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RES E AR C H A R T I C L E Open Access
Desk-based workers’ perspectives on using
sit-stand workstations: a qualitative analysis of
the Stand@Work study
Josephine Y Chau
1
, Michelle Daley
2
, Anu Srinivasan
2
,ScottDunn
2
, Adrian E Bauman
1
and Hidde P van der Ploeg
1,3*
Abstract
Background: Prolonged sitting time has been identified as a health risk factor. Sit-stand workstations allow desk
workers to alternate between sitting and standing throughout the working day, but not much is known about their
acceptability and feasibility. Hence, the aim of this study was to qualitatively evaluate the acceptability, feasibility
and perceptions of using sit-stand workstations in a group of desk-based office workers.
Methods: This article describes the qualitative evaluation of the randomized controlled cross-over Stand@Work pilot
trial. Participants were adult employees recruited from a non-government health agency in Sydney, Australia. The
intervention involved using an Ergotron Workfit S sit-stand workstation for four weeks. After the four week intervention,
participants shared their perceptions and experiences of using the sit-stand workstation in focus group interviews with
4–5 participants. Topics covered in the focus groups included patterns of workstation use, barriers and facilitators to
standing while working, effects on work performance, physical impacts, and feasibility in the office. Focus group field
notes and transcripts were analysed in an iterative process during and after the data collection period to identify the
main concepts and themes.
Results: During nine 45-min focus groups, a total of 42 participants were interviewed. Participants were largely intrinsically
motivated to try the sit-stand workstation, mostly because of curiosity to try something new, interest in potential health
benefits, and the relevance to the participant’sownandorganisation’s work. Most participants used the sit-stand
workstation and three common usage patterns were identified: task-based routine, time-based routine, and no
particular routine. Common barriers to sit-stand workstation use were working in an open plan office, and issues with
sit-stand workstation design. Common facilitators of sit-stand workstation use were a supportive work environment
conducive to standing, perceived physical health benefits, and perceived work benefits. When prompted, most
participants indicated they were interested in using a sit-stand workstation in the future.
Conclusions: The use of a sit-stand workstation in this group of desk-based office workers was generally perceived as
acceptable and feasible. Future studies are needed to explore this in different desk-based work populations and settings.
Background
Recently, sedentary behaviour has been emerging as a po-
tential health risk behaviour for premature mortality and
chronic health conditions such as cardiovascular disease
and diabetes mellitus, even when physical activity is taken
into account [1-5]. Sedentary behaviour is defined as activ-
ities that are done sitting or reclining and cost ≤1.5 times
the basal metabolic rate [6].
Energy expenditure at work has decreased, with workers
becoming more sedentary and less active over the past
50 years [7], and this trend has been projected to continue
to 2030 [8]. Among Australian workers, 42% and 47% of
men and women, respectively, characterise their jobs as
involving ‘mostly sitting’, and those working full-time in
such jobs sit for 6.3 h/day at work, on average [9]. In light
of the increasingly sedentary nature of modern work and
the high levels of occupational sitting time, it is important
* Correspondence: hp.vanderploeg@vumc.nl
1
Prevention Research Collaboration, Sydney School of Public Health,
University of Sydney, Medical Foundation Building (K25), Camperdown, NSW
2006, Australia
3
Department of Public and Occupational Health, EMGO Institute for Health
and Care Research, VU University Medical Center, van der Boechorststraat 7,
1081 BT Amsterdam, The Netherlands
Full list of author information is available at the end of the article
© 2014 Chau et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Chau et al. BMC Public Health 2014, 14:752
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to address sedentary behaviour as part of workplace health
promotion.
The workplace has been highlighted as an important
setting for health promotion globally and nationally [10].
Workers in desk-based occupations are considered a key
target group for workplace sitting reduction strategies
[11,12]. The current literature indicates that physical
activity workplace interventions are not effective for
specifical ly addressing workers’ sedentary behaviour and
also highlights a paucity of workplace interventions that
focus specifically on reducing workers’ sitting time [13].
Modifying the workplace environment by installing sit-
stand workstations is one potential approach for reducing
prolonged sitting among desk-based workers during work-
ing hours. Especially, as standing time has recently been
positively associated with lower all-cause and cardiovas-
cular disease mortality [14]. Much research on sit-stand
workstations has been from the perspective of occupa-
tional ergonomics, related to musculoskeletal health and
physical discomfort [15], and not to the prevention of car-
diovascular and metabolic diseases. While research has
begun to quantitatively examine the effectiveness of sit-
stand workstations for reducing sitting and increasing
standing during working hours as a strategy for chronic
disease prevention [16-19], to our knowledge, only one
study thus far has collected detailed qualitative data to
examine user experiences and perspectives related to sit-
stand w orkstations [17]. Hence, the aim of this study
was to qualitatively e valuate the acceptability, fea sibility
and perceptions of using sit-stand work stations in a
group of desk-based office workers in Sydney, Australia.
Methods
The study was approved by the University of Sydney Hu-
man Research Ethics Committee (No. 08-2011/14067) and
all participants gave written informed consent. The study
is registered with the Australian New Zealand Clinical
Trials Registry (No. ACTRN 12612000072819). This quali-
tative evaluation is one component of the Stand@Work
study. Details about the Stand@Work study and its quanti-
tative evaluation are provided elsewhere [20]. We report
this qualitative study following the RA TS qualitative re-
search review guidelines (http://www.biomedcen tral.com/
authors/rats).
Participants and design
Participants were employees recruited from a non-
government health agency in Sydney, Australia. Inclusion
criteria included: aged at least 18 years old, working at
least three days per week, and with sufficient English
language proficiency to complete study tasks. The project
was advertised to staff as part of their workplace wellness
program and interested employees contacted the research
team, who provided additional study information and an
expression of interest form. Eligible staff members who
returned an expression of interest form were randomly
drawn from a ballot by a researcher in the presence of po-
tential participants and other researchers, and were in-
cluded in the study after providing written informed
consent. The first four participants drawn from the ballot
were allocated to the intervention group to use a sit-stand
workstation for four weeks, the next four participants
drawn from the ballot served as the control group. The
remaining participants were assigned to the waitlist con-
trol condition and were placed on the waiting list in seven
groups (4–5 people per group). After the initial four
weeks, the previous control group (study group 2) re-
ceived the intervention with the next group from the bal-
lot draw serving as their controls (study group 3). This
was repeated until all nine groups had received the in-
tervention. This study design was used to maximise the
evaluation sample size taking into account the five avail-
able sit-stand workstations. The intervention involved
using an Ergotron model Workfit S sit-stand workstation
(Figure 1) for four weeks. Users were provided with a
demonstration and instructions on the use of the device,
but there was no accompanying behavioural intervention.
The study design and recruitment is described in more de-
tail elsewhere [20]. The current manuscript adhered to the
RATS guidelines for reporting qualitative studies.
Procedures
After trialling the sit-stand workstation for four weeks,
intervention participants attended a focus group facili-
tated by two membe rs of the research team who were
located at their workplace. One researcher facilitated
each focus group discussion (MD), while the other took
notes (AS). All focus groups were digitally recorded and
transcribed verbatim for the purpose of analysis. We
conducted focus groups rather than individua l interviews
due to time and resource constraints.
Each focus group discussion involved four to five par-
ticipants and ran for approximately 45 minutes. Using a
pre-prepared question guide (Table 1), participants were
invited to share their views on a range of issues relate d
to their experience with using the sit-stand workstation
(e.g., patterns of workstation use, barriers and facilitators
to standing while working, effects on work performance,
physical impacts, feasibility in the office and so on).
Analysis
We analysed the focus group field notes and transcripts in
an iterative process during and after the data collection
period to identify the main concepts and themes. The focus
group scribe reviewed the field notes following each session
and generated a summary of main ideas based on the pre-
prepared question guide (a priori themes of interest) and
any emergent themes. These focus group summaries were
Chau et al. BMC Public Health 2014, 14:752 Page 2 of 10
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then used as the basis of a framework for coding focus
group transcripts (checked and agreed by JYC and MD).
Transcripts were scanned for words or phrases that were
relevant to these topics and assigned codes using NVIVO
Version 10 (QSR International, 2013). All focus group re-
sponses are presented by focus group and participant num-
ber only, in order to ensure participant anonymity. Due to
the small number of participants, who all come from the
same workplace, age and gender constituted identifying
factors.
Results
A total of nine focus groups (N = 42 participants) were
held from September 2011 to July 2012. Each group had
four to five participants, and one person was interviewed
individually as they were not able to attend a focus group.
Table 2 presents the personal characteristics of the study
participants.
Motivation for participating in the study and trying out a
sit-stand workstation
Participants were largely intrinsically motivated to join the
trial and these motivations could be grouped into three
main themes: 1) curiosity to try something new; 2) interest
in potential health benefits; and 3) relevance to the partici-
pant’s own and organisation’swork.
Many expressed a curiosity about sit-stand workstations
and were interested in trying something new or different
at work. The idea of ‘trying before buying’ appealed to
some participants, as they did not feel as though they
would have to commit to ongoing use if it was not their
preference.
… to give it a test without actually having to com mit
to it really, long term… the trial aspect was very
interesting. (group 4, participant 1)
Other participants were motivated by potential health
benefits that they had heard were associated with sitting
less and/or being able to stand while going about their
usual daily work in the office. Potential benefits men-
tioned included musculoskeletal complaint s, postural is-
sues, energy levels and cardio vascular health.
I wanted to know that I wasn’t putting strain on my
cardiovascular system and arteries by sitting 8 hours
at a time and I just wanted to see if it had a difference
to my energy levels and my problems with my back
(group 7, participant 2)
Figure 1 Ergotron Workfit S sit-stand workstation.
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Some participants noted that this research was relevant
to their own and their organisation’s work focus. For these
participants, being able to contribute to research and
workplace policy, as well as experiencing first-hand what
it was like to use a sit-stand workstation were motivators
for engaging in the trial.
A small number of participants cited extrinsic factors
for trialling the sit-stand workstation, such as encourage-
ment from colleagues or managers.
General impressions of using sit-stand workstations
Participant’s impressions of the sit-stand workstation
revolved around three sub-themes 1) ‘surprise an d de-
light’; 2) impact on a bility to work; and 3) having choice.
Many participants expressed surprise and delight about
the sit-stand work stations , and discusse d how they used
thedevicemorethantheythoughttheywouldandhow
they experienced unexpected benefits, such a s improved
posture and increased alertness. Negative impressions
that impacted on user comfort a nd work ability focused
on specific design issues of the sit-stand workstation. A
few participant s described how they enjoyed having the
Table 1 Focus group questions
Questions
1) What motivated you to participate in the trial of the sit-stand
workstation?
2) What were your general impressions of using the sit-stand
workstation?
Prompts
a) How much did you use the sit-stand workstation?
b) Was there anything about using the sit-stand workstation that you
particularly liked?
c) Was there anything that you particularly disliked?
d) Any comments about the work surface attached to the
workstation?
3) What types of tasks did you generally do standing up?
Prompts
a) Where there times of the day when you stood more?
b) What made you change from standing to sitting?
c) Were there any reasons for those decisions?
4) What types of tasks did you generally do sitting down?
Prompts
a) Where there times of the day when you sat down more?
b) What made you change from sitting to standing?
c) Were there any reasons for those decisions?
5) Did anything encourage you to stand up more to complete your
work?
Prompts
a) Were other people around you using a workstation?
b) Did certain types of footwear make it easier?
c) Were you able to stand for longer periods over time?
d) How long did you tend to stand up for each time?
6) Was there anything that stopped you from standing more than
you did?
Prompts
a) Did being in an open plan office make any difference?
b) Were there any tasks that were not practical while standing?
c) Was it comfortable to stand and work?
d) Did you have any injuries or other personal factors?
7) What types of physical changes did you notice from using the
workstation?
Prompts
a) Any changes in posture?
b) Any musculo-skeletal changes?
c) Any changes in tiredness or energy levels?
d) Were these related to using the workstation?
8) What types of changes in your work performance did you notice
from using the sit-stand workstation?
Prompts
a) Any effect on productivity?
b) Any effect on ability to concentrate?
Table 1 Focus group questions (Continued)
9) Would you continue to use the sit-stand workstation if you could?
Prompt: why/why not?
10) In closing, is there anything else you’d like to say about your
experience of using the workstation or about your experience of
wearing the activity monitors?
Table 2 Participant characteristics of the Stand@Work
study
Characteristic Mean (SD) or n (%)
N42
Sex (female) 36 (86%)
Age (years)
a
38 (11)
Body mass index (kg/m
2
)
b
Underweight (<18.5) 5 (13%)
Normal range (18.5 – 24.9) 20 (50%)
Overweight (25.0 – 29.9) 10 (25%)
Obese (≥30.0) 5 (13%)
Highest level of education
Completed all years of high school 3 (7%)
Trade, technical certificate or diploma 6 (14%)
University 33 (79%)
Working full time 34 (81%)
Office type
Own office 6 (14%)
Open-plan 36 (86%)
a. Data missing for n = 1.
b. Data missing for n = 2.
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choice and flexibility to work either sitting or standing
positions.
I just enjoyed the choice, you know, since it’s been gone,
you know, I sit there and go “I should stand up and do
this task”. Yeah purely for choice and, yep, being able
to make that active choice. (group 5, participant 1)
Use of sit-stand workstation sitting vs. standing
Participants’ patterns of use of the sit-stand workstation
while sitting or standing could be grouped into three
sub-categories: 1) task-based routine; 2) time-based rou-
tine; and 3) no particular routine.
Some participants took a task-based approach to switch-
ing between sitting and standing postures over the course
of their workday. For example, they would sit to tackle
large word processing tasks, especially those that required
using multiple resources and “spreading out” work mate-
rials, talk on the phone (for those in the open plan office)
and stand to check emails, read documents on the com-
puter screen, or carry out small word processing tasks. It
is worth noting there was some variation in the tasks dif-
ferent users preferred to undertake in each position.
If I need to get stuck into writing something or I need
to go through to one of my files, I’ll sit back down
again, and then if I’m replying to emails, or you know
just working on one document on the screen, then I’ll
get back up again. (group 4, participant 1)
Others described using a time-based routine. One time-
based routine involved setting specific durations for sitting
and standing (e.g. every 30 or 60 minutes).
When I saw the clock tick over the hour, I was like,
“get up”. (group 5, participant 1)
I’d tried to do half hour on and half hour off. (group
6, participant 1)
Probably for around about 30 – 40 minute bouts, I
suppose, during the day. Probably once every two
hours or so. (group 9, participant 1)
Another time-based routine involved sitting or stand-
ing to work based on the time of day. For example some
participants indicated they would stand to start the day,
after lunch or later in the afternoon, when they felt
lower on energy, alertness, and capacity to concentrate.
I got in and normally tried to stand straight away
because I felt good standing up and it was probably
best to stand first thing in the morning. (group 1,
participant 3)
It was better concentrating in the afternoon because you
tend to get a bit dozy after lunch, so I think standing
after lunch was much better. (group 3, participant 3)
It’s a good change for me to be able to stand, and
definitely the afternoon is a point where I have a lag. It’s
a dead hour after lunch. It’s always hard getting over
that hump into the afternoon. (group 8, participant 4)
Other participants followed no specific routine and
simply alternated between sitting and standing postures
whenever they felt like it or if they felt tired from being
in one posture.
I didn’t stand for long periods. I stood and sat - I was
like a Jack-in-the-box. I was up and down, up and
down, rather than standing for a long time and sitting
for a while. (group 2, participant 2)
I didn’t really assign a pattern to it, I was just like,
“oh, I’ve been sitting for a bit, I ’ll stand up or I’m
getting a bit tired ”. (group 1, participant 3)
A few participants described standing to work as simi-
lar to developing a new habit and some viewed being
able to stand progressively for longer periods as a per-
sonal challenge.
I used to look at the clock and go “I’ll just do
20 minutes more” and, like , it was always like a little
self-competition going. (group 4, participant 6)
I think they say it takes 3 or 6 weeks to develop a new
habit and this is really kind of like having a new
habit. (group 6, participant 4)
Barriers to using sit-stand workstation in a standing position
When participants discussed the barriers they faced re-
garding using the sit-stand workstation in a standing
position, they were generally related to either 1) working
in the open plan office, or 2) sit-stand workstation de-
sign. Some described feeling self-conscious and con-
cerned about disturbing others in the open plan office as
inhibitors to standing. This included feeling they were
invading their neighbouring colleague’s privacy, revealing
confidential communications, and/or disturbing others
when talking on the phone.
I did feel if I was doing something confidential that it
was more on show, so I was a little bit wary of that.
(group 3, participant 2)
When I’m on the phone standing up I feel a little bit
conscious because I feel like I’m shouting out across
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everyone and I’m sort of distracting people next to me.
(group 7, participant 3)
Some participants reported being more distracted when
standing up, particularly in the open plan office; yet other
participants reported being more focused when standing
up to work. There was a view that distractions did or
would lessen over time, as more workstation users were in
the office and employees adapted to standing as a norm.
I think if everybody was standing/sitting all the time,
nobody would actually care, people would get used to it
because if I had people moving all the time and I was
standing up, I would probably learn to concentrate more
with those distractions. (group 1, participant 4)
Many participants repor ted issues with the design of
the sit-stand workstation that made it difficult or less
comfortable for them to work standing up. These in-
cluded an unstable work platform when typing, an un-
comfortable monitor distance, height restrictions in the
standing position for taller users, and the loss of desk
space for those users who liked to spread out materials
to work.
I think it kind of depends on your working style, I
think if you are somebody who just does nothing with
a pen and paper or rarely or very rarely does, it’s
perfect because you know you’ve got everything there
that you need, but I, I’m a person who often needs to
stop typing and starting jotting things down or
mapping things out or, you know, with a good old
fashion pen and paper, and then you’re like “okay, oh
that’s wobbling”. (group 5, participant 2)
I found it cut down on my desk space which was a
little bit annoying sometimes. (group 5, participant 1)
Other users also mentioned physical discomfort as a
barrier to standing as the ergonomic setup for the sit-
stand workstation differed from their usu ally desk setup.
E.g., sore eyes because of the closer monitor distance
when upright, wrist discomfort for mouse work
Sometimes I would be typing as I was standing and
going “oh wow I’m getting major pain … in my
forearms” and so that was “oh it would be nice if it
was already set at your height, perfectly” so you didn’t
have to (adjust it every time). (group 7, participant 2)
Facilitators to using the sit-stand workstation in a standing
position
Participants discussed a range of factors that encouraged
or enabled them to work in a standing position. These
can be grouped into three areas 1) a supportive work en-
vironment conducive to standing; 2) perceived physical
health benefits; and 3) perceived work benefits.
Many participants felt that a supportive work environ-
ment helped to normalise standing at work in the open
planned space. They said that seeing others standing in
the office prompted them to also stand up, and it also
created a more sociable work atmosphere and encour-
aged more personal interaction and communication.
It does make it a lot more sociable environment… Ithink
it encourages the interaction with going to speak to people
as opposed to just always reverting to an email and
sitting in your own little silo. (group 4, participant 2)
You don’t feel alone, you know, you’re going to stick
out like a sore thumb when you are doing work but it’s
good when other people do . (group 8, participant 1)
Some participants described perceived physical improve-
ments, such as reduced back pain and fatigue and in-
creased energy levels, as facilitators to standing more.
Others reported improved productivity, alertness, and con-
centration. There were design aspects that made standing
up to work an easy thing to do as well.
I found my back hurt less as well, ‘cause I’ve got back
issues and I found it a lot better, and I was worried
about it, you know, maybe it will be weird, but my
back has hurt a lot less standing up than sitting.
(group 2, participant 2)
I felt better at the end of the day. I felt a bit more not
as tired at the end of the day. (group 5, participant 2)
I was less fidgety I found it really good, cause I could
jump up and down and I found I got a lot more done.
(group 2, participant 1)
Willingness to continue using sit-stand workstations
Participants gave mixed responses when asked whether
they would like to continue using the sit-stand work-
station after the trial. A majority of part icipants was in
favour of using a sit-stand workstation in the future, but
some participants indicated they would prefer a different
model workstation.
Some participants did not want to continue to use
the sit-stand workstation. It is worth noting however
that almost all negative responses related to design is-
sues spec ific to th e sit-stand workstation model that
was trialled.
I don’t want to stand up, but not so much that I
would knock it back… I would get used to it and I
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would build it in to my day but I wouldn’t go looking
for it. (group 6, participant 5)
Honestly, no and that’s not becau se I didn’t like
standing up as much… it was the desk… I found it
quite a challenge with just the way I work. (group 1,
participant 1)
The majority of participants expressed a willingness
and desire to keep using a sit-stand workstation. How-
ever, few participants indicated that they would like to
use sit-stand workstations in the future without further
qualifying their response. Nearly all named improve-
ments they would want in the sit-stand workstation and
provided an unprompted list of attributes of a sit-stand
workstation that they would happily use in the longer
term. Suggestions for improvement included having
more desk space, less movement in the workstation
when in the standing position, and to better adjust the
unit for taller participants.
I would love to have it back, I just think it’s great to
have that option of sitting standing and not have to be
tied to sitting down all day. ( group 3, participant 2)
I would actually like one that can be adjusted to be,
you know, your height and also can be adjusted a s to
how far it is from your eyes. (group 1, participant 2)
Some participants also suggested alternatives to using
sit-stand workstations to reduce sitting time in the of-
fice, including computer prompts to stand up or having
access to a standing ‘hot desk’.
Changes in sitting and standing behaviours since the trial
At the end of the discussion, participa nts had the chance
to make general comments about their involvement in
the study. Many comment s related to increased aware-
ness about the time they spent sitting each day, and their
changes in sitting or standing patterns since the sit-
stand workstation trial ended and they no longer having
had access to the workstation. Examples included choos-
ing to stand more during meetings, or adapting the
home environment to sit less. Interestingly, for some, in-
volvement in the study had shifted their view about
standing and they were less likely to want or need to sit
on public transport during their daily commute.
I just learnt to tolerate to stand a little longer now. So
in a lot of, like, meetings I go to I get up out of my seat
and stand. ( group 3, participant 1)
When I’m at home on my laptop, I take it down to the
kitchen bench because it’s high enough for me to stand
there and do what I need to do, so I really prefer
standing now. (group 3, participant 1)
Standing on trains… 70% of my choice and 30% is
simply because there are no seats… I’ve sat all day at
work so I just would stand but yeah, now I think I like
standing more. (group 6, participant 3)
Some participants noted changes in their own perspec-
tive and consciousness about sitting and standing as well
as seeing changes in their workplace culture and norms.
There’s definitely more (standi ng). I think it’s the
awareness of all this happening and I think people
think “I can stand for a meeting. It’s okay to stand”… I
was actually in an externa l meeting yesterday with my
colleague and she got up and stood up and the
facilitator kind of looked at her as if to say “why are
you standing up?”…I just thought, you know, it’s quite
common in our workplace to do that now, but clearly
this woman wasn’t used to that sort of thing
happening. (group 3, participant 2)
Discussion
This qualitative evaluation of the Stand@Work study pre-
sents important formative research that describes office
workers’ user experiences and perceptions about the ac-
ceptability, and feasibility of a sit-stand workstation modi-
fication to their usual office desk. As a relatively new area
of intervention evaluation, this study was also an oppor-
tunity 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 ac-
ceptable 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 indi-
vidual motives (e.g., trying something new, interest in po-
tential 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 qualita-
tive findings from office workers, that implementing any
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workplace sitting reduction strategy is both the respon-
sibility of individual employees and organisational man-
agement [21], and evidence that greater investment in
educating and motivating workers to use sit-stand worksta-
tions results in greater uptake [22]. The collaborative ap-
proach 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 re-
searchers who were most likely highly supportive of work-
ing 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 [16].
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,
resultinginvaryingdegreesofuptakeindeskusewhile
standing up [17].
While the study workplace was a health-related non-
government organisation, not all participants described
positive user experiences, although most did. Positive feed-
back about using sit-stand workstations revolved around
surprise and delight with the ease of use of the device, hav-
ing a supportive work environment, and having choice and
flexibility in selecting whether and when to sit or stand.
Occupational health and safety practitioners have empha-
sised 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 imple-
menting any sitting reduction strategy as employees could
feel pressured to stand for extended periods, highlighting
a tension between optional standing versus compulsory
standing [11]. Stand@Work overcame this with clear in-
structions from the start that participants did not have to
stand to work, and that their participation was an eva-
luation to inform their workplace wellness program and
future procurement decisions. Another important issue is
that we do not yet have evidence based public health rec-
ommendations 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 musculoskel-
etal 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 deter-
mined their own preferred approach.
Further, participants did not hesitate to give negative
feedback about aspect s of the s tudy and sit-stand
workstations. To illustrate, when asked about their will-
ingness 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. Inter-
estingly, 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 in-
stability 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 main-
tenance and sustainability of standing to work may be dif-
ferent 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 work-
stations 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 re-
search could examine whethe r one approach might be
more suitable for certain types of workers or job roles.
For instance, some participants reported viewing stand-
ing up to work as a personal challenge to develop a new
habit; and while this was expressed by only a few partici-
pants, it is potentially novel and could be explored in fu-
ture studies to see if it might be another approach to
reducing sitting time.
Conducting phone calls was cited a s a barrier to using
the workstation standing by a majority of participants in
the open plan section of the office, despite being pro-
vided 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 whe n phone calls were con-
fidential. 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 ac-
ceptability and feasibility in this setting is recommended.
There were some positive, yet unintended consequences
of the trial where participants discussed an increased con-
sciousness about the need to sit less generally and trans-
ferred 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 sit-
ting time in non-occupational domains [20], and this pos-
sible transference of reduced sitting into non-work time
has not been reported in previous studies. Additionally,
Chau et al. BMC Public Health 2014, 14:752 Page 8 of 10
http://www.biomedcentral.com/1471-2458/14/752
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 rela-
tively short intervention period.
From an employer perspective, one of the potential ad-
vantages 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 prod-
uctivity improvements due to increased alertness, con-
centration and reduced fatigue, especially later in the
day. This needs to be validated by more objective mea-
sures, but very few users reported productivity impair-
ments from workstation use. Interestingly, those who
were distracted by sta nding 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 nov-
elty. 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 elsewh ere [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 find-
ing 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. Partici-
pants 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 quali-
tative 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 fol-
low 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.
Conclusion
The use of a sit-stand workstation in this group of desk-
based office workers was generally perceived as acceptable
and feasible. Most participants were interested in using a
sit-stand workstation in the future. Future studies will need
to determine the feasibility sit-stand workstations in other
populations and settings as well as the feasibility of longer
term workstation usage.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
JYC conceived the study, participated in its design and coordination,
analysed the data, and drafted the manuscript. MD conceived the study,
participated in its design and coordination, carried out the group interviews,
and assisted in analysing the data. AS carried out the group interviews, and
assisted in analysing the data. SD conceived the study, and participated in its
design and coordination. AEB conceived the study, and participated in its
design and coordination. HPvdP conceived the study, participated in its
design and coordination, and assisted in drafting the manuscript. All authors
read, revised, and approved the final manuscript.
Acknowledgements
This research was supported by funding from an Australian National Health
and Medical Research Council Program Grant (#569940). The authors thank
Mrs Janelle McNicholas and Mrs Melissa Gwizd for their contribution to data
collection and study management; Ms Catherine Kiernan for transcribing
focus groups; and the study participants and managers for their support of
this research.
Author details
1
Prevention Research Collaboration, Sydney School of Public Health,
University of Sydney, Medical Foundation Building (K25), Camperdown, NSW
2006, Australia.
2
Heart Foundation New South Wales, 3/80 William Street,
2011 Sydney, NSW, Australia.
3
Department of Public and Occupational
Health, EMGO Institute for Health and Care Research, VU University Medical
Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Received: 5 January 2014 Accepted: 21 July 2014
Published: 25 July 2014
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doi:10.1186/1471-2458-14-752
Cite this article as: Chau et al.: Desk-based workers’ perspectives on
using sit-stand workstations: a qualitative analysis of the Stand@Work
study. BMC Public Health 2014 14:752.
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