Implementation of sit-stand desks as a workplace health initiative: stakeholder views

Abstract

Purpose
Prolonged workplace sitting can harm employee health. Sit-stand desks are a potential workplace health initiative that might reduce and break up the time office-based employees spend sitting in the workplace. However, little is known about the feasibility and acceptability of providing sit-stand desks. The paper aims to discuss this issue.

Design/methodology/approach
The present study sought stakeholder employee views surrounding sit-stand desk implementation within two UK-based non-profit organisations with open-plan offices. This paper draws on qualitative semi-structured interviews with 26 stakeholder employees and 65 days of participant observations. Data were analysed using thematic analysis, and organisational cultural theory framed the study.

Findings
Stakeholders employees’ positioning of sit-stand desks as a workplace health initiative reflected their perceptions of the relationship between sit-stand desk provision, employee health and organisational effectiveness. Perceptions were shaped by the nature and context of the organisation and by occupation-specific processes. Relatively fixed (e.g. organisational structure) and modifiable (e.g. selecting products compatible with the environment) factors were found to restrict and facilitate the perceived feasibility of implementing sit-stand desks.

Practical implications
The findings offer several recommendations for workplaces to improve stakeholder employee attitudes towards sit-stand desk provision and to increase the ease and efficiency of implementation.

Originality/value
Whilst extant literature has tended to examine hypothetical views related to sit-stand desk provision, this study consulted relevant stakeholders following, and regarding, the sit-stand desk implementation process.

Full text

Implementation of sit-stand desks
as a workplace health initiative:
stakeholder views
Jennifer Hall
Department of Life Sciences,
Brunel University College of Health and Life Sciences, Uxbridge, UK and
Bradford Institute for Health Research,
Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
Tess Kay
Faculty of Health Sciences and Sport, University of Stirling,
Stirling, UK
Alison K. McConnell
Department of Human Sciences and Public Health,
Bournemouth University, Poole, UK, and
Louise Mansfield
Department of Life Sciences,
Brunel University College of Health and Life Sciences, Uxbridge, UK
Abstract
Purpose –Prolonged workplace sitting can harm employee health. Sit-stand desks are a potential workplace
health initiative that might reduce and break up the time office-based employees spend sitting in
the workplace. However, little is known about the feasibility and acceptability of providing sit-stand desks.
The paper aims to discuss this issue.
Design/methodology/approach –The present study sought stakeholder employee views surrounding
sit-stand desk implementation within two UK-based non-profit organisations with open-plan offices. This
paper draws on qualitative semi-structured interviews with 26 stakeholder employees and 65 days of
participant observations. Data were analysed using thematic analysis, and organisational cultural theory
framed the study.
Findings –Stakeholders employees’positioning of sit-stand desks as a workplace health initiative reflected
their perceptions of the relationship between sit-stand desk provision, employee health and organisational
effectiveness. Perceptions were shaped by the nature and context of the organisation and by occupation-specific
processes. Relatively fixed (e.g. organisational structure) and modifiable (e.g. selecting products compatible
with the environment) factors were found to restrict and facilitate the perceived feasibility of implementing
sit-stand desks.
Practical implications –The findings offer several recommendations for workplaces to improve
stakeholder employee attitudes towards sit-stand desk provision and to increase the ease and efficiency of
implementation.
Originality/value –Whilst extant literature has tended to examine hypothetical views related to sit-stand
desk provision, this study consulted relevant stakeholders following, and regarding, the sit-stand desk
implementation process.
Keywords Qualitative, Organisational culture, Physical activity, Acceptability, Feasibility,
Sedentary behaviour
Paper type Research paper
International Journal of Workplace
Health Management
© Emerald Publishing Limited
1753-8351
DOI 10.1108/IJWHM-02-2019-0026
Received 22 February 2019
Revised 6 May 2019
Accepted 6 July 2019
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/1753-8351.htm
The wider research project was supported by funding from Macmillan Cancer Support. Jo Foster and
Jenna Stockwell from Macmillan contributed to the design of the study. Sit-stand desks were provided
by Ergotron Inc. James Winslade and Carrie Schmitz provided ongoing logistical and ergonomic
expertise related to sit-stand desk implementation. The authors would like to acknowledge the support
of key personnel, and the provision of study sites, from both participating organisations.
Implementation
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1. Introduction
Over 74 per cent of UK adults aged 16–64 are employed (Office for National Statistics, 2017),
and a considerable policy effort is made by UK Government to support working-age adults
into the workforce as reducing unemployment lessens strain on the welfare budget (e.g. The
Department for Work and Pensions, 2017). In addition, work can have significant benefits for
the individual as it offers the chance of improved opportunities via remuneration and a sense
of purpose (Institute of Health Equity, 2014). Throughout history, changing ideologies and
workplace practices relating to organisational efficiency have implicated employee health and
well-being, however contemporary approaches recognise that key to improving organisational
efficiency is supporting employees’health and well-being (Browne, 2000). A healthy
workplace has been defined by the World Health Organisation (2010) as “one in which
workers and managers collaborate to use a continual improvement process to protect and
promote the health, safety and well-being of all workers and the sustainability of the
workplace”(p. 6). The political discourse positions the development of a healthy workplace as
being beneficial for both individual employee health and organisational efficiency. The
empirical literature supports a relationship between healthy workplaces, employee well-being
and organisational success (Dickson-Swift et al., 2014; Karakolis and Callaghan, 2014).
Despite the positive contribution of work to societies and individuals, work-related factors or
circumstances, such as autonomy, the physical environment and training opportunities, can be
linked to poor health and well-being for employees (Institute of Health Equity, 2014; Smith et al.,
2012). Work environments and cultures that encourage prolonged sitting and physical
inactivity can harm employees’physical and mental health and well-being (Dunstan et al., 2012).
Observational studies have consistently shown that office-workers sit for over two-thirds of the
working day (e.g. Smith et al., 2015), and a recent study of over 600 desk-based workers
indicated a preference for spending less time seated at work (53.8 per cent of the work day;
Wallmann-Sperlich, Chau and Froboese, 2017). In order to prevent the negative health
consequences associated with prolonged workplace sitting and inactivity, and positively
influence organisational success, workplaces might implement strategies that permit employees
to reduce or break up prolonged workplace sitting. Sit-stand desks, i.e. height-adjustable desks
allowing employees a choice of desk-based working positions, are commercially available and
thus represent a potential workplace health initiative to facilitate reduced workplace sitting via
regular postural change.
Sit-stand desks are amongst the most efficacious strategies to reduce workplace sitting
amongst office-based employees (Shrestha et al., 2016), and have potential to improve employee
health. A recent scoping review of studies investigating the health outcomes associated with
sit-stand desk use, reported positive, significant results for cardiovascular outcomes in
61 per cent of the 14 included studies, and positive, significant results for reduced discomfort in
43 per cent of the 22 included studies (Chambers et al., 2019). However, a cross-sectional study of
680 desk-based employees found that only 16 per cent of the employees have access to a
sit-stand desk, and of these employees, only 50 per cent use the sit-stand function regularly
(Wallmann-Sperlich, Chau and Froboese, 2017; Wallmann-Sperlich, Bipp, Bucksch and
Froboese, 2017). The feasibility and acceptability of workplace sit-stand desk provision is
largely influenced by the views of the employer and key stakeholders. Gilson et al. (2012) and
Hadgraft et al. (2016) reported employer and practitioner hypothetical perceptions of sit-stand
desks as a part of exploratory studies focused onreducingworkplacesittingtime.However,
examining the feasibility and acceptability of installing sit-stand desks alongside sit-stand desk
provision is necessary to understand the potential for the wider adoption of sit-stand desks
across organisations (Wijk and Mathiassen, 2011). The perceptions of organisational employees
whose roles and responsibilities are implicated in sit-stand desk provision e.g. health and safety,
human resources –herein described as “stakeholder employees”–are important in
understanding issues related to feasibility and acceptability.
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Proponents of realistic evaluation posit that whether an intervention “works”is not an
inherent property of the intervention, but rather depends on an interaction between
mechanisms –the intervention under study and stakeholders’responses –and the delivery
context (Dalkin et al., 2015; Pawson and Tilley, 2004). The extent literature has highlighted
that organisational cultural factors can facilitate or restrict the implementation of workplace
health initiatives (Spence, 2015). Organisational culture guides how people think, feel and
act, by offering an “interpretation of an institution’s history that members can use to
decipher how they will be expected to behave”(Martin and Siehl, 1983, p. 52). Culture is
manifest in the values and behaviours of groups, including organisations; it resides in
relations between people (Alvesson, 2002, pp. 1-6) and is developed through shared and
contested values; it is the context within which organisational interpretations are formed
(Mannion et al., 2008). Such and Mutrie (2016) explored the influence of organisational
culture on workplace sedentary behaviour in an in-depth, qualitative study. However, there
is a dearth of the literature examining the role of organisational culture and context in
shaping the feasibility and acceptability of sit-stand desk provision in workplaces. The aim
of the present study was to evaluate the cultural and contextual processes influencing the
feasibility and acceptability of sit-stand desk provision alongside, and in relation to, a
sit-stand desk installation process.
2. Methods
2.1 Background to the study
2.1.1 The wider work. This study was a part of a larger project involving a 12-month pilot
randomised controlled trial (RCT) and process evaluation of a multi-component workplace
sit-stand desk intervention within the office-based workplaces of two non-profit
organisations. The pilot RCT examined the efficacy of the intervention on reducing
sitting and increasing standing and physical activity using objective activity monitors
(ActivPAL3
TM
and Actigraph GT3X+) at five time-points: baseline, 2-weeks, 3-months,
6-months and 12-months. There were three arms to the pilot RCT: a multi-component
sit-stand intervention including sit-stand desk provision, e-mails from managers endorsing
reduced workplace sitting and motivational interviewing delivered over the phone, sit-stand
desk provision only and control, i.e. no intervention. Participants in both intervention arms
(n¼20) had a choice between two models of desk (Ergotron Workfit-A or Workfit-D, www.
ergotron.com). At the time of installation, the price of the desks ranged between £300
(Workfit-A) and £600 (Workfit-D) depending on the retailer. All of the sit-stand desks were
installed over a period of three days in the open-plan office spaces of the two participating
organisations, at the place of the usual desk of the intervention participants. The desk
suppliers (Workplace C) organised for an external company to complete the install, at no
cost to the participating organisations, aside from assistance provided by a small number of
stakeholder employees leading up to, and on, the install day(s). The protocol for the wider
project is published in Hall et al. (2015) and see Appendix 2 for an intervention delivery and
evaluation timeline. Ethical approval to conduct this research study was granted by Brunel
University London research ethics committee (RE45-13). All data collection took place
between May 2014 and January 2016.
2.1.2 The process evaluation. The findings from the process evaluation, underpinned by
the Medical Research Council Guidelines for evaluating complex interventions (Craig et al.,
2008), are reported here. Process evaluations largely focus on issues surrounding
implementation and place emphasis on examining social processes to unpick how the
intervention interacts with contextual factors to influence the delivery, acceptability and
success of the intervention (Moore et al., 2015). In the present study, a process evaluation
was undertaken to examine organisational attitudes related to the feasibility and
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acceptability of sit-stand desks as a workplace health strategy. Feasibility was defined as
the ease with which sit-stand desk interventions can be implemented. Acceptability refers to
whether workplace stakeholders consider sit-stand desk interventions to be appropriate,
possible and permissible within their workplace context. A further characteristic of process
evaluations is that they work with, and aim to develop, theory to add explanatory value
(Morgan-Trimmer and Woods, 2016). The present study interweaved empiricism and
theoretical reasoning to deepen understanding of how and why people think and act and the
impact this has on the perceived organisational feasibility and acceptability of investing in
sit-stand desks.
To gain an understanding of how workplace cultural and contextual factors underpin the
feasibility and acceptability of sit-stand desk implementation, in-depth qualitative methods
involving observations within the participating workplaces and semi-structured interviews
with stakeholder employees were employed (Hawe et al., 2009). Observational methods
permit the collection of data on behaviour, events and interactions as they occur within the
intervention delivery context (Morgan-Trimmer and Wood, 2016). The researcher undertook
a volunteer role within both workplaces to engage in observation whilst being a
“participant”(employee) within the workplace. Engaging in behaviours appropriate to the
setting, rather than simply observing, can facilitate a more nuanced understanding of
meanings attached to behaviours (Spradley, 1980, p. 61). Whilst observations are embedded
in social settings, semi-structured interviews provide (artificial) space –outside of natural
interactions –for relevant stakeholders to reflect on personal, social, work and/or
occupational values, attitudes and behaviours related to sit-stand desk provision. It was
proposed that combining observation and interview methods would provide the most
complete and nuanced understanding of the processes influencing the feasibility and
acceptability of sit-stand desk provision (Watson, 2011).
2.2 Participating organisations and employees
Two UK-based organisations volunteered to take part in the research, and consent was
obtained from senior management within both organisations. Workplace A is an established
health charity. The workplace is split over several floors and is the base for over 900
employees. Workplace B is a national health-related governmental organisation. The
workplace setting was a high specification office building that was the base for over 1000
employees. Organisational restructuring was ongoing in both organisations throughout their
participation in the research. Semi-structured interviews took place with stakeholder
employees –whose roles and responsibilities may be implicated in sit-stand desk
provision –from Workplaces A–C. Interviewees were identified via brainstorming potentially
relevant employees with a key contact within each organisation. This resulted in 26 interviews
being conducted with 10 stakeholders from Workplace A, 14 from Workplace B and 2 from
Workplace C. Stakeholders’roles and responsibilities varied, however interviewees were
categorised as to whether their role was operational (e.g. facilities, procurement), managerial
(e.g. director, programme lead) or workplace well-being related (e.g. human resources
advisor, workplace well-being champion) (see Table I). All participants received a participant
information sheet and provided written informed consent prior to any data collection
taking place.
2.3 Data collection and analysis
Observations involved three formal phases within workplace: prior to the sit-stand desk
installation, and at approximately 4 months and 10 months following sit-stand desk
installation. Each phase consisted of 9–13 working days (approximately 09.00–17.00). The
researcher observed within work spaces and departments of employee stakeholders and
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employees that were participating in the pilot RCT, being situated within three to four
separate departments during each formal observation phase. Departments were selected
across different floors, based on the type of work conducted, and according to the number of
sit-stand desks within the immediate work space, to capture a range of views and
behaviours. Initial, more general observations of the workplace setting and context shaped
more detailed and specific observations of organisational cultural and contextual processes
impacting on the sit-stand desk intervention implementation, as the data collection
progressed. The researcher would make condensed notes or prompts throughout the day
and expand the notes at the end of the working day (Spradley, 1980, pp. 69-70). Informal
observations and interactions were also recorded throughout the duration of the interaction
with the organisations. In total, 147,616 words of field notes based on the formal observation
phases, and 37,750 words of field notes based on informal observations and interactions
were recorded.
Interview guides were theoretically and empirically informed; organisational cultural
theory shaped questions and prompts relating to organisational policies, procedures,
initiatives and norms related to workplace sitting. Three pilot stakeholder interviews were
conducted with a Workplace Wellness Manager, a Health and Safety Manager and a senior
leader from a separate organisation (Brunel University London). The interview guides were
modified following the pilot interviews to include the addition of questions regarding
sit-stand desks, productivity and organisational effectiveness. The guides were then tailored
to the interviewees’specific organisational role, and specific questions were added for some
Pseudonym Role Job category Workplace
Simon Director (Corporate Resources) Senior/middle management A
Jade Programme Lead Senior/middle management A
Cath Programme Lead Senior/middle management A
Craig Consultant (Public Health) Senior/middle management B
Samantha Human Resources Advisor Workplace well-being A
Jill Human Resources Manager Workplace well-being A
Violet Communications officer Workplace well-being B
Fiona Equality and Diversity Lead Workplace well-being B
Faye Staff Well-being Lead Workplace well-being B
Finn Staff Well-being Lead Workplace well-being B
Annabel Workplace Well-being champion Workplace well-being B
Chloe Research Manager Workplace well-being C
Jim Facilities Manager Operational A
David Health and Safety Advisor Operational A
Katie Project Officer Operational A
Alexandra Business and Performance Manager Operational B
Ivy Estates and Facilities Manager Operational B
Barbara Procurement Manager Operational B
Aiden Procurement Manager Operational B
Harry Project Sponsor (Estates) Operational B
Ben Account Manager Operational C
Richard Human Resource Director Senior/middle management, workplace
well-being
A
Olivia Consultant (Occupational Health) Senior/middle management, workplace
well-being
B
Jayne Human Resources Director Senior/middle management, workplace
well-being
B
Drew Head of Procurement Senior/middle management, operational A
Tarak Deputy Director (Corporate Risk) Senior/middle management, operational B
Table I.
Participant
characteristics:
stakeholder employees
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stakeholders to unpick previously observed events or interactions. See Appendix 2 for an
example interview guide. All interviews took place approximately two months following sit-
stand desk installation. The interviews were 42 min long on average, ranging from 18 to 64
min. All interviews were audio recorded and transcribed and identifiable information was
removed, including assigning all stakeholder interviewees with pseudonyms. All
observations and interviews were conducted by one researcher ( JH). See Table A1 for an
illustration of the observation and stakeholder interview data collection timelines, including
how they fit within the wider pilot RCT work.
A thematic analysis was utilised to collectively analyse the interview and field-note
(observation) data across both organisations. The analysis process outlined by Braun and
Clarke (2013) was followed which includes: data familiarisation i.e. reading and re-reading
field-notes and interview transcripts, the generation of initial codes, interpreting codes to
develop themes and reviewing, refining and defining themes. When generating and
interpreting codes it was important to look beyond what participants said to understand the
context within which the participants spoke and acted (Perryman, 2012) which allowed for a
more process-oriented understanding of interviewees’accounts. Whilst coding was initially
inductive, realistic evaluation principles also guided the conduct of the analysis. The
researcher openly sought to identify the interplay between contextual factors and
mechanisms on the feasibility and acceptability of sit-stand desk provision and
implementation (Cruickshank, 2012, p. 14; Pawson and Tilley, 2004). One researcher ( JH)
reviewed and coded all raw data and another researcher (LM) independently reviewed and
coded approximately 20 per cent of the raw data; codes were compared, and discrepancies
were resolved through discussions. Coding was completed using NVivo 10.0 software. One
researcher ( JH) interpreted the codes to develop three themes addressing the feasibility and
acceptability of investing in sit-stand desks, which were reviewed, refined and agreed by all
researchers ( JH, LM, TK and AM). These themes, including illustrative quotes and field-note
extracts provided to support the analysis, are presented as findings.
3. Findings
Three main themes related to the feasibility and acceptability of investing in sit-stand desks
were generated and are presented here. The themes pertain to factors influencing the
perceived viability of implementing sit-stand desks, organisational factors and outcomes
influencing attitudes towards sit-stand desks and ethical considerations related to sit-stand
desk provision.
3.1 The viable thing to do? Factors influencing sit-stand desk implementation
This theme describes factors influencing stakeholder employees’commitment to sit-stand
desk implementation, including role capacity, and organisational structure and
restructuring (3.1.1) and the compatibility of sit-stand desks with the workplace
environment (3.1.2) which both shape perceived sit-stand desk installation feasibility.
3.1.1 Commitment to support sit-stand desk implementation. Stakeholder employees’
accounts revealed that the feasibility of sit-stand desk provision depends on the
organisation having a dedicated staff member with capacity and commitment to lead the
installation, supported by employees from relevant teams:
Where would be the natural home? […] Which team would be most appropriate to deliver and
support this? So, it doesn’t become a Pilates ball - an expensive Pilates ball - pushed in the corner.
(Violet, Workplace B)
Stakeholder interviewees’accounts revealed that the perceived capacity to dedicate time to
sit-stand desk installation influenced attitudes related to assisting with the delivery of the
project. Katie stated that the proportion of her work hours that she dedicated to the project
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was “between a fifth and a quarter […] it hasn’t been *too* much”(Katie, Workplace A).
Her commentary indicated that the incorporation of the project into her job role enabled her
to prioritise the installation of the sit-stand desks. Conversely, those with less capacity were
more likely to express frustration regarding installation-related tasks:
I thought ‘What? I’m ordering leads? Really? How daft! […] those sorts of things are seemingly
petty […] but for us […]it’s about how easy is it for an organisation to include these [sit-stand
desks], well actually it is quite difficult because you need to think about all these other bits and
pieces. (Faye, Workplace B)
Organisational restructuring influenced commitment of employees to support the project.
Many employees involved in the installation could not offer sustained commitment due to
fluctuating responsibilities because of ongoing restructuring processes: “Key staff in the
installation process keep getting re-deployed so the contact person is changing constantly
[…]”(Research notes, 5 Sept 2015), which also hindered communication between parties. In
addition, the extent of centralisation within the organisation shaped employees’
commitment to the installation of the sit-stand desks:
[At Workplace B] there were four or five people that needed to be making the decisions whereas, at
Workplace A, it felt like once we’d got […] the higher-level people on board it was just handed down
[…]. And I guess one person is easier to deal with than multiple. (Ben, Workplace C)
Workplace A has a less centralised structure than Workplace B, as continued and extensive
involvement with technical aspects of the installation was required by fewer employees
from different teams, which enabled one key employee to commit to assisting the delivery of
the project.
Observations revealed that employee time required to support the installation of sit-stand
desks depended on the degree of formalisation. Workplace B has a formalised organisational
structure; procedural necessities challenged the efficiency of the sit-stand desk planning and
installation processes. For example, form-filling requirements almost led to the postponement
of the installation:
Workplace B told us last week that we have to complete a RAMS (Risk and Method Statement)
form […] The install is due to take place next week, and if [Workplace C] are unable to complete all
elements of the form by then […] [team] at Workplace B have said that no work can take place on
site. (Research notes, 11 January 2015)
A higher level of formalisation at Workplace B was found to impede the efficiency with
which tasks connected to the sit-stand installation, a non-standard situation, could be
completed. Limited decision-making discretion led employees to adhere to procedures which
may not be wholly necessary, or indeed adequate, for sit-stand desk installation. Whereas, a
less formalised structure at Workplace A enabled the swift completion of tasks related to the
project delivery, and positively influenced employees’experiences of implementing sit-stand
desks within the workplace.
3.1.2 Sit-stand desk workplace compatibility. The compatibility of the sit-stand desks with
the office environment influenced the feasibility of sit-stand desk provision. For example,
the installation of some sit-stand desks required adaptations to be made to the
organisation’s standard equipment, such as “sawing a curve into two desks to enable the sit-
stand desk to be securely attached”(Research notes, 25 October 2014). The lack of
compatibility of certain aspects of the sit-stand desks with the workplace environment led to
some unexpected costs for the organisation, which restricted the feasibility of the sit-stand
desk installation. For example, it was necessary for the organisations to purchase longer
cables to ensure that desk equipment could be powered when the desk was raised.
Compatibility issues also led to unexpected time demands being placed on operational
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employees when sit-stand desk users required their desk to be relocated; “when I asked
[Susan] if she’d had chance to have a look at moving Steph’s sit-stand desk to her new
location, she said not yet, that she had been ‘bloody busy this week to be honest’” (Research
notes, 20 February 2015). The need to make adaptations to organisational equipment to
accommodate the sit-stand desks negatively influenced interviewees’attitudes:
[…] it seemed as though they [Workplace C] thought that Workplace B should adapt to be able to
use that desk, rather than the desk working for us […] and I think that is something that needs
some thinking about, otherwise you are going to start off with already some negative thinking […].
(Faye, Workplace B)
This theme revealed that organisational contextual factors can impede or facilitate the sit-stand
desk implementation process, and consequently, stakeholder employees’perceptions of the
feasibility of sit-stand desk provision. The viability of sit-stand desk provision is likely to vary
between organisations depending on the organisations’context, structure and physical
workplace environment.
3.2 The smart thing to do? Organisational factors and outcomes
This theme links sit-stand desk provision to employee health and organisational outcomes.
First, the perceived organisational benefits of investing in sit-stand desks are described (3.2.1).
Organisational factors influencing perceptions of the importance of supporting employee
health (3.2.2) and the relationship between supporting employee health via sit-stand desk
provision and organisational outcomes (3.2.3) are presented.
3.2.1 Organisational benefits of investing in sit-stand desks. Employees voiced that the
pursuit of organisational success guides business operations and decisions, including
whether to invest in employee health initiatives. For example, Jill reasoned that “if our
y’know, reason for being is to help improve the lives of everyone living with [health
condition] then if we can i-you have improved physical health […] you will also be more
productive. If you are absent from work, then obviously, you are not productive. But even if
you are in work and you’re not well then you will be less productive than someone else who
is feeling great”(Finn, Workplace B).
Interviewees perceived that employees seek out job opportunities that offer benefits
including staff well-being initiatives:
[…] but you know actually bringing it into the workplace and having specially adapted desks, you
know I was pleased that we were doing something that felt a little bit ahead of maybe our
competitors. ( Jayne, Workplace A)
Sit-stand desks were positioned as an aspect of competitive advantage. Employees also
identified a need for the organisation to “practice what they preach”:
We need to make sure that we are exemplar health and wellbeing employers for our own staff,
because otherwise why on earth would anybody listen to us when we say this is best practice […].
(Richard, Workplace B)
The organisations’external programmes of work are oriented around improving peoples’
health and well-being. Thus, interviewees perceived that it is necessary to support staff
health and well-being internally, to appear a credible source of information to stakeholders
including the public. The health-focused nature of the participating organisations garnered
additional support for investing in sit-stand desks. Sit-stand desks were described as a
visible and forward-thinking representation of the organisations’commitment to developing
a healthy workplace.
3.2.2 Organisational and occupational values influencing attitudes towards sit-stand
desks. Stakeholder attitudes related to sit-stand desk provision were shaped by the
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organisational (health) culture and employees’occupational identities. The health-related
nature of both organisations engendered taken-for-granted assumptions amongst
interviewees about the importance of health and well-being:
We’ve got the tag line now, of protecting and improving the nation’s health. It’s literally on every
email you send […] so it should be in your eye line *laughs* every single day […] this is who we
are. (Annabel, Workplace B)
Valuing health was embedded throughout the organisations and reflected in organisational
materials, which led to a shared understanding amongst employees that “healthy living are
[sic] generally better for you and you know, give you better outcomes”(Steph, Workplace
A). For employees in health-focused roles, e.g. human resources, their occupational identities
were consistent with and reinforced the dominant organisational values.
However, some interviewees that were employed in operational, non-health-focused
occupations, for example estates and facilities, held negative perceptions regarding
sit-stand desks. For example, Dorothy questioned “what benefit there is, health wise?
Standing for long periods is not good, because you get stagnation of blood […]
varicose veins”(Dorothy, Workplace B). In addition, some interviewees viewed sit-stand
desks as a luxury rather than as a preventative health measure that should be available to
all employees:
I think it’s quite different to something like, you know a laptop or an iPhone, which is essential to
conducting our business […] [but] certainly if there was a physical issue or health reason […]. we
would be supportive. (Tarak, Workplace B)
Employee health and well-being are not always prioritised within non-health focused
occupations. This analysis indicates that organisational cultural contradictions can arise
when the occupational values of employees responsible for the management of office
equipment are not consistent with those of the organisation:
She [health-focused Workplace B employee] vented her frustrations regarding the current
procedure, saying “we have to have a [health] problem, a symptom, a justification to request a sit-
stand desk at Workplace B, which goes against all the work we are trying to do nationally”.
(Research notes, 19 September 2014)
Seated desks as standard office equipment were symbolised by employees with health-related
occupations as inadequately investing in the health of their staff, which undermines the
organisations’the dominant cultural value of preventative health.
3.2.3 Financial implications of investing in sit-stand desks. Interviewees identified that
evidence of cost-effectiveness and ROI would be required to justify any future financial
investment in sit-stand desks:
There needs to be definite proof […] that any investment internally [on sit-stand desks], you’d get
the money back eventually I guess. (Samantha, Workplace A)
Interviewees expressed concern regarding a potential negative reaction of employees and
the public to organisational spend on sit-stand desks. At Workplace B, this was influenced
by the organisational economic climate. The governmental stipulation to reduce
organisational spending incited restructuring, job losses and increased workload at
Workplace B. Organisational conditions fostered low need satisfaction, which engendered
negative attitudes towards formal employee health provision amongst employees:
Employees see these [employee health] initiatives as “add-ons”,“not getting at the root cause”,
“putting over a plaster”–so not solving the problems inherent within the organisation –long
hours, email culture, constant restructuring and job insecurity. (Researcher notes, Workplace B, 25
November 2015)
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Spending money on employee health initiatives was perceived by some employees as a
feeble attempt to minimise negative impacts on staff well-being caused by organisational
conditions, which was recognised by interviewees:
It would be quite difficult to weigh up if you went for a carte blanche and spent thousands and
thousands because […]we’re cutting staff […]. so, it would be a delicate balance for senior
management to promote that […]. in the current climate. (Ivy, Workplace B)
Concern that substantial expenditure on sit-stand desks might exacerbate negative feelings
amongst employees towards employee health initiatives engendered a perception that
spending money on sit-stand desks is not justifiable. Interviewees expressed concern that
expenditure on sit-stand desks might negatively influence the organisations’image:
You’d have to be accountable for spending public funds […] and certainly as a taxpayer I would be
pretty annoyed. (Dorothy, Workplace B)
This theme indicates that the “healthy workplace”rationale for investing in sit-stand desks
is strengthened due to the health-focused nature of the organisations, as appearing a
“credible source”is unlikely to be linked to organisational success for non-health-focused
organisations. However, views differ between individual employees due –in part –to
differing occupational identities, and financial concerns are likely exacerbated in public or
charitable organisations compared to private organisations. These findings highlight that
organisational contextual factors factor into, and complicate, the relationship between
employee health initiatives and organisational effectiveness and influence stakeholder
employees’attitudes towards sit-stand desk provision.
3.3 The right thing to do? Challenging the ethics of the healthy workplace model
The data in this theme consider issues surrounding the corporate social responsibility of
organisations with office-based workplaces to provide sit-stand desks for their employees.
Interviewees spoke of an ethical responsibility of the employer for supporting employee
health, in a part due to the nature of their organisation:
I think a responsible employer […] their core philosophy has to be look[ing] after their employees
[…]. we are [Workplace B] […] it would be wrong […] if we were generating overworked, stressed
out people just about to break. (Bridget, Workplace B)
The data highlight a view that employers have a responsibility not to contribute to reduced
employee health and well-being via physical or psychosocial working conditions.
Positioning the provision of sit-stand desks as a responsibility of office-based
organisations, to offset the health risks incited by prolonged workplace sitting, increases
the acceptability of sit-stand desks within such organisations. However, deeper analysis of
interview and observation data illustrate that employees would not expect their
organisation to support their health without there also being benefits for the
organisation. For example, Cath commented that sit-stand desks are “the right thing to
do”yet later remarked that “businesses are businesses, and they look at the bottom line”
(Cath, Workplace A).
Interviewees recognised that employee health initiatives can be used in ethically dubious
ways. For example, Finn described attempts of “tech[nology] companies”to, in his view,
overtly regulate the behaviour of their employees. Discussing a recent visit to one such
technology company, Finn described how “everything you need is within the building, so
you never need to leave. They have a gym, they have breakfast, they have everything. Food
all day basically. So, they keep them there […]. terrible”(Finn, Workplace B, workplace
well-being stakeholder). There was a feeling amongst interviewees that imposing health
behaviours on employees represents an abuse of the organisations’power. Regarding
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employee eating habits, Jayne remarked “why should we be prescriptive with people about
what they do […] what they put in their mouth […] we haven’t got a right to do that”( Jayne,
Workplace A). Interviewees expressed a belief that the organisation should be supportive of
health by not restricting, but equally not enforcing, health behaviours amongst employees.
Annabel envisaged this involving “putting things out on a plate that’s right in front of
people, so if you are up for it, then it’s really easy for them, but if they don’t want to, that’s
okay too”(Annabel, Workplace B). This suggests that employees should be given a choice
regarding their desk (i.e. whether it is a conventional seated desk or a sit-stand desk) if the
organisation does provide sit-stand desks for employees.
This theme demonstrates the ethical complexities surrounding workplace health
initiatives such as sit-stand desk provision, linked to the normative power that
organisations have over their employees.
4. Discussion
This study examined the feasibility and acceptability of implementing sit-stand desks in
office-based workplaces by conducting observations and interviewing key stakeholders
within two workplaces taking part in a pilot RCT of a workplace sit-stand desk intervention.
Factors related to the sit-stand desk implementation process, perceived organisational
benefits and costs and ethical issues linked to supporting employee health were illustrated
as being instrumental in shaping views regarding sit-stand desk provision.
4.1 Sit-stand desk provision and implementation: mediating causal mechanisms
Mediating mechanisms related to components of an intervention and how it is implemented
that have an influence on outcomes, e.g. how sit-stand desk provision is perceived, and the
ease of implementation (Dalkin et al., 2015). Whilst the two workplaces that delivered the
intervention were both health-focused, non-profit organisations, and mediating mechanisms
interact with context to influence outcomes, the analysis pointed to modifiable factors that
might influence the feasibility and acceptability of sit-stand desk provision and
implementation across organisations more generally.
Positive attitudes related to providing sit-stand desks were consistent with the healthy
workplace discourse –which posits that reduced absenteeism and presenteeism, and
increased work motivation, increase productivity via improved employee health and well-
being (Wadsworth et al., 2010) –as a rationale for investing in sit-stand desks. Indeed, the
extant literature is supportive of a relationship between using a sit-stand desk and employee
health benefits, including improved musculoskeletal comfort and cardiovascular outcomes
(Chambers et al., 2019). The pursuit of productivity and organisational success is a
taken-for-granted priority, which guides organisational operations (Such and Mutrie, 2016).
Thus, positioning sit-stand desk provision as a strategy to increase organisational
effectiveness –via improved employee health –is likely to increase organisations’
receptibility towards supplying sit-stand desks for employees. Additionally, highlighting
the consistency between sit-stand desk provision and the occupational values of key
organisational decision-makers is likely to increase acceptability. However, the findings
indicate that employees are wary of organisations supporting employee health for
underlying corporate motives; such motives question the positioning of workplace health
initiatives as socially responsible (Holmqvist et al., 2009), as they represent a means for the
organisation to –wittingly or unwittingly –manipulate and control employees’
health-related attitudes and behaviour (Vander Schee, 2008). Offering employees the
choice of a sit-stand desk or seated desk was considered an appropriate strategy, as
interviewees felt that such an approach increases employees’capacity for agency over their
health behaviours at work. Such a strategy might increase the acceptability of sit-stand desk
provision amongst employees and across organisations more broadly. However, placing
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desks

value on employee health can lead to the development of a normative power which may
compel individuals to partake in healthy behaviours and workplace initiatives (Zoller, 2003),
even when participation is construed as voluntary by the organisation, given the moral
connotations of, and virtues (e.g. discipline, self-responsibility) connected to, health
behaviours (Verdonk et al., 2010).
The analysis identified various modifiable factors related to the implementation process
that influenced views related the feasibility and acceptability of sit-stand desk
implementation. Factors that might improve the ease of implementation of sit-stand
desks include: designating a lead employee with overall responsibility for sit-stand desk
provision, assembling small project support team consisting of employees from key relevant
departments including (but not limited to) health and safety, internal communications,
facilities and human resources, a clear internal communication plan, having a budget for
unexpected costs and choosing models of sit-stand desks that are compatible with the
workplace environment.
4.2 Sit-stand desk provision and implementation: moderating causal mechanisms (context)
The analysis unpicked various factors linked to the culture and context of the participating
organisations that influenced stakeholder views related to sit-stand desk provision and
implementation. For example, the findings reveal nuanced and context-specific processes by
which supporting employee health might be connected to organisational outcomes. The
health-focused nature of the participating organisations led to a perception that supporting
employee health would enhance the organisations’credibility. Conversely, spending charity
or public money on sit-stand desks might damage the organisations’reputation; there can be
increased scrutiny of spend, and a greater sense of accountability to external stakeholders,
in non-profit organisations compared to private organisations (Dhanani, 2009). Financial
concerns linked with the current dearth of ROI evidence (Buckley et al., 2015) limited the
possibility of wider adoption of sit-stand desks within the participating organisations. The
healthy workplace model should recognise how complex organisational contextual factors
such as the nature of the organisation and employees’occupations can influence the
processes that underpin, and the type and strength of the relationship between employee
health initiatives and organisational success.
Organisational contextual factors that impeded or facilitated the sit-stand desk
implementation process were identified. For example, higher organisational structural
formalisation –which refers to the presence of rules, policies and procedures that stipulate
organisational operations and decisions (Pertusa-Ortega et al., 2010) –restricted
implementation. The feasibility of initial sit-stand desk installation may be reduced in
organisations with highly formalised structures as rules and processes designed to increase
efficiency can contribute to inefficiency in new or non-standard situations (Bozeman and
Scott, 1996, p. 3). However, routine sit-stand desk provision might trigger the adaptation of
current procedures or development of new policies suited to the task to increase the
efficiency of sit-stand desk implementation (DeHart-Davis et al., 2013).
4.3 Strengths and limitations
Whilst extant literature has investigated managers’and practitioners’attitudes towards
hypothetical sit-stand desk provision (Gilson et al., 2012; Hadgraft et al., 2016) this study
consulted relevant stakeholders following, and regarding, the sit-stand desk implementation
process. Conducting observations were particularly valuable for examining organisational
culture and contextualising interview data, as it involves the collection of data within the
naturalistic setting and enables direct access to organisational processes and employee
interactions (Morgan-Trimmer and Wood, 2016). However, the generalisability of the findings is
uncertain as they are based on a study of only two workplaces. Investigation into organisational
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contextual factors that impede and restrict the sit-stand desk implementation process within
varied organisational settings would help strengthen and extend the evidence generated in this
study. A detailed map of relevant organisational contextual factors and the processes that link
them to the ease of implementation would permit an assessment of how feasible sit-stand
desk implementation is likely to be for a given organisation. This study contributed to
methodological advancement of approaches to conducting process evaluations of workplace
sit-stand desk interventions by combining interviews with participant observation.
5. Conclusion
The present study sought stakeholder employee views of sit-stand desks as a workplace
health initiative alongside the implementation of a sit-stand desk intervention within two
UK office-based workplaces. This approach permitted the examination of organisational
contextual and structural factors that influence sit-stand desk implementation feasibility
and acceptability, which may assist organisations in selecting appropriate workplace health
interventions and improve the ease and acceptability of sit-stand desk provision; see list
below for workplace recommendations. Identified modifiable factors influencing feasibility
and acceptability –such as developing an appropriate communication strategy –can assist
organisations in improving the process of implementing sit-stand desks. However, various
factors related to the organisational culture and context were found to moderate attitudes
related to the sit-stand desk provision and implementation. Given the relatively fixed nature
of organisations, employers should carefully consider the suitability of sit-stand desks as a
workplace health strategy within the context of their organisation –taking into
consideration the moderating factors influencing feasibility and acceptability identified in
this study linked to the nature, structure and values of organisations.
Sit-stand desks as an employee health strategy: recommendations for workplaces:
(1) To increase acceptability of sit-stand desk provision:
•Employees in health-related roles should champion sit-stand desks to convince
employees in non-health-related roles of thebenefitsofsupportingemployeehealth.
•Employees in health-related roles ( for example, human resources) should work
alongside facilities employees in the procurement of desk-based equipment, to
increase the likelihood of employee health considerations being incorporated into
desk selection.
•Develop a communication strategy to inform employees and external
stakeholders of why sit-stand desks are a positive investment, to reduce the
likelihood of reputational damage and negative employee attitudes.
•Consider potential cost-saving options, e.g. investing when a refurbishment is
required, investing in a small number of sit-stand desks, seeking sit-stand desk
donations or explore external funding avenues.
•If only investing in a small number of sit-stand desks, consider which employees
should receive them. Provide sit-stand desks for employees that want one,
focusing on alternate strategies for reducing sitting for employees who express
negative attitudes towards sit-stand desks.
(2) To increase the ease of sit-stand desk implementation:
•Provide leadership by a relevant department; and form a project team to support
the implementation, involving employees from other relevant departments
including health and safety, IT, facilities, communications, etc. The project team
should be small to facilitate open and close communication.
Implementation
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desks

•Incorporate sit-stand desk provision into the job role of at least one employee, to
increase capacity for investing time into sit-stand desk provision.
•Allocate an agreed budget for sit-stand desk provision and monitor budget
over time.
•Extensively research sit-stand desk options and select models that are
compatible with the workplace environment, and conduct a site survey with
potential sit-stand desk suppliers to recognise the specific requirements of the
organisation for successfully installing sit-stand desks.
•Develop organisation-specific policies and processes for sit-stand desk provision,
based on the organisational context and early experiences of sit-stand desk
provision, to improve the efficiency of sit-stand desk provision over time.
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Appendix 1
Time
line
Sit-stand
desk only
(SS-O)
Multi-
component
sit-stand
desk (SS-
MC)
Seated desk
control (CG)
Randomisation
–2 weeks Measurement of outcomes
–4 to –1 weeks Participant observation
Baseline (time 0)
2 weeks
3 weeks
4 weeks Measurement of outcomes
5 weeks
8 weeks
6–10 weeks Stakeholder interviews
12 weeks
14 weeks Measurement of outcomes
16 weeks
16–20 weeks Participant observation
21 weeks
6 months
Measurement of outcomes
7–8 months Pilot RCT participant interviews
10 months Participant observation
12 months Measurement of outcomes
“Motivational interviewing” phone call to support participants
to use their sit-stand desk to reduce sitting and increase PA
Emails from organisation managers sent to participants to
express organisational support for the intervention
Sit-stand desk provision
a
a
a
a
b
b
b
b
b
d
a
cdcd
Verbal instruction on correct ergonomic posture for sitting and
standing
Table AI.
Intervention delivery
and evaluation
timeline
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desks

Appendix 2. Example stakeholder interview guide (health and safety staff member)
Part A: Job role
(1) What is your role within the organisation?:
•(PROMPTS: how does it fit into organisation aims, what do you do day-to-day)
(2) How does your job role relate to the sit-stand project?:
•(PROMPTS: Do you see it as having an impact on your work stream? Do you have any
specific roles or responsibilities as part of this project?
Part B: Understanding the culture of the organisation in relation to sit-stand desks and
workplace health
(1) Are there any H&S policies/training related to sitting, standing and moving?:
•(PROMPTS: restricting or encouraging movement/activity).
(2) Do you feel that employees have opportunities to reduce sitting and increase activity in the
workplace?
(3) Does the sit-stand desk intervention fit with (Workplace A’s) health, safety and well-being
approach?:
•(PROMPTS: Will any amendments need to be made to current policy / guidelines to
accommodate sit-stand working? Have you learnt anything so far from your experience
with sit-stand working? Does the management style/priorities of senior leaders influence
your role in delivering health, safety and well-being programmes?)
Part C: Responsibility of the organisation
(1) Do you feel there is a desire within the organisation to promote health of employees?:
•(PROMPTS: How much of a priority is it? Does [Workplace A] have a responsibility to
employees to promote their health? If so, why? (e.g. organisational benefits, nature of
organisation, ethically) What about reducing sitting specifically?)
Part D: Planning and implementation of sit-stand project
(1) What do you think went well in the planning phases of this project? What could we have done
better? How could we have done it better?
(2) Can you anticipate any challenges over the next year?
(3) What do you think would need to happen for (Workplace A) to consider a wider adoption of
sit-stand desks?:
•(PROMPTS: Would there be any special considerations from a health and safety
perspective?)
Corresponding author
Jennifer Hall can be contacted at: jennifer.hall@bthft.nhs.uk
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