UCLA

Background: Integrating physical activity "active-by-default" or "push" strategies into the standard conduct of organizational settings is a promising approach to engage sedentary and overweight individuals in regular physical activity. However, organizations must navigate a number of factors to ensure these strategies remain sustainable over time and elicit favorable outcomes. This project examined the implementation process health and human services worksites undertook while participating in the UCLA WORKING Project, a NIH-funded physical activity and healthy eating promotion intervention.

Methods: Process evaluation notes and descriptive summaries obtained from worksites assigned to an active intervention group (N=24) were used to assign worksites to four implementation success categories. Key informant interviews (n=13) with employee program champions and middle managers provided insight and context to roles and responsibilities, organizational dynamics, and factors associated with implementation success and failure. Individual clinical indicator and survey data collected on a voluntary sample of individuals (n=989) employed at participating worksites (N=40) were analyzed to determine any associations between the degree to which a worksite implemented strategies and changes in individual outcomes over a 6-month observation period. Organizational-level data collected from worksite representatives (n=4) were assessed to determine any associations between degree of implementation success and changes in organizational-level physical activity policies and practices over time.

Results: Middle managers played a crucial role in translating and enforcing priorities for their worksites, supporting the efforts of program champions, participating in PA breaks, and advocating for the prioritization of PA strategies. Clear and explicit PA policies, leadership support, pre-existing wellness infrastructure, and negotiating heavy workloads were cited as factors most strongly associated with successful implementation. Worksites that most successfully implemented the PA strategies had greater improvements over time in employees' BMI, systolic blood pressure, weight, and perception of co-workers initiating PA breaks than less successful worksites.

Conclusion: These findings suggest that implementation success may be linked to favorable outcomes, and that the WORKING Project may have successfully elicited favorable changes among employees with the poorest outcomes and highest risk of obesity and its related co-morbidities. Lessons learned from this project will inform future physical activity implementation and dissemination efforts within organizational settings.