Abstrakti
Background: Altering the choice architecture of decision contexts can assist behaviour change, but the acceptability of this approach has sparked debate. Considering hypothetical interventions, people generally welcome the approach for promoting health, but little evidence exists on acceptance in the real world. Furthermore, research has yet to explore the implementers’ perspective, acknowledging the multidimensionality of the acceptability construct. Addressing these knowledge gaps, this study evaluated the acceptability of a quasi-experimental implementation-effectiveness trial that modified the worksite choice architecture for healthy eating and daily physical activity. Methods: Fifty-three worksites participated in the 12-month intervention and implemented altogether 23 choice architecture strategies (Mdn 3/site), including point-of-choice prompts and changes to choice availability or accessibility. Retrospective acceptability evaluation built on deductive qualitative content analysis of implementer interviews (n = 65) and quantitative analysis of an employee questionnaire (n = 1124). Qualitative analysis examined implementers’ thoughts and observations of the intervention and its implementation, considering six domains of the Theoretical Framework of Acceptability: ethicality, affective attitude, burden, intervention coherence, opportunity costs, and perceived effectiveness. Quantitative analysis examined employees’ acceptance (7-point Likert scale) of eight specific intervention strategies using Friedman test and mixed-effects logistic regression. Results: Implementers considered the choice architecture approach ethical for workplace health promotion, reported mostly positive affective attitudes to and little burden because of the intervention. Intervention coherence supported acceptance through increased interest in implementation, whereas low perceived utility and high intensity of implementation reduced cost acceptance. Perceived effectiveness was mixed and varied along factors related to the implementer, social/physical work environment, employer, and employee. Employees showed overall high acceptance of evaluated strategies (Mdn 7, IQR 6.4–7), though strategies replacing unhealthy foods with healthier alternatives appeared less supported than providing information or enhancing healthy option availability or accessibility (p-values < 0.02). Greater proportion of male employees per site predicted lower overall acceptance (OR 4.4, 95% CI 1.2–16.5). Conclusions: Work communities appear to approve workplace choice architecture interventions for healthy eating and physical activity, but numerous factors influence acceptance and warrant consideration in future interventions. The study contributes with a theory-based, multidimensional evaluation that considered the perspectives of implementers and influenced individuals across heterogeneous real-world settings.
Alkuperäiskieli | Englanti |
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Artikkeli | 2451 |
Sivumäärä | 22 |
Julkaisu | BMC Public Health |
Vuosikerta | 23 |
Numero | 1 |
DOI - pysyväislinkit | |
Tila | Julkaistu - jouluk. 2023 |
OKM-julkaisutyyppi | A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä |
Rahoitus
We gratefully acknowledge all participating worksites and organisations and their representatives for collaboration, and Mikko Valtanen (Finnish Institute for Health and Welfare and University of Turku, Finland) for statistical consulting. Open Access funding provided by Finnish Institute for Health and Welfare. This work was funded as part of the StopDia study by the Strategic Research Council of the Academy of Finland (grant number: 303537). The first author (E.R.) has also received personal funding from Juho Vainio Foundation (grant number: 202100138), Yrjö Jahnsson Foundation (grant number: 20207314), Finnish Cultural Foundation, North Savo Regional fund (65221698), and the Diabetes Research Foundation (grant number: 220016). The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript, or in the decision to submit the manuscript for publication.
Rahoittajat | Rahoittajan numero |
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Finnish Institute for Health and Welfare and University of Turku | |
Mikko Valtanen | |
Yrjö Jahnssonin säätiö | 20207314 |
Fondazione Diabete Ricerca | 220016 |
Academy of Finland | 303537 |
Suomen Kulttuurirahasto | |
Juho Vainion Säätiö | 202100138 |
Suomen Kulttuurirahasto/Pohjois-Savon rahasto | 65221698 |
Finnish Strategic Research Council |
Julkaisufoorumi-taso
- Jufo-taso 1
!!ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health