Insufficient physical activity is a major problem
]. In 2008, 61% of men and 71% of women in England reported insufficient activity, with objective measurements revealing 94% of men and 96% of women below recommended levels
]. Accumulating activity during daily life is one public health approach to this problem
]; walking rather than driving and choosing stairs rather than lifts would increase lifestyle physical activity.
Stair climbing uses 9.6 times the energy of the resting state
], i.e., requires more energy per minute than jogging or rowing. As ascent requires two to three times the energy expenditure of descent, increased stair climbing is the preferred public health goal
]. To increase stair use, messages are positioned at the ‘point-of-choice’ between stairs and the escalator, encouraging individuals to climb the stairs for their health. For a choice between stairs and escalators in public access settings, stair climbing increases on average +5.9%. When pedestrians choose between stairs and a lift in worksites, however, the average increase for stair use is +0.1%
]. This equivocal evidence in worksites is problematic; regular stair climbing provides the greatest dividend and worksites are a plausible location for its occurrence. In this paper, we use the theoretical mechanisms underlying stair climbing interventions to provide a new approach for worksites.
One influential model of health behaviour, the Theory of Planned Behaviour TPB;
], posits that behaviour is determined by intentions to perform it. Attitudes, the strongest predictor of intentions to be physically active, reflect positive and negative beliefs about the consequences of that behaviour
]. For example, beliefs that stair use will influence weight have been related to observed stair climbing
]. Mass media campaigns target attitudes by providing information about the positive benefits of health enhancing behaviour and/or the negative costs of health threats. Hence, they target motivations towards the behaviour by providing the reason why
the behaviour should be performed. Mass media campaigns target decisions to enhance one’s health, i.e. intentions, by outlining future benefits or costs. By contrast, a second type of intervention helps translate intentions into action, e.g., making an implementation intention
] or planning participation in the intended behaviour
]. Point-of-choice prompts for stair climbing are a further example of these volitional interventions. Exposure to a prompt is fleeting, perhaps lasting a few seconds during an individual’s journey. This brief exposure provides insufficient time to change attitudes. Rather, point-of-choice prompts alert individuals with existing
intentions to be physically active that stair climbing is a health enhancing means of meeting their intention. Thus, point-of-choice prompts help translate prior
intentions to be more physically active into action. Hence, a campaign that targets attitudes, the precursors of intentions, in addition to prompting the behaviour at the point-of-choice, may optimize the impact on stair climbing. As adults spend half their waking hours at work
], the workplace allows repeated exposure of individuals to the more elaborate campaign required to change attitudes.
The campaign that we report added two elements that targeted attitudes to a conventional point-of-choice campaign. First, an extended message translated information about the calorific expenditure of stair climbing into lay terms. The core message informed employees that ‘One flight uses about 2.8 calories but 10 flights a day would use 28 calories. Over a year that adds up to 10,000+ calories; that’s more than four days worth of food’. This core message specified the amount
of stair climbing required to achieve the outcome see
]. It aimed to contrast an achievable daily task, i.e., 10 flights, with the benefit accumulated over a year to maximize the possible gain, i.e., four days without food. The main text in one worksite (Poster alone) was compared with a second worksite (Poster
Stairwell messages) in which supplementary messages in the stairwell described calorific outcomes of stair use, e.g., ‘burns more calories per minute then jogging’. These supplementary messages also target attitudes. Thus, the extended text and supplementary messages targeted attitudinal change, whereas the conventional point-of-choice prompt at the lift button aimed to translate any changed intentions into action.
Overview of research sections of the paper
The schematic in Figure
summarises the evidence presented in the paper. First, we pre-tested calorific expenditure messages for use as supplementary messages for the stairwell; weight related messages were not reported as motivating in previous pre-testing
]. Next, an observational study used two worksites to test the new campaign aimed at attitudinal change on stair climbing. Both worksites displayed the extended message and conventional point-of-choice prompts. For one worksite, Poster
Stairwell messages, the supplementary messages were added in the stairwell. We predicted an increase in stair usage when the campaign was installed, with a greater increase at the Posters
Stairwell messages site than the Poster alone one. Finally, a post-campaign questionnaire tested the effects of the campaign on individuals’ attitudes and intentions towards stair use.
Schematic of the evidence presented in the paper and the intervention components at the two worksites.