Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction

Leonard et al. BMC Public Health (2022) 22:1086

https://doi.org/10.1186/s12889-022-13476-3

RESEARCH

Qualitative comparative analysis

of the implementation fdelity of a workplace

sedentary reduction intervention

Krista S. Leonard1* , Sarah L. Mullane2

, Caitlin A. Golden3

, Sarah A. Rydell4

, Nathan R. Mitchell4

, Alexis Koskan1

,

Paul A. Estabrooks5

, Mark A. Pereira4 and Matthew P. Buman1

Abstract

Background: Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery person￾nel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time

varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach

to examine potential explanatory factors that could distinguish higher from lower performing worksites based on

reduced sedentary time.

Methods: We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12

worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher

vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services

framework, we created an indicator of intervention fdelity related to adherence to the protocol and competence

of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and

surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table con￾taining implementation construct presence or absence), and used to examine diferences between higher and lower

performing worksites.

Results: There were substantive diferences in the magnitude of change in sedentary time between higher

(-75.2 min/8 h workday, CI95: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI95: -38.3, -22.7) performing worksites.

Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route

accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to

protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face

interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in

some of the lower performing sites suggesting we were unable to identify sufcient conditions to predict program

success.

Conclusions: Higher intervention adherence and implementer competence is necessary for greater program suc￾cess. These fndings illustrate the need for future research to identify what factors may infuence intervention fdelity,

and in turn, efectiveness.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which

permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the

original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or

other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line

to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory

regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this

licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco

mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Open Access

*Correspondence: [email protected]

1

College of Health Solutions, Arizona State University, 425 N 5 th Street,

Phoenix, AZ 85004, USA

Full list of author information is available at the end of the article