Introduction: Long periods of sitting have been associated with an increased risk of a wide range of negative health outcomes, such as all-cause mortality, cardiometabolic diseases, and musculoskeletal symptoms. The office workplace is the domain in which most sedentary time is accumulated. As a result of the COVID-19 pandemic, office-based work has increasingly shifted to hybrid work models, which combines work from home and in the office. This new working modality has continued post-pandemic and appears to further increase levels of sedentary behaviour and, consequently, could further worsen the health and well-being of these workers. Especially, home-based working has been associated with increased musculoskeletal symptoms, that were partly explained by increased sitting time. Although evidence has shown that workplace interventions to break and reduce sedentary behaviour can be effective, there is still a lack of evidence regarding their impact in hybrid work contexts. Digital strategies have demonstrated the potential to deliver behavioural change interventions. However, no research has yet examined the effectiveness of such approaches in the home-office or hybrid settings. For that reason, it is critical to develop and evaluate new interventions considering the end- users alongside other stakeholders. Therefore, the aim of this thesis was to co-create a digital-based intervention for reducing sedentary behaviour among hybrid office workers and to explore the activity patterns of these workers, as well as their relationships with musculoskeletal symptoms. Methods: This thesis is part of the Click2Move programme, which includes two different doctoral theses focused on the development, implementation and evaluation of the programme. Specifically, the methodology applied in the present thesis was a mixed- methods approach that includes a systematic review, followed by a co-creation phase and a compositional data analysis. These methodological components were applied across four individual studies. In study one, a systematic review and meta-analysis were conducted to examine the effectiveness of digital workplace interventions to reduce sedentary behaviour among office workers who work from home or not. The second study focused on collating an expert consensus on the most feasible and usable digital work strategies to reduce sedentary behaviour in a home-office setting based on the findings of the literature. This study also included a modified Delphi study in which focus groups were undertaken and analysed. The third study was developed incorporating the information obtained from the previous two, but also from other qualitative studies developed within the Click2Move programme, resulting in a protocol study to implement and evaluate the intervention developed. This study describes the Click2Move programme and its implementation and evaluation. The fourth and final research study of this thesis used the baseline data from the Click2Move to examine the sedentary behaviour and physical activity patterns of hybrid workers and examined the potential impact of replacing sitting time with moderate-to-vigorous intensity physical activity on musculoskeletal symptoms through compositional analysis approaches. Results: The literature review identified a wide variety of interventions and technological features. Delivery of information and educational materials were the most common strategies, followed by reminders to break sitting time, and feedback provision. Technological features, such as text messages, websites, videos and use of desktop or mobile phone applications were the most common for delivering information or reminders. The review concluded that multicomponent (i.e., including at least two levels of strategies: individual, environmental and/or social or organisational) digital workplace interventions are effective in reducing sedentary behaviour in office workers, showing a reduction of -29.9 (95% CI: -45.3, -14.5) minutes per 8 hours of workday. However, none of the included studies had been conducted in a home-office context. The second study identified a total of 36 work strategies, 18 of which reached consensus as feasible strategies to reduce sedentary behaviour among office workers when working from home. The digital elements for delivering the work strategies were divided into five categories including a total of 30 elements, 16 of which were considered useful for delivering such strategies. According to experts, these strategies could be transferable to both, office and home settings. Additionally, they highlighted the importance of social, individual and environmental factors working together to facilitate and maximize the implementation of the strategies and the achievement of behaviour change. Built on the results of the literature study and the Delphi study among experts, the protocol study for the evaluation of a multicomponent digital-based intervention (i.e., Click2Move) was defined and described in the third research chapter. The intervention consists of an activity tracker working alongside a mobile phone application, to reduce occupational sedentary behaviour in hybrid office workers. Finally, the fourth study found that hybrid- office workers sit 10.95 hours per day, which translates into 6.46 working hours (hours per 8 hours workday) sitting. On days of home-office work, sitting time is higher (6.62 h/8h workday) than days of office location work (6.28 h/8h workday; p<0.001). Moreover, hybrid workers perform less moderate-to-vigorous physical activity on days of homeoffice work (0.08 h/8h workday) than in the office (0.18 h/8h workday; p<0.001). Regarding light-intensity physical activity, although statistically significant differences were found between contexts (p<0.001), the difference is small, being higher at home (0.28 vs 0.27 h/8h workday). Total sitting time was associated with musculoskeletal symptoms (OR: 2.75, 95% CI: 1.24, 6.55) but reallocating it with moderate-to-vigorous physical activity was associated with a gradual decrease in the odds of such symptoms, reaching an estimated odd ratio of 0.45 after substituting 60 minutes. Conclusions: The results of this thesis contribute to the development and implementation of future digital interventions aimed at positively impacting sedentary behaviour and its associated effects on health among hybrid workers. Furthermore, the findings of this thesis promote information about the different patterns of activity and sedentary behaviour according to the context in which they work (home or office), as well as their impact on the well-being and health of hybrid workers, contributing to active and healthy home-office work and public health policies.
Iris Parés Salomón (Fri,) studied this question.