Globally, society is undergoing a demographic shift characterised by an ageing population and increased life expectancy, posing challenges to the healthcare system that may be addressed through health promotion interventions supporting beneficial health behaviours. The transition from working life to retirement could be a potential window for such interventions. Sedentary behaviour, common among older adults, is associated with adverse health outcomes. Although eHealth interventions incorporating self‑management strategies may support reductions in sedentary time, there is a lack of research targeting reduced sedentary time during the transition to retirement. Involving end users in the development of eHealth interventions through participatory design may help ensure alignment with users’ needs. The overall aim was to contribute to health promotion by generating new knowledge on how sedentary time can be reduced, and how adherence to reduced sedentary time can be promoted, through an eHealth intervention including self-management strategies, in older adults transitioning from working life to retirement. A further aim was to develop and test such an intervention.
The thesis comprises four studies following a participatory design approach. In the initial needs‑assessment phase, focus groups with older adults transitioning to retirement explored perceptions of self‑management strategies for reducing sedentary time (Study I). In the idea generation phase, workshops were conducted to explore desired features of an eHealth intervention including self‑management for reducing sedentary time and promoting adherence to the reduced sedentary time among the target group and to develop a digital prototype of such an intervention (Study II). In the testing and retesting phase, the feasibility and usability of the developed eHealth intervention were examined through a mixed-methods evaluation study which applied an ABA single-case experimental design (Study III). In the evaluation phase the effect of the eHealth intervention on daily sedentary time, assessed using an accelerometer, was examined through a randomised controlled trial (RCT) (Study IV).
The findings highlight the importance of supporting autonomy in eHealth interventions for reducing sedentary time through adaptable self‑management strategies and user‑directed intervention use (Studies I–II). Reducing sedentary time required support for making changes in everyday life. Self‑management strategies addressing both affective and cognitive determinants – especially identifying joyful activities – were identified as central in reducing sedentary time and supporting adherence (Studies I–II). The GAUdiS (an acronym for the Swedish equivalent of Joyful Activities Facilitate Reduced Sedentary Time) eHealth intervention was developed, comprising features for identifying joyful activities and supporting goalsetting and planning based on mental contrasting with implementation intentions, which can be understood based on the Integrated Behavior Change model (Study II). Although GAUdiS was developed together with older adults transitioning to retirement as active participants, it demonstrated only modest feasibility and usability, possibly partly due to the demands associated with a standalone eHealth design (Study III). The final RCT showed no reduction in sedentary time with GAUdiS among older adults transitioning to retirement; these findings should be interpreted in light of the small sample size (Study IV).
In conclusion, the findings suggest that employing autonomy‑supportive approaches, as well as targeting both affective and cognitive determinants, are considered central to reducing sedentary time in the transition to retirement. However, for an eHealth intervention to be effective in reducing sedentary time in the transition for retirement, additional components beyond those offered by the current standalone version of GAUdiS may be needed. Given that the studies included in the thesis involved a limited number of participants, further research including larger groups is needed in order to examine how sedentary time can be reduced during the transition to retirement. While this thesis focused on total sedentary time, future research might explore whether GAUdiS could be effective when targeting only those sedentary behaviours that individuals perceive as unwanted or unhealthy, in alignment with health promotion values.