This qualitative evaluation of the Stand@Work study presents important formative research that describes office workers’ user experiences and perceptions about the acceptability, and feasibility of a sit-stand workstation modification to their usual office desk. As a relatively new area of intervention evaluation, this study was also an opportunity to assess whether the workplace culture of sitting to undertake desk-based work could be challenged through an environmental modification alone.
The sit-stand workstations were implemented within the study workplace through a collaborative approach. Managers responsible for initiating the trial promoted the study as an opportunity to evaluate how effective and acceptable sit-stand workstations were as a sitting reduction strategy, before committing to a larger roll out, given the lack of evidence to guide decision making. Employees felt they were contributing to both research and organisational health policy, as they were consulted about their views on the workstations while they were given an opportunity to participate in a new area of health promotion that aligned with the organisations purpose. This is reflected in their reasons for participating, which encompassed both individual motives (e.g., trying something new, interest in potential health benefits, flexibility to work standing up) and organisational factors (e.g., relevance to their own and their organisation’s work around workplace wellness and cardiovascular health).
The collaborative engagement of employees in the Stand@Work study is consistent with previous qualitative findings from office workers, that implementing any workplace sitting reduction strategy is both the responsibility of individual employees and organisational management , and evidence that greater investment in educating and motivating workers to use sit-stand workstations results in greater uptake . The collaborative approach taken in this study is likely to have contributed to participants’ willingness to try using the sit-stand desk in a standing position. This is consistent with one study where the intervention group comprised sedentary behaviour researchers who were most likely highly supportive of working in a standing posture, educated on the potential health effects of prolonged sitting, and applying ‘sit-less’ strategies in the workplace already with management support . In contrast, another study took a top-down approach where management decided to install a combination of electric powered and manually operated sit-stand desks for all staff in an office refurbishment with little information provided to employers on how to use the new desks, resulting in varying degrees of uptake in desk use while standing up .
While the study workplace was a health-related non-government organisation, not all participants described positive user experiences, although most did. Positive feedback about using sit-stand workstations revolved around surprise and delight with the ease of use of the device, having a supportive work environment, and having choice and flexibility in selecting whether and when to sit or stand. Occupational health and safety practitioners have emphasised the importance for workers to have choice over whether they sit or stand to work, and expressed concerns regarding the potential for perceived coercion when implementing any sitting reduction strategy as employees could feel pressured to stand for extended periods, highlighting a tension between optional standing versus compulsory standing . Stand@Work overcame this with clear instructions from the start that participants did not have to stand to work, and that their participation was an evaluation to inform their workplace wellness program and future procurement decisions. Another important issue is that we do not yet have evidence based public health recommendations to guide sit-stand workstation users on how often they should break up sitting time or how long they should stand for in each bout. Current guidelines broadly recommend that adults should reduce the time they spend sedentary or sitting and break up prolonged periods of sitting [23–25]. In our view some caution is needed so that we don’t send a message to stand all day at work either, as this can increase the risk on musculoskeletal problems and varicose veins [26, 27]. Participants in this study were advised to alternate between sitting and standing and build standing time gradually, but then determined their own preferred approach.
Further, participants did not hesitate to give negative feedback about aspects of the study and sit-stand workstations. To illustrate, when asked about their willingness to continue using the sit-stand workstations, the majority of participants responded to the effect of “yes, but…” and provided an unprompted wish list of attributes that they would like to see as part of any new sit-stand workstations that might be purchased in the future. Interestingly, almost all negative feedback related to participant perceptions of design limitations of the model of sit-stand workstation trialled, such as the distance of the computer screen to their eyes, loss of desk space, or platform instability when typing. Thus, it would appear that it was not the act of standing up to work that posed a barrier per se, but rather workstation design, and it is possible that sentiments about future use or considerations about maintenance and sustainability of standing to work may be different should another model of sit-stand workstation, or height adjustable desk be used. In fact, most participants talked about how much they liked having the option to stand to complete desk-based work, even if they did not like the particular device trialled.
We identified several clear patterns of using the workstations in the sitting and standing position in the Stand@Work study. Participants cited task-based, time-based or non-specific routines, with some mentioning they felt they were developing a new habit. Future research could examine whether one approach might be more suitable for certain types of workers or job roles. For instance, some participants reported viewing standing up to work as a personal challenge to develop a new habit; and while this was expressed by only a few participants, it is potentially novel and could be explored in future studies to see if it might be another approach to reducing sitting time.
Conducting phone calls was cited as a barrier to using the workstation standing by a majority of participants in the open plan section of the office, despite being provided with a headset device that made this ergonomically possible. Participants indicated that standing up while on the phone could disturb colleagues in the open plan office and was also an issue when phone calls were confidential. This could present a particular challenge for implementing similar desk modifications in open plan workplaces that have a primary function built around phone calls, such as call centres. Future research on acceptability and feasibility in this setting is recommended.
There were some positive, yet unintended consequences of the trial where participants discussed an increased consciousness about the need to sit less generally and transferred this new awareness into non-work contexts, such as standing up on public transport or when working at home. However, we did not find a quantitative reduction in sitting time in non-occupational domains , and this possible transference of reduced sitting into non-work time has not been reported in previous studies. Additionally, we found no indication that standing up to work caused harm to participants and this may be attributable to the emphasis on gradually building up durations of standing time for those who chose to work in a standing position, the ability to easily switch between positions and the relatively short intervention period.
From an employer perspective, one of the potential advantages of this type of environmental modification to reduce sitting is that work time is not interrupted. Usual tasks can still be undertaken in the same location, and from our participant’s feedback, there may also be productivity improvements due to increased alertness, concentration and reduced fatigue, especially later in the day. This needs to be validated by more objective measures, but very few users reported productivity impairments from workstation use. Interestingly, those who were distracted by standing generally felt this lessened over time, as more people were involved in the trial and seeing someone standing up to work was less of a novelty. Since the completion of the trial, the organisation has invested in additional workstations of a newer model that overcomes many of the design limitations reported by users (i.e. taller height limits, wider and more stable keyboard platforms, and sits more stable on an existing desk in the sitting position). Nonetheless, it is too early to make a strong business case for large scale investment in sit-stand workstations, as the health and productivity benefits are yet to be quantified and there is a need for more evidence about longer term use and maintenance of reductions in sitting time reported elsewhere [16–20].
It would also be important to explore lower cost options for reducing sitting because not all workplaces may be able to install or afford sit-stand workstations. Participants reported sitting less in other domains of their day or finding alternatives to break up their sitting time, suggesting that other strategies may be viable as well, whether as complementary or alternative components to using sit-stand workstation and height adjustable desks. Participants also noted the emergence of a ‘sitting less culture’ within the workplace and there are a number of ways this could be encouraged. A menu of sitting reduction options could be designed and provided to workplaces to allow more choice for employers and employees.
Strengths and limitations
A strength of the study was the collaborative approach to workplace health promotion practice, which facilitates and informs organisational planning in terms of procurement and workplace health promotion. Furthermore, for a qualitative evaluation, the study had a relatively large sample size. A limitation of the study was the use of a convenience sample of participants working in a health-related field who were mostly female, had tertiary education levels, and were of healthy BMI. The generalisability of the results to other office/desk-based workers especially in non-health related workplaces remains unclear. Another limitation of the study was the short term follow-up. Longer term follow up was not possible as participants could only trial the sit-stand workstations for four weeks and we did not have the opportunity to re-assess their behaviours for example at 12 months.