title: Development and evaluation of a multi-component intervention to help call agents to sit less and move more at work
Creators: name: Morris, A
Publisher: name: Liverpool John Moores University
Year: 2019

description: Sedentary behaviour (SB) and physical inactivity are risk factors for non-communicable diseases, morbidity and premature mortality. Conversely, reducing total and prolonged SB and increasing physical activity (PA) can improve cardiometabolic and musculoskeletal health, wellbeing, and improve work outcomes such as absenteeism and productivity. In the UK, ~766,000 adults are employed within call centres. Worryingly, contact centre call agents spend ~90% of their working day seated, which can negatively impact cardiovascular and metabolic health, presenteeism and productivity. Despite knowing the relationships between SB, PA and health, little research has been conducted within the contact centre setting to develop robust SB and PA interventions for call agents. The overarching aim of this thesis therefore was to develop and evaluate a multi-component intervention to help call agents to sit less and move more at work. Three empirical studies were undertaken to achieve this aim; Study 1 explored factors influencing call agent’s workplace PA and SB and strategies perceived to help agents move more and sit less at work. Fifteen focus groups and interviews were conducted across four contact centres in the North West of England and perspectives were captured from three key stakeholder groups including; call agents (n=20), team leaders (n=11) and senior team leaders (n=12). Thematic analysis revealed insights into the impact of high occupational sitting and low PA on call agents physical and mental health, and factors influencing their motivation to move more and sit less. Team leaders, although pivotal, identified their own workload, and agents’ requirement to meet targets, as factors influencing their ability to promote agents to move more and sit less at work. Senior team leaders offered a broad organisational perspective into the business needs and importance of return on investment from PA and SB interventions. Unique factors including continuous monitoring of productivity and personal time, a physical connection to their workstation, and low autonomy over working practices, seemed to limit call agent’s opportunity to move more and sit less at work. Proposed strategies were acknowledgement of PA and SB within policy and job roles, height-adjustable workstations, education and training sessions, and greater interpersonal support. Evaluating the impact of interventions was perceived key for developing a business case and enhancing organisational buy-in. Multi-level interventions embedded into current working practices appeared important for the multiple stakeholders, while addressing concerns regarding productivity. Study 2 used a mixed-methods approach to explore the feasibility of an 8-week non-randomised pre-post SB and PA intervention in one contact centre. Six of 20 team leaders were recruited, with 17 of 84 call agents (78% female, 39.3±11.9 years) completing baseline assessments and 13 completing follow-up. High workload influenced agent and team leader recruitment. Call agents perceived data collection as acceptable, with strategies needed to enhance fidelity. Education sessions, height-adjustable workstations and weekly emails were perceived as the most effective intervention components; however, height-adjustable hot-desks were not feasible. The intervention was largely perceived positively, with call agents and team leaders describing numerous perceived benefits on behavioural, health and work-related outcomes. This study identified unique, pragmatic considerations for conducting a multi-level, multi-component PA and SB intervention and associated evaluation in the challenging contact centre setting. Study 3 evaluated a pilot randomised controlled trial of a multi-component intervention, with (SLAMM+) and without (SLAMM) height-adjustable workstations, in one contact centre. Process and outcome evaluations assessed the response, recruitment and attrition rates, outcome measure completion rates, acceptability of randomisation and the interventions, adverse effects, and derived estimates of preliminary effectiveness. Stakeholders perceived the recruitment, randomisation, data collection and intervention delivery as acceptable, though fluctuating call volumes impacted offline time for agents for data collection and education and training sessions. 59 of 213 eligible call agents (68% female, 30.9±11.6 years) completed baseline, with 39 completing 12-week assessments. There were no adverse events reported. Except height-adjustable workstations, call agents in both arms ranked the individual feedback, education sessions, and weekly emails as the most important intervention components for moving more and sitting less at work, with team leader support, Stand Up Champions and daily logs least important. Both interventions reduced total and prolonged sitting time at work, and a significant difference in mental health was found in SLAMM+ relative to SLAMM at 12 weeks, although more strategies to promote increased PA for both arms are warranted. Overall, the thesis has indicated that following the MRC framework has produced two interventions that appear acceptable in the contact centre setting, and, appear to have positive effects on sitting time, but not PA. Numerous perceived benefits were highlighted across health and work-related outcomes, although unique challenges highlighted in particular, the ongoing challenge surrounding scheduling offline time for call agent in this setting. Interventions need to be embedded into working practices to minimise concerns regarding productivity. Future research should seek to refine the intervention based on the findings from this thesis and evaluate the short and longer-term effectiveness of a full scale multi-component intervention with and without a height-adjustable workstation on behavioural, cardiometabolic, psychosocial and objectively measured work outcomes. If the findings are replicated in larger trials, it could inform changes to policy and practice for the benefit of employees and employers.