How do workplace walking programmes produce their effects? A realist evaluation of the Step Count Challenge
Background: There is robust evidence that walking reduces risk factors for non-communicable diseases; however, the few studies of interventions to increase walking in workplaces settings (where we spend a large proportion of our working lives) have reported only limited success. This leaves programme designers with inadequate guidance. To address this, a realist research approach was used to evaluate how and why the Step Count Challenge, which is a long-established programme from the charity Paths for All, produces the effects it does. This thesis is the first to explain how the Step Count Challenge might work. Methods: This evaluation was aligned with the standards for the conduct of realist research. Stage one included interviews, a workshop and desk research. From these data, programme theories were developed. In stage two, a realist synthesis was used to refine these theories. In stage three, case studies of workplaces were used to test the programme theories. Results: The core theories of how the programme works include employer leadership, teamwork, health needs, a need for headspace, peer pressure and competition. Commitment to employee wellbeing is important for employer sign-up. For employees, sign-up is influenced by knowing the value of walking for health, combined with gentle peer pressure. The core process of ‘step counting in a workplace group’ is a balance between personal goals and group dynamics. High levels of physical activity are generated from having fun, participating in a competition, and challenging oneself to do more. In other contexts, goal focus and group pressure can generate stress and/or drop out. Conclusions and Recommendations: Workplace walking challenges should encourage participants to clarify and develop personal health goals. Offering participants ideas and options to manage their group dynamics should also be included. Realist research proved fruitful to explain this complex physical activity intervention and documenting the method may help others to try it.