The aim of the thematic analyses was to elicit the main themes and subthemes that were considered to be important factors for engagement/disengagement with the intervention and the maintenance of physical activity. The themes pertaining to the patients’ overall perceptions of the intervention were very positive, including those relating to mental health and well-being, social aspects and physical fitness and health. In terms of the key behaviour change and intervention components, themes included the issue of rewards by means of a financial incentive (and also disincentives linked to ‘voucher type’) and technology as a means of tracking progress, support and feedback (and also negative aspects relating to technological issues with sensors and key fobs (see General perceptions of the intervention for further details).
Participants
In total, nine focus groups (FGs) were conducted at the end of the intervention period across the study sites: Lisburn (n = 3 FGs; n = 21 participants), Stormont Estate (n = 2 FGs; n = 12 participants), Queen’s University Belfast (n = 2 FGs; n = 16 participants) and Belfast City Hospital (n = 2 FGs; n = 16 participants). Sixty six participants took part in the FG discussions [n = 52, 78% female; mean age 43.8 (SD 9.0) years]. At 12 months, 17 participants who had taken part in the 6-month FGs also took part in the 12-month FG discussions [n = 9, 53% female; mean age 46.1 (SD 9.3) years].
The following coding was applied to quotes to distinguish between the different FGs and semistructured interviews undertaken: FG denotes the focus group sessions (1–9) at 6 months (e.g. FG1, FG2); FG12 denotes the focus group session (12.1–12.6) at 12 months (e.g. FG12.1, FG12.2); MR denotes male respondent; FR denotes female respondent; R denotes retailer; SM denotes senior manager.
General perceptions of the intervention
The overall feedback from participants about the PAL scheme was positive. Many participants cited how the scheme had helped them engage in more physical activity and develop habits that could be maintained once the intervention had ended:
It’s been a very positive thing to get people out walking and to encourage them to walk more, with all the wee perks and to do a bit extra every day.
FG3, FR
So it’s been a brilliant success to get me walking and it’s now part of my daily routine.
FG8, FR
Type of physical activity
The type of physical activity on which the intervention was based was also viewed as positive by the participants, with many citing how convenient walking and/or jogging were compared with other activities:
. . . it doesn’t suit everybody to go to a class, to be there at a certain time . . . that’s the good thing about walking and running, that you can do it at any time it suits . . .
FG3, FR
It wasn’t hard, that’s what I quite liked about it. You could do as much or as little as you wanted, and that was quite nice.
FQ9, FR
Format of the physical activity loyalty scheme
Many participants felt that the format of the scheme, targeted at changing physical activity across the working day, was restrictive. Participants highlighted that the timing of the intervention did not enable them to account for how active they had been across the whole day:
What I found with it was that I was really doing the most of the stuff. I was a bit aggrieved because I was doing a lot in the morning which wasn’t recorded on the fob, you didn’t record those things.
FG6, FR
Some participants also found the intervention limiting because it did not take account of other types of physical activity:
I think it’s very restrictive in just having walking or running, because we do have very good staff membership for the gym, which a lot of the staff do avail of but you didn’t get any recognition for it . . .
FG3, FR
Increasing physical activity and health benefits
A number of key themes emerged when participants discussed their reasons for signing up to the PAL scheme. Increasing physical activity across the work day was cited by many participants as their main reason for signing up:
I felt I needed more exercise, I knew that it was beneficial, I thought it was a good idea and would help me do more.
FG1, FR
Mine was to get up from my desk and get out to walk more, that was my reason, more self-motivation . . .
FG7, FR
In addition to being more active, the associated health benefits of this behaviour change were also noted by participants, with many commenting that they signed up to lose weight or improve their health:
For me, it was health and fitness and good habit forming, plus you could see it was just better for you to get away from the desk, mentally.
FG6, FR
Some participants felt that they were already active during the working day and that the scheme was worthwhile to gain something for their efforts:
I did walk a lot anyway, at lunchtime and before work and stuff and I sort of thought I might as well get something for it. I was doing it anyway . . .
FG9, FR
Whereas other participants noted that helping out with research was a factor that encouraged them to sign up:
I do a lot of cycling and running and record it. I just figured that there’s a bit of data that maybe someone else could use, they may as well have my data.
FG1, MR
The convenience of an intervention being delivered within the workplace was also an influencing factor in encouraging people to take part:
I think generally if you can incentivise anything that’s within work hours, I know personally for me, with working with a young family, if I can get that activity within those hours from 8 to 6 then it will really work for me . . .
FG8, FR
Key barriers to and facilitators of the physical activity loyalty scheme
Key barriers to and facilitators of the PAL scheme and of being active throughout the working day were identified through the FG discussions. Work demands, time and the weather were cited by participants as barriers to being more active at work and participating in the PAL scheme. The structure of the working day meant that it was not always possible for participants to be active during lunchtime:
I find, especially in this place, you don’t always get the chance to get out at lunchtime anyway. Once I started, if I didn’t get out at lunchtime I would be more inclined to make sure that I did get out in the evening for a walk.
FG6, MR
In addition, increased workload had an impact on the time participants had available to be active:
But as term got busier and we got into September it just got more and more difficult to find the time to fit it all in.
FG9, FR
Participants highlighted how the weather was also a barrier, deterring them from taking part in the scheme on occasions:
We walked in a group, so I think if it rained the girls got their hair wet, so that sort of stopped them, really. If it rained we didn’t walk basically.
FG6, MR
With regard to facilitating increasing physical activity through the PAL scheme across the working day, a number of key themes emerged. Access to nice areas for physical activity was noted as a facilitator:
We’re very fortunate in this area, we’ve this lovely green park and you can walk out there and walk back.
FG6, FR
Support within the workplace from colleagues was another facilitator of physical activity, with participants commenting on the importance of sharing experiences of being involved in the scheme:
Even if you didn’t want to walk in a group, just chatting about it ‘How much did you do . . .?’ I think that works for a lot of people.
FG8, FR
In addition to support from colleagues, the attitude of employers was noted as another important influence:
I think that this council is very good as an employer, as they do put on the likes of the classes at lunchtime, you have access to the gym and everything.
FG3, FR
General benefits of the physical activity loyalty scheme
A number of themes emerged from the FG discussions on the benefits participants received from their participation in the PAL scheme. Benefits of the intervention included increased levels of physical activity, health benefits, social benefits and increased productivity. Participants highlighted how the scheme had instigated changes in their usual routine, leading to increased physical activity across the day:
If I got the train in I would actually make my route longer to make sure that I passed a few points in the way in and on the way home, rather than just straight here.
FG4, MR
A number of health benefits were listed by participants, including the impact that being more active had on their physical well-being:
I wanted to lose weight. I’ve lost 2 stone since I started, but I’ve done lots of other activity. But it spurred me on and gave me the motivation, and actually I built up my fitness so that I could do some of the other activities.
FG9, FR
In addition to the positive impact that the intervention had on physical health, participants also noted the benefits in relation to their mental health and well-being:
It’s quite nice too, because even the mindfulness idea, as you’re walking along on your own you’re more mindful of what you’re doing, and you’re into health issues there too.
FG8, FR
There were mixed responses from FG participants with regard to how physical activity behaviour change was maintained post intervention. A number of participants noted how the PAL scheme had changed their routine from doing no physical activity across the working day to now being more active:
I would walk more now; I wouldn’t have thought of doing it at all.
FG4, FR
Incorporating physical activity into habits and daily life
In addition, being involved in the intervention encouraged participants to make small changes to their daily habits to facilitate physical activity within the working day:
. . . I do at least as much now, even after it’s finished, as I did when I was doing it, and in fact I probably do more now and I’m probably much more conscious of what I do because of even trying to think up how I was going to make those points in a day. I keep walking, I still walk up and down from the school every day, and I do it at least five times a week, if I can, to build up 150 minutes.
FG9, FR
Other participants commented on how being involved in the intervention had made them think about their physical activity and that they were still making efforts to increase their activity as a result of being involved in the PAL scheme:
I haven’t continued as much but I am really determined to, because I am aware of the fact when I’m not walking and that your health is not quite as good, so I have made more of a conscious effort recently to try and get back into it, especially now that the days are a little bit longer and it’s a bit brighter outside. I kept up other exercise, other than walking as well, quite consistently, even more so than I would have done previously.
FG9, FR
For some, the extra physical activity that they were doing during the PAL scheme stopped once the concept of the points and rewards was removed:
I did it when the vouchers were there but now I wouldn’t . . . I would go outside but I wouldn’t actually make an effort now. So I would never dream of going for a walk or anything during work.
FG7, FR
Social aspects of the physical activity loyalty scheme
The participants commented on the social aspects of being involved in the PAL scheme, with many citing the intervention as a good way of socialising with colleagues:
There was a social element to it too, like someone would say ‘oh, do you want to go outside and get some points?’
FG6, FR
Participating in the intervention group identified a number of benefits specific to the workplace. Within the FG discussions, participants noted that the intervention provided them with the opportunity to have a proper break during the work day:
Yeah, usually you have your lunch here, sometimes at your desk, so you aren’t getting away from it, so it’s good to get outside and get fresh air and you’re more awake in the afternoons then because you have been out.
FG3, FR
Furthermore, participants felt that the opportunity to be active during the day had a positive effect on their productivity:
I probably worked harder because I’d normally be sleeping after lunch.
FG4, MR
As well as increasing levels of physical activity across the work day, participants highlighted an additional effect being involved in the PAL scheme had on other types of physical activity they were involved in:
It triggered off for me to go and join a club, a rowing club, because you weren’t really aware that you weren’t doing as much and you were sitting quite a bit at the desk, and you thought ‘right OK’ . . .
FG7, FR
In addition, the PAL scheme increased awareness of other improvements individuals could be making to their overall health and well-being:
Like others, it stimulated me to look at other parts of my lifestyle and try to amend them, to make small changes as well.
FG8, MR
Perceptions of intervention components and behaviour change techniques
The key themes in relation to participants’ thoughts on the different intervention components of the PAL scheme for behaviour change are summarised in . These include the use of incentives, sensors, maps, feedback, fobs, e-mail and social support.
Results from the process evaluation regarding participant perceptions of the intervention components
With regard to the sensors, participants reported some issues that affected the day-to-day running of the intervention, including issues with the accuracy, placement and restrictiveness of the sensors (see ). The participants had mixed opinions on a number of website components, including the maps and e-mail prompts. The feedback element of the website was a positive feature for many, with participants highlighting that the visual feedback often prompted them to be more active.
A number of themes emerged in relation to rewards (retail vouchers) offered to participants in exchange for points they had accumulated during their participation in the PAL scheme. Some participants felt that the vouchers did not provide a sufficient reward for the effort and activity undertaken:
You’ll get incentives joining gyms anyway, so there wasn’t really any incentive in the incentives, really, unless it was a free cup of tea. Walking ten miles for a cup of tea. It needed to be more; the incentives just weren’t enough for me.
FG5, FR
Meanwhile, other participants felt that the vouchers were limited:
The vouchers were an issue, when you go to get them there wasn’t the ones you wanted, such as Argento. Just there was only so many available.
FG3, FR
Participants noted that the issues around the format and availability of the vouchers had an impact on their interest in other elements of the intervention:
And I found then that I lost interest because the points weren’t really going anywhere. And then whatever points I had, the incentive wasn’t good enough for the points I had.
FG5, FR
Focus groups at 12 months post baseline
The main aim of the FGs conducted at 12 months was to explore behaviour change maintenance. On the whole, participants referred to their maintained, or at least their attempt to maintain, physical activity levels and a desire to keep up with the levels that they had achieved during the 6-month intervention:
I know I started well but I think I wasn’t consistent the whole way through because of other factors that were happening at work at the time, but I tried to maintain a level, I was trying to sort of hit the target a week.. after the scheme ended I did try and keep it going.
FG12.4, MR
The detailed walking routes provided during the scheme were also still utilised after the intervention period ended:
. . . so, I would do that route more or less exactly everyday whenever I do go out.
FG12.4, MR
. . . and in the mornings I’m still doing a lot of the same routes.
FG12.3, FR
For participants, the notion of building physical activity into their day was a key aspect to maintaining levels of physical activity:
Yeah, and I’ll tell you another thing, while even waiting on the train on the platform I’ll be walking up and down the platform, rather than just stand there, I’ll walk.
FG12.1, FR
Another key aspect was the notion of making conscious efforts to move more:
Well now, if I’m cooking, I would tend to do that step, from one side to the other or back and forth, so as I’m not just standing still.
FG12.1, FR
This was also noted with regard to the idea of looking for opportunities to be active beyond the 6-month intervention period:
It’s something I can work into my lifestyle, and even when you don’t have it you’re sort of thinking well is there an opportunity to perhaps go for a walk at lunchtime to just keep that activity going.
FG12.4, MR
Participants commented on looking for additional opportunities in their day to be active:
. . . I can adapt my pattern and I spotted two other opportunities, the beginning of the working day and the end of the working day, where I can do something that fits in.
FG12.4, MR
Habit, be that continuing with the established walking routes or continuing with their lunchtime walk or step goals, alongside seeking out opportunities to be active were common threads throughout the FGs for maintained physical activity behaviour change after the scheme had ended.
Senior managers of participating employees
Semistructured interviews were also undertaken with senior managers of six participating employers (n = 7 managers) and four participating retailers. Feedback about the intervention was positive from employers, with themes emerging from the interviews about employee benefits, both by means of getting active (a focus on physical and mental health) and relating to workplace productivity. Senior managers’ perceptions of the intervention were aligned with participants’ perceptions, regarding time as a key barrier to physical activity in the workplace.
Senior managers’ overall perceptions of the physical activity loyalty scheme
Employers’ overall thoughts on the PAL scheme were positive, with managers highlighting the benefits of getting their employees to be more active:
We know that walking is better than being sedentary and it reduces lots of different diseases and things. So in principle it’s very good.
SM2
It’s the health benefits . . . that people are more active. You know yourself, it reduces risks of lots of different types of diseases . . .
SM2
. . . it’s the mental health and people are enjoying the brighter evenings and the sunshine.
SM4
The wider benefits of the intervention were also noted for the employer in relation to productivity:
A lot of them [employees] commented recently on feeling more productive in the afternoon when they’ve had a chance to get some fresh air and a chance to stretch their legs. We’ve seen a great stretch in productivity.
SM4
In addition, senior managers commented on how the intervention aligned with other initiatives within the workplace:
I think it’s very valuable to add some evidence to the research that’s already been done, and obviously it fits very nicely with us in terms of workplace health . . .
SM3
In addition, employers commented on the benefits of the intervention in terms of making contacts with other businesses and organisations:
. . . suppose in terms of the business side of it too, in terms of the partnerships with the business side, in terms of incentives, that’s of value too.
SM6
Senior managers highlighted a number of barriers to promoting physical activity within the workplace. Time and resources were commonly cited as barriers to being active within the working day:
Time. I think that’s the reality, is we are all increasingly . . . work pressure is probably the most significant barrier, certainly in my opinion and from my own personal experience . . .
SM1
Employers noted the need for a change of attitudes at management level to facilitate such schemes:
. . . question comes from their line managers: ‘Where are the staff going to get the time for this?’ And our job is really to convince them of the bigger picture . . .
SM1
Retailers
Semistructured interviews were undertaken with four participating retailers. A number of key themes emerged with regard to why retailers became involved with the PAL scheme, including benefits for their business and the broader benefits of the scheme for participants. Of the participating retailers interviewed, all cited the potential benefits being involved in the PAL scheme could have for their business.
Potential of the physical activity loyalty scheme to improve business
The PAL scheme had the potential to increase use and sales within participating businesses:
. . . somebody that hadn’t been into the shop before, they’ve got a voucher so they might be encouraged to come in, they might like what they see when they come in . . .
R1
It also provided businesses with an opportunity to promote their services and entice participants into their businesses over other similar businesses surrounding the workplace:
The opportunity to go down Botanic Avenue and go into those cafes and restaurants is always there. So this was an opportunity for me to promote the cafes and restaurants on the site.
R1
Potential benefits of the physical activity loyalty scheme for participants
Participating retailers also acknowledged the benefits such a scheme could have on the health and well-being of participants, and cited this as another factor behind their willingness to participate in the scheme:
. . . doing more exercise is kind of what everybody needs to be doing but people don’t do it, and encouraging them in some way, I think is definitely a good idea.
R2
Incentives and rewards
A number of themes emerged in relation to the incentive-based element of the scheme, including (1) the concept of incentive-based physical activity, (2) the type of reward and (3) the value of the rewards. All participating retailers felt that incentivising participants to increase their physical activity was a good idea, from both a behaviour change perspective and also for the added benefit that it could have for businesses:
. . . if I knew there was something at the end of it that you’re going to or you’re working towards getting money off or working towards a different voucher then it makes it seem more worthwhile.
R2
We like it from the idea of the retail point of view because they don’t have to pay anything and they’re getting free promotion, which everybody should appreciate . . .
R3
The type of reward offered varied across the participating businesses, with different reward structures being perceived to have a different influence from the retailers’ points of view. Some retailers offered a cash value voucher as their reward, with a view that participants would spend more when cashing in their voucher:
So a £10 voucher, there’s a fair chance if they come in they will upscale in terms of what they’re going to buy. So you’ll hopefully get it in the long-term.
R4
There was consensus among retailers that the rewards offered to participants were not ‘overly generous’.
The retailers highlighted a number of issues that may influence upscaling the present intervention or taking part in similar schemes in the future. All retailers spoke about the sustainability of the incentive-based approach and highlighted that they would take part in future schemes if they were getting a good return from a business perspective:
. . . future for me going, is down the voucher route. So yeah, it’s sustainable providing people come and use it.
R4
Retailers also cited requests from other organisations and schemes as a potential barrier, with most retailers constantly being asked to provide rewards and sponsorship:
But the down side is we as a shop again are always asked for vouchers and sponsorship and you have to pick what you can go for.
R4
Questions regarding the impact and financial gains from participating in the scheme were cited as another key theme in relation to future participation. All retailers highlighted the need for feedback from participants and the need to track how the rewards were used, which was not monitored within the present study by the researchers or the businesses themselves. Retailers noted that they would make efforts to track voucher use and spending in future. In addition, retailers highlighted that tracking use could also provide them with an opportunity to gain feedback from new customers:
. . . I would just like some feedback from the participants of the scheme in terms of their experience . . . on a purely customer-focused level, did they have a positive experience when they used the cafes . . .
R1
