Sedentary behaviour and theory- and evidence-informed intervention features to reduce occupational sitting time in Bangladesh : A mixed-methods study

Abstract

Research on sedentary behaviour, a cardiovascular disease (CVD) risk factor, focuses predominantly on developed countries with little undertaken in low-and-middle-income countries (LMIC). The aim of this thesis is to measure sedentary behaviour in desk-based workers and to develop a concept of a theory-based behaviour change intervention to reduce prolonged occupational sitting time (OST) in Bangladesh.

Using a mixed-methods approach, findings from three primary studies were collated. The first study was a cross-sectional survey (n=360 participants) conducted in three workplaces. Regression analyses were used to examine the association of individual level factors with total sedentary time and OST. In the second study, a scoping review (n=43) on workplace health promotion (WHP) interventions for CVD in LMICs was conducted to inform the research, then a descriptive qualitative study was employed to understand the socioecological factors of implementing WHP programs. The third study utilised qualitative methods to identify factors influencing breaking up prolonged OST. Finally, intervention features were developed applying the Behaviour Change Wheel framework.

We found total sedentary time to be 9.6 hours/day (SD±2.35) of which half occurred in workplaces. Significant differences in OST were found by sex, income, worksite, and sitting break pattern. All participants showed enthusiasm for the idea of WHP, but the complexities of implementation were poorly understood. Limited awareness of the health consequences of prolonged sitting, work type, productivity concerns, and perceived negative judgement by others were reported as barriers to interrupting prolonged OST. Findings suggest that multiple levels of behaviour (intrapersonal, inter-personal, organisational and societal) must be addressed in designing interventions for OST. Twenty-five behaviour change techniques were identified and translated for delivery through a mobile phone application.

The research found that sedentary behaviour is high among desk-based workers in Bangladesh. Given Bangladesh’s rapid urbanisation and growing burden of CVD, more research is required into its risk factors for behaviour change. By identifying opportunities for reducing OST in Bangladesh, this thesis contributes to public health evidence and proposes a potential intervention for LMICs. The recommendations offered will strengthen policy and programs to initiate WHP to tackle the increasing burden of CVD in Bangladesh and similar settings.