The purpose of this study was to examine the overall maintenance of behavior during the 12 to 24 month period of the ​Stand&Move@Work​ study and the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change. The design of the study was a cluster randomized trial which was facilitated by researchers for the first 12 months of the study. The primary aim of the study was to examine the maintenance of behavior change (i.e., sitting time) at the 12 month and 24 month marks using objectively measured sedentary behavior (activPAL micro). The secondary aim of the study was to examine the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change during the 12 through 24 months maintenance period. Participants (N=630) included full-time, caucasian, middle-aged office workers. For the primary aim, descriptive means were used to cluster for observations within-persons and were adjusted for age, gender, race, job-type, and ordering effects.. For the secondary aim, descriptive means adjusted for workplace culture and environment were computed. At the 24 month mark, participants spent 280.67 ± 87.67 min/8hr workday sitting and 161.94 ± 85.87 min/8hr workday standing. The top performing worksites displayed reductions in sitting time which largely translated into standing time by about 30 minutes per 8 hour workday at 24 months. Feasibility findings indicated that implementation strategies do not show differences between the top 25% and bottom 25% performing worksites. This study provides insight to implementation strategies for interventions in the workplace.

While type 2 diabetes (T2D) rates have soared, the number of Americans classified as ‘prediabetic’ has also increased. Despite this, current preventative approaches are costly and often not without undue side-effects. Instead, behavioral lifestyle approaches hold promise in reducing conversion rates of T2D as the latest treatment option that could mitigate and transform disease management. However, present interventions do not possess the scope necessary for implementation in a realistic, scalable way that can target the large at-risk population.
The application (app) “BeWell24” mitigates this diabetes risk through targeting sleep, physical activity, sedentary behavior, and diet, and is being delivered through mHealth technology to attenuate the higher-risk of the prediabetic Veteran population. In order for full scale dissemination, this thesis examines a provider perspective of the ‘Post-intervention interview guide’, performed with a Phoenix Veterans Affairs Health Care System (PVAHCS) provider. It then suggests revisions to the interview guide based on the provider’s interview and existing literature. This thesis also emphasizes the rationale behind these proposed changes to be organized in line with the iPARIHS framework (integrated Promoting Action on Research Implementation in Health Services).
Overall, the provider responded positively to BeWell24 and the ‘Post-intervention interview guide’, with constructive suggestions for each question in the interview guide. The main theme of the provider’s answers and comments were to prioritize efficiency and preserve standard clinical flow. A revised interview guide is provided, which prospectively presents as a more brief and focused interview organized by the iPARIHS framework. This revised interview guide could aid in the clarity of provider responses, specifically for the prospective interviews of the ongoing larger BeWell24 study and future studies.

The purpose of this study was to examine the feasibility and preliminary efficacy of a theory-driven and a atheoretical reminder point-of-choice (PoC) prompt interventions on reducing workplace sedentary behavior in office workers with self-reported low usage (<4 hours per day) of their sit-stand workstations in the standing position. The design of this study was a cross-over trial including randomization into either the theory-driven or atheoertical reminder condition, after completion of a no prompt control condition. Participants (N=19) included full-time, primarily female, Caucasian, middle-aged office workers. The primary aim of this study was to assess the feasibility of these two PoC prompt conditions on reducing sedentary behaviors through the use of a Therapy Evaluation Questionnaire. The secondary aim of this study was to assess the preliminary efficacy of the two PoC prompt conditions on reducing sedentary behaviors relative to no-prompt control using the activPAL micro device. For the primary aim, descriptive means adjusted for ordering effect were computed. For the secondary aim, mixed-effects regression models were used to cluster for observations within-persons and were adjusted for age, gender, race, job-type, and ordering effects. During the no-prompt control, participants spent 267.90 ± 68.01 sitting and 170.20 ± 69.34 min/8hr workday standing. The reminder PoC prompt condition significantly increased sanding time (b[se] = 24.52 [11.09], p=0.034) while the theory-driven PoC condition significantly decreased time spent in long sitting bouts b[se] = -34.86 [16.20], p=0.036), both relative to no prompt control. No statistically significant reductions in sitting time were seen in either PoC prompt condition. Furthermore, no statistically significant differences between the two PoC prompt conditions were observed. This study provides feasibility insight in addition to objective measures of sedentary behaviors regarding the use of PoC prompt interventions in the workplace.