Effects of an Integrated Physical Activity Program for Physically Inactive Workers - Based on the PRECEDE-PROCEED Model -

Hye-Jin Kim; Jina Choo

doi:10.4040/jkan.2018.48.6.692

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Kim and Choo: Effects of an Integrated Physical Activity Program for Physically Inactive Workers - Based on the PRECEDE-PROCEED Model -

Original Article

J Korean Acad Nurs 2018;48(6):692-707.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.6.692

Effects of an Integrated Physical Activity Program for Physically Inactive Workers - Based on the PRECEDE-PROCEED Model -

Hye-Jin Kim, Jina Choo

College of Nursing, Korea University, Seoul, Korea

Address reprint requests to : Choo, Jina College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-3290-4925 Fax: +82-2-928-9107 E-mail: jinachoo@korea.ac.kr

Received 1 August 2018 Revised 20 November 2018 Accepted 21 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

We aimed to examine the effects of an integrated physical activity (PA) program developed for physically inactive workers on the theoretical basis of the PRECEDE-PROCEED model.

Methods

Participants were 268 workers in three departments of L manufacturing unit in South Korea. The three departments were randomly allocated into integration (n=86) (INT), education (n=94) (ED), and control (n=88) (CT) groups. The INT group received self-regulation, support, and policy-environmental strategies of a 12-week integrated PA program, the ED group received self-regulation strategies only, and the CT group did not receive any strategies. After 12 weeks, process evaluation was conducted by using the measures of self-regulation (autonomous vs. controlled regulation), autonomy support, and resource availability; impact evaluation by using PA measures of sitting time, PA expenditure, and compliance; and outcome evaluation by using the measures of cardiometabolic/musculoskeletal health and presenteeism.

Results

Among process measures, autonomous regulation did not differ by group, but significantly decreased in the CT group (p=.006). Among impact measures, PA compliance significantly increased in the INT group compared to the CT group (p=.003). Among outcome measures, the changes in cardiometabolic/musculoskeletal health and presenteeism did not differ by group; however, systolic blood pressure (p=.012) and a presenteeism variable (p=.041) significantly decreased only in the INT group.

Conclusion

The integrated PA program may have a significant effect on increases in PA compliance and significant tendencies toward improvements in a part of cardiometabolic health and presenteeism for physically inactive workers. Therefore, occupational health nurses may modify and use it as a workplace PA program.

Keywords: Occupational Health Nursing, Physical Activity, Health Promotion, Risk Factors, Presenteeism

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Figure 1.

Conceptual framework based on the PRECEDE-PROCEED model.

Figure 2.

Flowchart for recruitment, randomization, and dropout.

Table 1.

Contents of a 12 week-Integrated PA Program at the Intervention Alignment Phase

Strategies	Components	Contents	Who intervened	How intervened	When intervened (week)
Self-regulation strategies	Autonomy	Addressing meaningful rationales: Influences and benefits of healthy PA on Health at the workplace	Researcher	- Lecture	1,5
				- Discussion
		Conveying options:		- Practicum	1,5,9
		- To choose appropriate alternatives to comply with the principles of PA
		- To acknowledge barriers against healthy PA and to set up strategies to solve the barriers
		Acknowledging conflicting feelings: To recognize participant's surrounding factors that disturb or help healthy PA			5,9
		Encouraging change talk: To share behavioral changes in PA			5,9
	Competence	Setting appropriate goals for healthy PA			1
		Enhancing self-efficacy: Self-monitoring training and knowledge & skill training for PA			1,5,9
		Providing positive feedbacks on PA via daily PA records			5,9
	Relatedness	Exploring concerns of participants			1,5,9
		Expressing empathy			1,5,9
Support strategies	Autonomy support	Choice: Supervisor’s choice of appropriate support and encouragement methods by freewill	Department	- Monitoring	Weekly
			Manager	- Persuasion
		Rationale: Supervisor's cultivation of meaningful rationales		- Use of text messages and cards	Weekly
		Empathy: Supervisor’s empathy for understanding of feelings and opinions about realistic situations of the workers’ PA			Weekly
		Collaboration: Supervisor’s collaborative monitoring and action planning for daily PA records		- Feedbacks	Weekly
		Strengths: Supervisor’s positive feedback on strengths for workers’ behavioral change			Weekly
Policy-environmental strategies	Building a supportive organizational climate	Forming self-help groups using SNS	Researcher	- Advertising	Weekly
		Increasing educational opportunities at workplace via advertisements	Department	- Supporting physical environment for PA	Weekly
			Manager
		Conducting competition contests, i.e., naming the BAND and evaluating PA compliance levels			1,5,9,12
		Operating customized interventions during working hours: Time arrangement for workers’ PA			1,5,9
		Establishing workplace policies for healthy PA: ‘At least 30 minutes of moderate to vigorous-intensity aerobic PA daily’			1
	Enhancing the availability of environmental resources	Installing exercise equipments (e.g., yoga mats, elastic bands) and health-related leaflets/posters at the staff lounge			1,5,9

PA=Physical activity; SNS=Social network service.

Table 2.

Homogeneity of General Characteristics between Groups (N=268)

	All	Integration	Education	Control group
Characteristics	(N=268)	group (n=86)	group (n=94)	(n=88)	F or χ²	p
		n (%) or M±SD
Sociodemographic
Age (yr)	31.17 (5.11)	30.65 (5.89)	32.31 (5.29)	30.47 (3.79)	3.68	.027
Gender (women), yes	124 (46.3)	43 (50.0)	25 (26.6)	56 (63.6)	25.79	<.001
Marital status (non-married), yes	130 (48.5)	44 (51.2)	45 (47.9)	41 (46.6)	0.39	.824
Education (college educated), yes	141 (52.6)	49 (57.0)	52 (55.3)	40 (45.5)	2.74	.254
Monthly household income (≥4,000,000 won), yes	87 (32.5)	28 (32.6)	29 (30.9)	30 (34.1)	0.22	.897
Health-related
Current smoking, yes	69 (25.7)	18 (20.9)	39 (41.5)	12 (13.6)	19.98	<.001
Alcohol drinking (≥1/month), yes	217 (81.0)	65 (75.6)	78 (83.0)	74 (84.1)	2.42	.298
Self-rated health (≥good), yes	61 (22.8)	23 (26.7)	23 (24.5)	15 (17.0)	2.57	.227
Work-related
Shift work, yes	262 (97.8)	84 (97.7)	91 (96.8)	87 (98.9)	0.88	.644
Duration of employment, months	9.21 (3.53)	8.83 (2.99)	9.39 (4.02)	9.47 (3.46)	1.14	.320
Weekly working hours	51.39 (7.96)	51.00 (7.84)	50.16 (9.25)	53.10 (6.19)	3.32	.038
Work intensity	11.63 (3.86)	11.70 (3.86)	11.30 (3.69)	11.91 (4.06)	0.59	.555
Break time during working, minutes	20.93 (8.10)	20.84 (9.02)	22.93 (9.14)	18.89 (4.88)	5.86	.003

SD=Standard deviation.

Analysis of Variance (or chi-square test) was conducted for testing homogeneity by group.

Table 3.

Effects of an Integrated PA Program on Outcome Variables (N=268)

			Integration group (n=86)		Education group (n=94)		Control group (n=88)		Homogeneity		Changes by group
Phases	Concepts	Outcome variables	Pretest	Posttest	Pretest	Posttest	Pretest	Posttest	F or χ²	p	F or χ²	p
			n (%) or M±SD		n (%) or M±SD		n (%) or M±SD
Process	Predisposing factor	Autonomous regulation	3.59	3.53	4.21	4.01	3.97	3.64	4.62	.011	0.75	.475
			(1.40)	(1.20)	(1.36)	(1.48)	(1.38)	(1.41)**
		Controlled regulation	3.07	3.07	3.32	3.34	3.53	3.30	3.07	.047	0.50	.609
			(1.28)	(1.07)	(1.26)	(1.36)	(1.15)	(1.16)*
	Reinforcing factor	Autonomy support	4.88	4.77	4.91	4.80	4.86	4.55	0.06	.946	0.95	.387
			(1.19)	(1.27)	(1.05)	(1.05)	(0.96)	(0.96)**
	Enabling factor	Resource availability	3.54	3.47	3.38	3.20	3.41	3.36	1.31	.273	0.72	.490
			(0.78)	(0.70)	(0.72)	(0.64)*	(0.70)	(0.69)
Impact	PA	Sitting on workday	495.55	495.58	405.11	426.37	521.55	521.53	13.50	<.001	1.14	.320
			(168.78)	(173.75)	(163.55)	(173.25)	(144.21)	(162.92)
		(min/day)
		Sitting on non-workday	461.88	404.12	398.67	410.74	398.78	378.58	2.64	.073	1.15	.097
			(232.52)	(189.12)*	(177.99)	(226.71)	(216.20)	(194.50)
		(min/day)
		PA expenditure	3035.20	2586.07	4564.03	3546.38	1927.75	1520.50	9.89	<.001	1.25	.288
		(MET-min/week)	(3368.18)	(3358.42)	(5522.09)	(3978.22)*	(2350.64)	(2361.69)
		PA compliance	139.0 (	62.58)^†	141.1 (	71.68)^††	114.9 (	(71.63)			5.89	.003
		(%)
Outcome	Cardiometabolic health	BMI (kg/m²) c	22.79	22.79	23.53	23.72	23.62	23.84	1.51	.222	2.73	.067
			(3.43)	(3.59)	(3.09)	(3.19)*	(3.87)	(3.91)*
		WC (cm)	76.90	76.53	79.92	79.90	78.62	78.47	1.87	.156	0.29	.750
			(11.32)	(11.02)	(9.65)	(9.83)	(10.47)	(10.30)
		SBP (mmHg)	125.38	122.80	128.34	127.54	124.62	122.74	1.80	.167	0.92	.402
			(13.87)	(13.05)*	(14.45)	(14.01)	(13.58)	(14.17)
		FBS (mg/dl)	97.06	101.49	98.39	103.66	96.73	101.64	0.74	.478	0.25	.779
			(9.93)	(10.48)*	(11.90)	(10.76)*	(6.76)	(9.30)*
		TC (mg/dl)	186.54	194.36	196.18	207.13	195.13	197.66	0.32	.729	2.51	.083
			(36.13)	(37.93)*	(31.06)	(35.52)*	(35.04)	(31.54)
	Musculoskeletal health	WMSD (yes)	21	18	19	16	20	18	0.47	.792	0.74	.691
			(24.4)	(20.9)	(20.2)	(17.0)	(22.7)	(20.5)
	Presenteeism	Primary health problems (yes)	64	54	62	53	59	57	1.75	.418	1.62	.446
			(74.4)	(62.8)*	(66.0)	(56.4)	(67.0)	(64.8)
		Work impairment	36.44	33.01	28.22	28.31	33.64	34.57	4.75	.010	0.64	.527
			(14.78)	(16.72)	(14.82)	(17.40)	(16.03)	(17.70)

BMI=Body mass index; FBS=Fasting blood sugar; M=Mean; MET=Metabolic equivalent of task; PA=Physical activity; SBP=Systolic blood pressure SD=Standard deviation; TC=Total cholesterol; WC=Waist circumference; WMSD＝Work-related musculoskeletal disorders.

^†integration vs control (p<.05) and ^††education vs control (p<.05); paired t-test or McNemar test was conducted for testing significant changes within each group (*p<.05, **p<.01).

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