min/day, −88.40 to −30.25, P<0.001) and 12 months (−82.39 min/day, −114.54 to −50.26, P=0.001). Group differences (in favour of the intervention group compared with control) were found for prolonged sitting time, standing time, job performance, work engagement, occupational fatigue, sickness presenteeism, daily anxiety, and quality of life. No differences were seen for sickness absenteeism.ConclusionsSMArT Work successfully reduced sitting time over the short, medium, and longer term, and positive changes were observed in work related and psychological health.Trial registrationCurrent Controlled Trials ISRCTN10967042.

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“…A previous study targeting sitting also highlighted that regular assessments motivated participants. 68 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Edwardson

Yates

Biddle

et al. 2018

BMJ

169

254

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“…Associated trials where sedentary behaviour was measured as an outcome were published between 2007 and 2020. Five trials focused specifically on reducing sedentary behaviour19–21 or sitting time 22 23. The remaining 12 trials aimed to increase physical activity or promote healthier lifestyles but measured sedentary behaviour as an outcome (online supplemental file 3).…”

Section: Resultsmentioning

confidence: 99%

“…Seven trials were conducted in the UK,20–22 24–27 the remainder in the USA,19 23 28 Netherlands,29 30 Brazil,31 Ireland,32 Canada,33 Hong Kong34 and Belgium 35. Participants recruited into the trials varied, including: mothers or parents of infants, pregnant women, adults, older adults, overweight adults, individuals with chronic illnesses and individuals with intellectual disabilities or serious mental illnesses.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults

et al. 2022

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ObjectivesTo systematically review and synthesise findings from process evaluations of interventions in trials which measured sedentary behaviour as an outcome in adults to explore: (1) how intervention content, implementation, mechanisms of impact and context influence outcomes and (2) how these interventions are experienced from different perspectives (participants, carers, staff).DesignSystematic review and narrative synthesis underpinned by the Medical Research Council process evaluation framework.Data sourcesDatabases searches were conducted in March 2019 then updated in May 2020 and October 2021 in: CINAHL, SPORTDiscus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, AMED; EMBASE, PsycINFO, MEDLINE, Web of Science and ProQuest Dissertations & Theses.Eligibility criteriaWe included: Process evaluations of trials including interventions where sedentary behaviour was measured as an outcome in adults aged 16 or over from clinical or non-clinical populations. We excluded studies if interventions were delivered in educational or workplace settings, or if they were laboratory studies focused on immediate effects of breaking sitting.Data extraction and synthesisTwo independent reviewers extracted and coded data into a framework and assessed the quality of studies using the Mixed Methods Appraisal Tool. We synthesised findings using a narrative approach.Results17 process evaluations were included. Five interventions focused on reducing sedentary behaviour or sitting time, 12 aimed to increase physical activity or promote healthier lifestyles. Process evaluations indicated changes in sedentary behaviour outcomes were shaped by numerous factors including: barriers (eg, staffing difficulties and scheduling problems) and facilitators (eg, allowing for flexibility) to intervention delivery; contextual factors (eg, usual lifestyle and religious events) and individual factors (eg, pain, tiredness, illness, age and individual preferences).DiscussionIntervention requires careful consideration of different factors that could influence changes in sedentary behaviour outcomes to ensure that interventions can be tailored to suit different individuals and groups.PROSPERO registration numberCRD42018087403.

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“…Six studies mentioned a framework but did not state that the evaluation was informed by it. These included one study that provided a logic model but made no reference to this other than in the figure caption [ 64 ], and four studies that mentioned the MRC guidance on evaluating complex interventions and one that mentioned the MRC guidance on process evaluation of complex interventions but did not explicitly state that the study was informed by these guidance documents [ 69 – 71 , 75 , 112 ] (four of these were companion studies relating to the same intervention). In three (4%) further studies the description lacked sufficient clarity to determine whether the study was intended to be based on the reported framework or not; for example these referred to the formulation of a logic model but did not describe the evaluation and outcomes as being based on the logic model [ 48 , 49 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions

Fynn

Hardeman

Milton

et al. 2020

Int J Behav Nutr Phys Act

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Background Evaluation of physical activity interventions is vital to inform, and justify, evidence-based policy and practice to support population-wide changes in physical activity. Several evaluation frameworks and guidance documents have been developed to facilitate the evaluation and reporting of evaluation studies in public health. However, there is a lack of evidence about whether frameworks are being used to guide evaluation. There continues to be claims of poor and inconsistent reporting in evaluation studies. The aim of this review was to assess the use of evaluation frameworks and the quality of reporting of how they were applied within evaluation studies of physical activity interventions. Objectives To identify whether evaluation frameworks are reported to have been used within evaluation studies of physical activity interventions, and which frameworks have been used. To appraise the quality of reporting with regards to how evaluation frameworks have been used. Method We developed a checklist of indicators to enable a critical appraisal of the use and reporting of different evaluation frameworks in evaluation studies. We conducted a systematic search and review of evaluation studies published between 2015 and the date of the search to appraise the use and reporting of evaluation frameworks. A narrative synthesis is provided. Results The review identified 292 evaluation studies of physical activity interventions, only 69 (23%) of these mentioned using an evaluation framework, and only 16 different frameworks were referred to. There was variation in the quality of reporting of framework use. 51 (74%) studies were identified as being explicitly based on the stated framework, however only 26 (38%) provided detailed descriptions consistently across all the checklist indicators. Details of adaptations and limitations in how frameworks were applied were less frequently reported. The review also highlighted variability in the reporting of intervention components. More consistent and precise reporting of framework and intervention components is needed. Conclusion Evaluation frameworks can facilitate a more systematic evaluation report and we argue their limited use suggests missed opportunities to apply frameworks to guide evaluation and reporting in evaluation studies. Variability in the quality of reporting of framework use limits the comparability and transferability of evidence. Where a framework has been used, the checklist of indicators can be employed to facilitate the reporting of an evaluation study and to review the quality of an evaluation report.

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Reducing sedentary time in adults at risk of type 2 diabetes: process evaluation of the STAND (Sedentary Time ANd Diabetes) RCT

Cited by 13 publications

References 26 publications

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Effectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial

Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults

A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions

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