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“It has to be fun”: – Health promotion through reduced sedentary time in older adults transitioning from working life to retirement
Mälardalen University, Faculty of Engineering and Health Sciences, Department of Health Sciences, Innovation and Design.
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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. 

Place, publisher, year, edition, pages
Västerås: Mälardalens universitet, 2026.
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 463
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:mdh:diva-76472ISBN: 978-91-7485-752-8 (print)OAI: oai:DiVA.org:mdh-76472DiVA, id: diva2:2053052
Public defence
2026-06-10, Gamma, Mälardalens universitet, Västerås, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2026-04-15 Created: 2026-04-15 Last updated: 2026-05-19Bibliographically approved
List of papers
1. It Has To Be My Way-Reducing Sedentary Time in the Transition to Retirement
Open this publication in new window or tab >>It Has To Be My Way-Reducing Sedentary Time in the Transition to Retirement
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2025 (English)In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, no 3, p. 233-242Article in journal (Refereed) Published
Abstract [en]

Background: Sedentary behavior is highly prevalent in older adults transitioning to retirement. Sedentary time is all of the time spent in sedentary behavior, and prolonged sedentary time is associated with an increased risk of noncommunicable diseases. The aim of this study was to explore perceptions among older adults transitioning from working life to retirement regarding selfmanagement strategies for reducing sedentary time and adhering to the reduced sedentary time. Methods: Twenty-eight older adults, age 60-75 years, participated in one of four focus group interviews. Qualitative content analysis was used to analyze the data. Results: The analysis resulted in the theme " It has to be my way," and the three categories " Activities scattered with joyfulness," " Support for changes in everyday life," and " Health affects willingness and ability, and is affected by adherence." Conclusions: Interpreted from the perspective of self-determination theory, self-management strategies for reducing sedentary time should be adaptable as every individual is unique, indicating a need for autonomy. Sedentary time was said to be reduced by activities that evoked joyfulness, and joyfulness was considered to increase adherence. Support for changes to one's everyday life was considered necessary. The support that was mentioned primarily involved targeting cognitive determinants such as self-efficacy and attitudes. This new knowledge can be included when designing self-management interventions; however, more research is needed in order to evaluate whether self-management strategies targeting autonomous motivation and affective determinants, such as affective judgment and cognitive determinants, can reduce sedentary time in those who are in the transition to retirement.

Place, publisher, year, edition, pages
Human Kinetics, 2025
Keywords
adherence, joyfulness, sedentary behavior, self-management strategies
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-69249 (URN)10.1123/japa.2023-0414 (DOI)001361816400001 ()39566479 (PubMedID)2-s2.0-105005560583 (Scopus ID)
Available from: 2024-12-04 Created: 2024-12-04 Last updated: 2026-04-29Bibliographically approved
2. Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study
Open this publication in new window or tab >>Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study
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2025 (English)In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 9, article id e63567Article in journal (Refereed) Published
Abstract [en]

Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

Place, publisher, year, edition, pages
JMIR Publications, 2025
Keywords
adherence, affective determinants, autonomous motivation, behavior change intervention, integrated behavior change model
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:mdh:diva-69950 (URN)10.2196/63567 (DOI)001447515800020 ()39832361 (PubMedID)2-s2.0-85215675819 (Scopus ID)
Available from: 2025-01-29 Created: 2025-01-29 Last updated: 2026-04-15Bibliographically approved

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