ORIGINAL RESEARCH 1 SAJSM VOL. 34 NO.1 2022 Creative Commons Attribution 4.0 (CC BY 4.0) International License “If money was no object”: A qualitative study of South African university office workers’ perceptions of using height-adjustable sit- stand desks PJ Gradidge,1 PhD; M Phaswana,1 MSc; JY Chau,2 PhD 1 Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 2 Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia Corresponding author: PJ Gradidge (philippe.gradidge@wits.ac.za) Sedentary behaviour is a growing global public health concern. Elevated levels of sitting time are associated with all-cause mortality and cardiovascular disease risk factors, especially among people who are not sufficiently active. [1] Sedentary behaviour is defined as sitting or lying recumbent or such activities that result in energy expenditures of ≤ 1.5 metabolic equivalents. [2] Obesity and related comorbidities have strong links with sedentary behaviour, particularly in low-income and middle-income countries (LMICs), such as South Africa, where populations continue to shift into obesogenic urban environments and adopt these sedentary lifestyles. [3] Recent data demonstrate that the prevalence of South Africans sitting ≥ eight hours per day is approximately 4.6% of the population, and this is mostly among those living in urban areas. [4] Office workers in South Africa are prone to sitting for long periods of time during vocational hours, [5] that are similar to high- income countries (HICs) where employees are sedentary for at least two-thirds of the workday. [6,7] A recent systematic review using pooled data reported that interventions for reducing sitting in office workers have found small improvements in cardiovascular health, particularly with systolic blood pressure (−1.1 mm Hg), body composition (body weight: -0.6 kg; body fat percentage: −0.3%; waist circumference: −0.7 cm, and lipid profile (high-density lipoprotein cholesterol: 0.04 mM) and insulin (−1.4 pM). [8] Interventions in free-living environments, including workplaces, that target sedentary behaviour alone or in conjunction with physical activity, are effective for improving biomarkers associated with cardiometabolic risk profiles. [8] Most of the sedentary behaviour interventions have been carried out in high-income countries and Eurocentric populations. The evidence indicates that sit-stand workstations are effective in workplace strategies in high-income country settings. [8] Little is known about the feasibility of this strategy in the context of low-middle income countries, possibly due to the comparatively longer duration of interventions conducted in the studies in high-income countries. [8] For example, an Australian workplace intervention that included environmental modifications (sit-stand desks), messaging to encourage behaviour adjustment and health coaching observed significant reductions in occupation-related sitting time and cardiometabolic biomarkers at 3- and 12-months. [9] South African workers (n=1954) recruited from 18 companies were estimated to have a high prevalence of non-communicable diseases due to the growing obesity epidemic in the country. [10] Hene et al. also reported that 67% of workers in their study were overweight, while 77% were insufficiently physically active. [11] What is lacking, however, is the comprehension of how tools to disrupt occupation-related sitting are feasible for workers in South Africa. To our knowledge, strategies using sit-stand desks have not been applied in the South African workplace and not in a university context in particular. Therefore, we sought to target this knowledge gap by exploring the perceptions of South African university office workers regarding the feasibility of sit-stand desks to reduce sedentary behaviour at work. Methods Setting, design, participants and recruitment This study was conducted at the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. The study aimed to assess the feasibility of an environmental modification to promote less sitting using sit-stand desks. On the 20th of November 2020, all office staff from one building in the Faculty of Health Sciences were invited by email to participate in this study. Of the thirty-two potential participants who were working in the office during the COVID- 19 lockdown, 11 responded to the invitation and completed an online pre-screening survey. The email invitation included a participant information sheet and a consent form. Ethical Background: Data from empirical investigations on the feasibility and acceptability of using sit-stand desks in an office-based setting in low- and middle-income settings are limited. Objectives: To explore the perceptions of South African office workers towards using height-adjustable sit-stand desks to reduce sitting time during vocational hours. Methods: Self-reported sedentary behaviour and in-depth, semi-structured interviews were conducted in December 2020. Thematic content analysis approach was used to develop themes. Results: Eleven office workers with a work-time sitting time of 8 (6-8) hours were interviewed (age 40.5 ± 12.6 years), most (91%) were female. The main themes emerged and included: overall impressions of the height-adjustable sit-stand desks; enablers versus barriers to using the desk and readiness to continue using sit-stand desks. Conclusion: The findings of this research add to the evidence on environmental workstation modifications for reducing sedentary behaviour. Further investigations on the efficacy of sit-stand desks are recommended in South African university office workers. Keywords: sit-stand desks, university office-based workers, workplace, sedentary behaviour, South Africa S Afr J Sports Med 2022;34:1-6. DOI: 10.17159/2078-516X/2022/v34i1a13881 mailto:philippe.gradidge@wits.ac.za http://dx.doi.org/10.17159/2078-516X/2022/v34i1a13881 https://orcid.org/0000-0001-6261-2545 https://orcid.org/0000-0002-5917-1619 https://orcid.org/0000-0001-5225-1184 ORIGINAL RESEARCH SAJSM VOL. 34 NO.1 2022 2 approval was obtained from the University of the Witwatersrand (ethics certificate number M190224). Written consent was provided by all participants. The inclusion criteria included adults (aged above 18 years) with access to a desk or workstation within an office, the ability to communicate in English, the ability to walk or stand for at least 10 minutes, and individuals who worked in the office for at least three days a week. The sit-stand workstation consisted of a height-adjustable workstation (JUMBO DeskStand™, DeskStand, South Africa) that allowed office workers to vary their posture throughout the workday between sitting and standing for a period of two weeks. The participant’s workstation was set up by one of the investigators (MP) in the best ergonomic position in relation to the participant’s height and needs. Upon installation, participants were educated on the benefits of standing-based work and interrupting sitting time. Participants were provided with training on how to optimally set up the workstation for their own individual job roles. The participants were asked to disintegrate their sitting time by accumulating bouts of standing activities of at least 10 minutes initially and, then progressing to longer bouts of 30 minutes or more as the study progressed. Data collection procedure Participants were first asked to self-report their estimated time spent sitting (hours) in various aspects of sitting during work, commuting and at home using an adapted version of the Workforce Sitting Questionnaire (WSQ). [12] The WSQ is reliable and has been validated for use in office-based workers. [12] The semi-structured interviews took 10-30 min each, and were all recorded and conducted in English. Interviews were conducted by one researcher (MP) using a semi-structured interview guide (Supplementary File 1) via Microsoft teams or in-person between 1st of December 2020 to 19th February 2021 as preferred by the participants during the Covid-19 pandemic. Recorded audio files from the discussions were transcribed verbatim. All transcripts were checked against the recordings to verify accuracy and credibility, and grammatical editing was adopted where necessary. Data credibility and trustworthiness The authors followed and adopted the Eight “Big-Tent” criteria for excellent qualitative research in conducting this study. These criteria included a worthy topic, rich rigour, sincerity, credibility, resonance, significant contribution, ethical and meaningful coherence. [13] Exploring the perceptions of using height-adjustable sit-stand desks was considered a worthy topic to inform environmental sedentary behaviour interventions in the South African context. Regarding rich rigour, the authors followed the established methodology for data collection, processing, and analysis. Sincerity was observed by the authors that confirmed that the interviews were transcribed correctly and processed using recognised software (Atlast.ti) and that there was agreement on the themes and sub-themes to ensure optimal trustworthiness. Credibility was confirmed by presenting the themes that could be anchored to participant quotations. The exemplar quotations are presented systematically for a visual resonance of the participants’ perceptions of using the height- adjustable sit-stand desks. Concerning significant contribution, the authors describe the conceptual relevance of interrupt sitting time during office hours and the importance of informing further studies of environmental tools to reduce sedentary behaviour in the South African workplace. Ethical approval was obtained as described. Finally, meaningful coherence for this study was realised by ensuring robust methodology consistent with previous research of sedentary behaviour interventions in the workplace. [14] Data analysis Recordings were transcribed and de-identified by a professional service. All transcripts were read at least twice by each researcher and then coded line by line using a thematic analysis approach with Atlas.ti 9 (9.1.5.0, Atlas.ti Scientific Software Development GmbH). Two researchers (MP and PJG) read and coded the imported textual data to identify emergent themes. Discrepancies were discussed, and revisions were made until full consensus was achieved. Results The participants (n=11) were mostly female (91%) and had a mean age 40.5 ± 12.6 years (Table 1). The majority had tertiary qualifications (91%) and 82% (n=9) were paid a monthly salary ≥R20000. The estimated self-reported sitting time ranged from Table 1. Demographic characteristics (n=11) Characteristic N (%) Age (years)* 40.5 ± 12.6 Female 10 (90.9) Highest level of education Completed high school 1 (9.1) Diploma/ College certificate 1 (9.1) University degree 3 (27.3) Postgraduate degree 6 (54.4) Monthly income Prefer not to answer 1 (9)