BHendersonThesis final (2)

USER EXPERIENCES OF A SIT STAND WORKSTATION
Brendan Henderson
Bachelor of Applied Science (Human Movement)
Master of Applied Science (Research)
Thesis submission for the fulfilment of Master of Ergonomics,
safety and health
Principal supervisor: Dr Tessa Keegel
Co-supervisor: Dr Rwth Stuckey
School of Psychology and Public Health
College of Science, Health and Engineering
Latrobe University

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Abstract
In recent years, many workplaces have implemented sit stand workstations (SSWs), which enable a
worker to choose whether they sit or stand as they perform their work activities. However the factors
which actually determine the initial adoption, sustainability or cessation of use for a SSW, remain
largely unexamined. The purpose of this study is to investigate the experiences of staff within a
university workplace who had previously used or are currently using a SSW. Participants who were
current or past SSW users as well as workplace key informants were interviewed for the study. A
number of important personal, postural and usability factors related to ergonomics, safety and health
domains were identified relative to ongoing and ceased SSW users in a workplace environment. We
found that workers who were able to adopt their working style were able to sustain ongoing use of a
SSW.

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Declaration
‘I Brendan Henderson declare that the Masters thesis entitled ’User experiences of a sit stand
workstation is no more than 50,000 words in length including quotes and exclusive of tables, figures,
appendices, bibliography, references and footnotes. This thesis contains no material that has been
submitted previously, in whole or in part, for the award of any other academic degree or diploma.
Except where otherwise indicated, this thesis is my own work’.
Signature: Brendan Henderson Date: 23/1/2016

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Acknowledgements
I would like to express my sincere gratefulness to Dr Tessa Keegel for her guidance and supervision
across what has been a pretty hectic year. Thank you for the time, effort and contribution towards
what is the final thesis. You have always kept me on track, challenged me and provided valuable
insight and support throughout my candidature. I would like to thank my co-supervisor, Dr Rwth
Stuckey for your feedback and guidance, especially in the foundation phases of my thesis. A big
thank you to all my willing study participants, as without you, this would have not become a reality.
To my wife Fiona, thank you for all of your positive support and understanding about the rigors I’ve
faced with having to spend time outside of normal working hours on undertaking my second thesis
(yes, call me crazy!), whilst attempting to support you and our new adventure of raising a family. Your
support has been fantastic. Finally, my parents whom I would like to thank you for your positive
encouragement whenever I’ve attempted to challenge myself. It never goes unnoticed. Thank you!

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Table of Contents
Abstract ...................................................................................................................................................................2
Acknowledgements.................................................................................................................................................4
Table of Contents ....................................................................................................................................................5
Chapter one: Introduction and overview................................................................................................................7
1.0 Introduction.......................................................................................................................................................7
1.1 Aim.................................................................................................................................................................8
1.2 Significance....................................................................................................................................................8
1.3 Literature review ...........................................................................................................................................8
1.3.1 Posture .......................................................................................................................................................9
1.3.2 Sedentary work (behaviour).......................................................................................................................9
1.3.3 Seated posture and MSD risk ...................................................................................................................10
1.3.4 Standing desks and adjustable sit stand workstations.............................................................................10
1.3.5 Sustainability of sit stand workstations....................................................................................................11
1.4 Summary..........................................................................................................................................................12
1.5 Thesis by publication.......................................................................................................................................12
1.6 Methods ..........................................................................................................................................................12
1.6.1 The Workforce sitting questionnaire........................................................................................................13
1.6.2 Photographs of the workspace.................................................................................................................13
1.7 Results .............................................................................................................................................................15
1.7.1 Final thematic maps .................................................................................................................................17
1.8 Future recommendations................................................................................................................................18
1.9 Conclusion .......................................................................................................................................................18
References.............................................................................................................................................................19
Appendix one: Initial thematic maps.....................................................................................................................22
Chapter two: Thesis by Publication.......................................................................................................................25
Journal submission cover page:.............................................................................................................................25
Abstract .................................................................................................................................................................26
1. Introduction.......................................................................................................................................................27
2. Methods ............................................................................................................................................................28
2.1 Study setting and design .............................................................................................................................28
2.2 Users recruitment procedure......................................................................................................................28
2.3 Quantitative survey instrument and demographics ...................................................................................28
2.4 Qualitative data collection ..........................................................................................................................29

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2.4.1 Key informant interviews .........................................................................................................................29
2.4.2 Individual current and ceased user interviews.........................................................................................29
2.5 Qualitative data analysis .............................................................................................................................29
3. Results ...............................................................................................................................................................30
3.1 Sampling and participants...........................................................................................................................30
3.2 Quantitative data.........................................................................................................................................30
3.3 Qualitative data...........................................................................................................................................31
3.4 Personal considerations for use/sustainability ...........................................................................................31
3.5 Posture ........................................................................................................................................................34
3.6 Usability.......................................................................................................................................................35
3.7 Key informant findings ................................................................................................................................36
4. Discussion..........................................................................................................................................................38
4.1 Personal considerations for use/sustainability ...........................................................................................39
4.2 Posture ........................................................................................................................................................40
4.3 Usability.......................................................................................................................................................41
4.4 Key informants ............................................................................................................................................41
4.5 Study strengths and limitations...................................................................................................................42
5. Conclusions........................................................................................................................................................42
References.............................................................................................................................................................43
Appendix two: Applied Ergonomics submission guidelines..................................................................................45
Appendix three: Consent and participant information forms...............................................................................57
Appendix four: Interview schedule for ceased and current sit stand desk users .................................................65
Appendix five: Interview schedule for key informants .........................................................................................68

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Chapter one: Introduction and overview
1.0 Introduction
It is well established that adult employees can spend the majority of their day in a seated position,
with research reporting that call centre workers in Europe can spend as much as 90% of their working
day in a sedentary position. (Straker et al., 2013; Toomingas et al., 2012). It is also well recognised
that the work environment is associated with an individual’s health and wellbeing status (Bambra et
al., 2009; Ryan et al., 2015). Specific to the office work setting, there is now a growing body of
evidence that suggests that there is an association between poor workstation setups and upper
extremity body region pain and discomfort, which may increase an individual’s risk of musculoskeletal
disorder when using a seated workstation environment (Lindegård et al., 2012; Wahlström, 2005).
In recent years, many workplaces have implemented sit stand workstations (SSWs) which enable a
worker to sit and stand as they choose whilst working (Ebara et al., 2008; Karol and Robertson,
2015). Literature suggests that a sit stand workstation (SSW) can assist in reducing workplace sitting
time, increase metabolic function and possibly reduce musculoskeletal disorder risk of employees
within the workplace, (Karakolis and Callaghan, 2014; Neuhaus et al., 2014b; Thorp et al., 2014).
Whilst users have reported greater musculoskeletal comfort from use of height adjustable workstation
use over a short term period (Hedge, 2004), it is still not understood how longer term use is
perceived, or how it impacts on an individual’s health and safety (Callaghan et al., 2015). Additional to
this there is a current lack of evidence around users’ understanding of their musculoskeletal disorder
risk when seated compared to standing (Callaghan and McGill, 2001; Lehman et al., 2001; Vieira and
Kumar, 2004). It is also unexamined within the literature what factors actually determine the initial
adoption, and ongoing or cessation of use of a sit stand workstation (SSW), as most published
literature to date has been restricted to introduction of SSWs within the scenario of a research trial
intervention methodology or evaluating after short term use (Alkhajah et al., 2012; Chau et al., 2014a;
Grunseit et al., 2013). Finally, encompassing an ergonomics aspect which looks at the issue of
adoption and ongoing use of a SSW from a wider systematic perspective will provide a greater
understanding of the range of workplace factors to be reported on, in comparison to just the sitting
and standing components (Huysmans et al., 2015).
Given the limited understanding of both longer term and ceased users of SSWs, the purpose of this
thesis is to investigate the ergonomic, safety and health related experiences of staff within a university
workplace who had previously used or are currently using a SSW. As limited qualitative research is
available within this area, the conducting of individual interviews and a thematic analysis were
employed to provide insights into these key areas. Focus groups were considered, however the
research team felt there would be greater detail and insight provided through a semi-structured

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individual interview which comprised of targeted questions relative to the ergonomics, safety and
health domains (Gaskell, 2000; Gibbs, 1997). Specifically this thesis examined ergonomic, safety and
health factors associated with longer term or ceased SSW use.
1.1 Aim
This project will primarily aim to gain insight from current and ceased sit-stand desk users about their
experiences of using a sit stand desk workspace. Specifically this project will investigate the
ergonomics, safety and health factors associated with SSW usage. The project will also ascertain a
number of key and associated themes related to current and ceased users of a SSW through the
means of a thematic analysis. The addition of two key informants will also help gain an understanding
of the workplace policies and procedures and how these might influence the uptake and usage of
SSWs.
1.2 Significance
This study will add to the limited current body of knowledge surrounding the sustainability of use, the
experiences, perceptions and feelings for both current and ceased users of a SSW, within their
workspace within a natural life office-based workplace setting. As the information being provided is
from longer term and ceased users, reasons for continued and ceased use will be discussed, which
will help provide interested parties and researchers in this space with considerations for future work.
Finally an encompassing view of the workplace system will be developed within the context of
ergonomics, safety and health. The interviewing of two key informants will assist in shaping this.
1.3 Literature review
Whilst the research design of this project is qualitative in nature, it is important that both qualitative
and quantitative literature relevant to the ergonomics, safety and health of SSWs is discussed
(Hignett and Wilson, 2004). This review of the literature will enable insight into the critical factors that
affect the worker when undertaking employment in a seated or standing posture. The topic areas of
posture, sedentary work, seated posture and musculoskeletal disorder risk, standing posture,
standing desks and adjustable SSWs, as well as sustainability are briefly discussed under specific
headings. From this review is it envisaged that the reader will be provided with an understanding of
the broader issues associated with SSWs, which will assist to contextualise the reasoning behind the
qualitative research methods design outlined in the subsequent methodological research design and
framework section.

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1.3.1 Posture
Posture is defined in many ways and needs to take into account the task, the movements, the
mechanical variables and the load (Grandjean, 1989). Additionally, one needs to consider the
biomechanical alignment, the spatial arrangement of body parts and their positioning in relation to the
task/s being performed (Vieira and Kumar, 2004). The literature reports that there have been many
methods developed to assess posture such as a job task analysis or work demand profile, using lifting
tables (Snook and Ciriello, 1991; Waters et al., 1994), however, these have mainly been established
to aid the industrial setting where workers are not typically engaged in sedentary based office work
(Graf et al., 1995).
The consensus within the research indicates that there is no one ideal posture for either gender (Yang
and Cho, 2012). It is well established that posture is strongly influenced by workstation layout (Das
and Sengupta, 1996). However, the relationships between job demands, workstation layout and
posture are lacking (Haslegrave, 1994; Hsiao and Keyserling, 1991).
1.3.2 Sedentary work (behaviour)
Sedentary work (behaviour), also referred to as occupational sitting time, is when an individual is
expending energy at a marginally higher rate than their resting level, or less than 1.5 times their basal
metabolic rate (Chau et al., 2014b; Pate et al., 2008). As society has evolved and advances in
technology have taken place to assist in the automation of many tasks and production to meet
society’s needs, it has seen an increase in sedentary based office work (Choi et al., 2010). A sitting
posture is the typical posture adopted in many occupations, including work undertaken by university
employees, which has been reported to take up a large component of a working day (Smith et al.,
2015).
Occupational sitting time is now recognised as an emerging health concern similar to that of too little
exercise or smoking (Chau et al., 2014b; Hart, 2015; Owen, 2012). Also noteworthy is that research
now indicates that there are associations with some cancers, diabetes and poor heart health with
prolonged seated work (Boyle et al., 2012; Da Costa and Vieira, 2010; Gilson et al., 2012; van Uffelen
et al., 2010). Recent literature has a strong focus on reporting the cardio metabolic impacts of
prolonged sedentary work and sitting time, particularly amongst office based workers in developed
countries where workers are required to undertake prolonged sitting within their employment (Healy et
al., 2013; Neuhaus et al., 2014a; van Uffelen et al., 2010).

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1.3.3 Seated posture and MSD risk
It is well established that postural stress and work related musculoskeletal disorders are an ongoing
issue within developed nations (Bridger, 1991). Prolonged sitting and the use of seated postures have
been shown to cause lower limb discomfort and swelling (Seo et al., 1996). In regards to prolonged
static sitting within the workplace when undertaking relatively static and repetitive tasks such as desk
bound computer work for prolonged periods of time, there has been a reported increase of
musculoskeletal disorders to a number of regions of the body including the neck, shoulders and lower
back (Bernard and Putz-Anderson, 1997; Da Costa and Vieira, 2010; Wahlström, 2005).
Sitting postures can be leading factors in the causation of pain and injury to the muscles, tendons,
joints and ligaments (Grandjean and Hünting, 1977; Toomingas and Gavhed, 2008). It has been
acknowledged that the adoption of either a static or a poor working posture is associated with
musculoskeletal discomfort, which is a common pre-cursor to the development of a musculoskeletal
disorder (Graf et al., 1995; Messing et al., 2015). Whilst the term ‘poor working posture’ is broad in its
definition and can be occupation or task specific, there are some common elements within an
occupation that put stress on to the individual which are known to be precursors to increased
musculoskeletal risk (Haslegrave, 1994). These include inappropriate desk height, poor chair and
seating position, performing work in an uncomfortable or uncompromising position for prolonged
periods, poor lighting, minimal movement of the body to perform tasks, and placing biomechanical or
physiological stress on the body (Salvendy, 2012).
To mitigate musculoskeletal disorder risk, many workplaces provide employees with an ergonomic
assessment of their workstation, which is similar to a risk assessment of a workplace but specifically
targets the employee and their workspace (Salvendy, 2012). An ergonomic workstation assessment
enables employee workspace discomfort factors to be addressed and moderated, which have been
reported as a key contributor towards work related musculoskeletal disorders (Korhan and Mackieh,
2010).
1.3.4 Standing desks and adjustable sit stand workstations
As part of larger initiatives where workplaces aim to provide employees with safer workplaces,
employers are now implementing initiatives to attempt to minimise sedentary work practices and
mitigate musculoskeletal disorder risk, as well as enhance productivity and improve organisational
culture. (Cantley et al., 2014; Manini et al., 2015; Westgaard and Winkel, 2011). However, the multi-
factorial nature of musculoskeletal disorder causation is broad in what it encompasses which places a
level of difficulty in accurately understanding how such interventions impact on injury outcomes and
worker performance (Cantley et al., 2014).

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SSWs offer the worker a height adjustable workspace which allows one a choice of desk-based
working positions (Hall et al., 2015). There has been a recent increase in workplaces implementing
SSWs, due to the increased media attention regarding chronic disease and total mortality associated
with prolonged sitting (Karakolis and Callaghan, 2014). Literature suggests that when using a sit
stand desk, particularly one that is retrofitted to a typical standard desk setup, it needs to enable
height adjustment for the user so that work can be performed comfortably in a seated or standing
posture (Grunseit et al., 2013). If this is not achieved, then musculoskeletal disorder risk may arise
(Davis and Kotowski, 2015).
More recently, as a means to possibly mitigate musculoskeletal disorders within the workplace, office
furniture such as SSWs have been implemented by numerous workplaces (Husemann et al., 2009).
However, it is not just the desk that needs to be taken into consideration, but also what can be utilised
within the entire workspace (Bridger, 1991). When frequently used items are outside of the immediate
workspace reach, this being typically within arm’s reach, a heightened risk for musculoskeletal
disorder could be present (Corlett and Clark, 2003). The available evidence suggests that there may
be a reduction in back, neck and shoulder discomfort with the use of a SSW, but there is still a level of
scepticism present about the true benefits, despite workers reporting a good level of usability and
acceptability, as no study to date has reported on SSW use in an ongoing basis or why users have
ceased use (Ebara et al., 2008; Grunseit et al., 2013; Hasegawa et al., 2001). It has also been
reported that substituting prolonged sitting with standing can give rise to other health and
musculoskeletal problems (Chia et al., 2015; McCulloch, 2001). Thus, further research is not only
required to validate the cost effectiveness of SSWs, but also research into user acceptability and
adoption within the workplace over a longitudinal period to help better understand what contributing
factors exist in relation to ongoing sustainable SSW use and cessation (Cantley et al., 2014; Hall et
al., 2015).
1.3.5 Sustainability of sit stand workstations
To date, there is limited work which has utilised a qualitative research framework to report on the
factors that influence the sustainability of SSW use. One qualitative study to date has been
undertaken which asked users three months post implementation to evaluate and discuss their
experiences and perceptions and if they thought that longer term use would be sustainable (Grunseit
et al., 2013). What is required is qualitative evidence that seeks to better understand the ergonomics,
safety and health factors from individuals related to ongoing sustainable use, in addition to the factors
related to cessation of use within a natural work environment. With this information available, it will
assist organisations and practitioners to understand better the barriers and enablers employees may
possibly encounter during the initial adoption and in an ongoing capacity.

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1.4 Summary
Whilst there is developing literature within the quantitative framework around employees and SSWs,
particularly around the relationships between occupational sitting time and improvements in cancer,
cardio-metabolic health and musculoskeletal disorder risk outcomes (De Cocker et al., 2014; Healy et
al., 2015; Ryan et al., 2015; van Uffelen et al., 2010), there is a lack of qualitative research in this area
(Tudor-Locke et al., 2014). The experiences and perceptions of long term users using SSWs within an
ergonomics framework have not been assessed, with reported research to date employing
implementation evaluation, short term use or trial based methodologies (Alkhajah et al., 2012; Chau
et al., 2014b; Dutta et al., 2015; Grunseit et al., 2013; Karakolis and Callaghan, 2014). Specifically,
there is a lack of evidence available that provides insight into sit stand desk users experiences and
understanding of ergonomics factors and possible musculoskeletal disorder risks when using a SSW
over longer term periods. To advance this area, qualitative studies are required to assist in identifying
the ergonomic, safety and health issues people take into consideration in relation to SSW use across
both the short and long term (Dutta et al., 2015).
1.5 Thesis by publication
This study has been conducted with a view to publication of the findings, and as such, this thesis has
been developed as a “thesis by publication”. This approach will mean that some repetition will occur
within the sections – for example, explanation of the methods used. The College of Science, Health &
Engineering, Department of Public Health, Latrobe University does not require that the manuscript be
accepted for publication at the time of thesis submission. Chapter Two at the time of submission was
in the final stages of refinement for submission to the journal Applied Ergonomics (impact factor
2.023).
For ease of the reader, a consistent approach has been presented in regards to heading, section and
reference style. All reported information within the associated thesis chapters is the same as, or
provides a development of the work submitted for publication. For this non-published material, specific
topic heading that are better suited to the content have been employed. Additional material related to
the thesis are presented within the appendices.
1.6 Methods
In addition to the methods described in the publication chapter, there were a few other research
components that were collected as part of the study process, but were not included in the material
prepared for publication.

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1.6.1 The Workforce sitting questionnaire
Prior to the commencement of the individual interview, the participants completed the Workforce
sitting questionnaire (Chau et al., 2011). The Workforce sitting questionnaire is a self-reported
retrospective questionnaire that provides insight into a participants’ overall sitting time across a typical
working and non-working day across a range of activities including time spent sitting at work, sitting
when in transit and sitting whilst watching television (Chau et al., 2011; Marshall et al., 2010).
1.6.2 Photographs of the workspace
Also obtained were a number of photos of current users SSWs. Examples of some of the participants
SSWs are provided in images one to four. Within these images are three different and SSW models.
The types of SSWs used by the participants were either a Standing Kangaroo model, a Ergotron
Workfit A or Ergotron Workfit S, or model. These models can broadly be defined as pull-up, push
down units, fitted to existing workstations. The space of these models only holds the monitor,
keyboard and mouse, with limited room for other items in the workspace.
Image one: Example of a Standing Kangaroo model

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Image two: Example of a Ergotron WorkFit-A model.
Image three: Example of a Ergotron WorkFit-S model
Image four: Example of a Ergotron WorkFit-S model with dual screen setup

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1.7 Results
The main results section is in the material presented for the publication chapter. The results of the
Workforce sitting questionnaire, as well as information regarding the development of the qualitative
framework are presented below.
Results from the Workforce sitting questionnaire (Chau et al., 2011) indicate that on average,
participants spend a total of 536 minutes per day undertaking sitting based activities. Of this, 268
minutes was spent undertaking seated tasks at work, which equated to half of their daily sitting time.
A non-working day saw participants report a lower total sitting value of 491 minutes, with watching
television and other leisure activities accounting for close to half of this. A summation of the
Workforce sitting questionnaire responses in minutes, across all participants for both a working and
non-working day is presented in Table one. Whilst numbers are not sufficient to undertake a formal
comparative analysis, the results do indicate there are some differences between current and ceased
users in regards to their overall daily sitting activities and times.
On analysis of the results from the Workforce sitting questionnaire there seemed to be a systematic
misunderstanding with the reporting of sitting time. Current users reported more time spent sitting at a
desk using a computer compared to ceased users. We suspect that this is because participants had
possible issues with interpreting the need for accurate reporting of their sitting time across a working
and non-working day, despite being administered under the supervision of a member of the research
team. It was also identified that the data obtained through the use of the Workforce sitting
questionnaire does not allow for users to report on standing time. The reporting of sitting time only
within this study does not help us better understand the sitting and standing times of this cohort. With
this in mind, it is suggested that an amended version of this questionnaire is used that asks the same
questions but for standing time as well as sitting time for future research studies.
Because of uncertainty about this data we decided that it was inappropriate to include it in the
material prepared for the journal article.

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Table one: Workforce sitting questionnaire responses (mean) from all SSW users and ceased users on working and non-working days (n=22).
All users time spent
sitting: Working day
(mins) (n=22)
Current
users
(n=16)
Ceased
users
(n=6)
All users time
spent sitting: Non-
working day (mins)
(n=22)
Current
users
(n=16)
Ceased
users
(n=6)
For transport- in car, bus train, etc 68 66 73 74 84 47
Work tasks – sitting at desk, using a
computer
268 274 248 87* 90 80
Watching TV 102 103 100 134 129 145
Using computer at home – emails,
games, information, chatting
61 65 50 86 77 110
Other leisure activities – socialising,
movies (excluding TV and computer
use)
37 36 40 110 112 105
Total minutes 536 544 438 491 492 487
*A number of participants reported that they undertook an amount of paid employment work at home on their non-working day.

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1.7.1 Final thematic maps
To add validity and trustworthiness to both interview schedules, the research team performed an interview
and reflection prior to the first participant for both the current and ceased users, and the key informant
interview schedules. Throughout the interview process, the interviewer (BH) continually reflected upon the
interview schedule questions and amended these in an ongoing manner so that new and common themes
arising could be added. The use of the NVIVO qualitative analysis software platform assisted in the
determination of common factors from the interviews conducted. In addition to the above, the student
researcher and principal supervisor met numerous times to collaboratively discuss and refine the possible
themes present from the interview respondents. From this process, a final agreement on the naming and
relevant definition of themes occurred.
Figures one and two provide the final thematic maps for the current and ceased users, and the key
informants. Appendix one provides a summary of the initial thematic maps.
Figure one: Final thematic map for current and ceased SSW users
Figure two: Final thematic map for key informants

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1.8 Future recommendations
This study has some notable strengths in that the majority of the cohort investigated were longitudinal and
ongoing SSW users within their natural work setting. Whilst valuable insights were obtained from
participants who had ceased use which to our knowledge has not been reported on to date, the number of
ceased users (n=6) is low and further research into this specific cohort would be of value to understand
better the reasons behind cessation of use.
From the research undertaken within this project, a number of future research avenues could be
investigated. Qualitative survey design focused around the sustainability of use that explores the reported
and associated factors found within this thesis, could assist in providing a greater understanding of users
across all spectrums of the SSW usage scale. Finally, the utilisation of objective device technology could
be employed to better understand and obtain time course sitting and standing data, which could be used
to explore the relationships between objective sitting and standing times and self-reported measures.
1.9 Conclusion
In conclusion, this study has provided valuable insights into the ergonomics, safety and health domain
relative to both short and longer term SSW use within a natural work environment. The information
obtained has practical relevance to organisations who are looking to implement SSWs for employees. A
number of important personal, postural and usability factors related to the ergonomics, safety and health
domain have been identified and discussed relative to ongoing and sustainable SSW use within a natural
workplace environment. It has been found that sustainability of use of a SSW is achievable, however, it
most likely comes with some element of adaptation for those wishing to use this type of workspace.
Important insights have also been obtained from the small number of now ceased users, which
demonstrates that not all uptake for using a SSW is successful. Future work in this area with a larger
cohort would help develop with what can be described as a preliminary assessment of ceased SSW
users. Finally, the key informants highlighted the importance of having a systematic approach when
ascertaining individual and organisational use for the implementation of such ergonomics based devices.

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Appendix one: Initial thematic maps
Figure three: Initial thematic map for current and ceased SSW users for the theme of ‘Personal
considerations for use/sustainability’.
Figure four: Initial thematic map for current and ceased SSW users for the theme of ‘Behaviours’.
This map was merged with the Personal considerations for use/sustainability as many of the factors were
identified to be linked.

23
Figure five: Initial thematic map for current and ceased SSW users for the theme of ‘Posture’.
Figure six: Initial thematic map for current and ceased SSW users for the theme of ‘Usability’.

24
Figure seven: Initial thematic map for current and ceased SSW users for themes identified from key
informant interviews.

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Chapter two: Thesis by Publication
Journal submission cover page:
The manuscript presented within this chapter is ready to be submitted to the journal Applied Ergonomics.
The journal has an impact factor of 2.023. The rationale for submission of this work to Applied
Ergonomics is due to the research design, findings and practical recommendations being within the
context of an ergonomics, safety and health framework. Importantly, the findings within this manuscript
have suggested practical applications that are relevant towards those employed within the ergonomics,
safety and health occupations. A copy of the author guidelines for this journal are presented in appendix
two.

26
Article Title: Ceased and current sit stand workstation users: A qualitative
evaluation of ergonomics, safety and health factors within a workplace
setting.
Authors: Brendan Henderson, Rwth Stuckey, Tessa Keegel* (*corresponding author)
Centre for Ergonomics and Human Factors, School of Psychology and Public Health, College of Science,
Health and Engineering, Latrobe University. Melbourne, Australia.
Corresponding author address: Dr Tessa Keegel Centre for Ergonomics and Human Factors, School of
Psychology and Public Health, College of Science, Health and Engineering, Latrobe University.
Melbourne, Australia.
t.keegel@latrobe.edu.au
Abstract
In recent years, many workplaces have implemented sit stand workstations (SSWs), which enable a
worker to choose whether they sit or stand as they perform their work activities. However the factors
which actually determine the initial adoption, sustainability or cessation of use for a sit stand workstation
(SSW), remain largely unexamined. The purpose of this study is to investigate the experiences of staff
within a university workplace who had previously used or are currently using a SSW. Participants who
were current or past SSW users and workplace key informants were interviewed for the study. A number
of important personal, postural and usability factors related to ergonomics, safety and health domains
were identified relative to ongoing and ceased SSW users in a university office environment. We found
that workers who were able to adopt their working style to the new workstation were able to sustain
ongoing use of a SSW.
Highlights:
 SSW use may have longer term sustainability
 Personal, posture and comfort considerations are critical to long-term usability
 Workspace adaptation may be required to ensure long-term SSW use
Key words: Sit stand workstation, Ergonomics, Sustainability of interventions

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1. Introduction
Adult employees can spend the majority of their day in a seated position, with research reporting that call
centre workers in Europe can spend as much as 90% of their working day in a sedentary position.
(Straker et al., 2013; Toomingas et al., 2012). It is also well recognised that the work environment is
associated with an individual’s health and wellbeing status (Bambra et al., 2009; Ryan et al., 2015).
Specific to the office work setting, there is now a growing body of evidence that suggests that there is an
association between poor workstation setups and upper extremity body region pain and discomfort, which
may increase an individual’s risk of musculoskeletal disorder when using a seated workstation
environment (Lindegård et al., 2012; Wahlström, 2005).
In recent years, many workplaces have implemented sit stand workstations (SSWs) which to varying
degrees enable a worker to sit and stand as they choose whilst working (Ebara et al., 2008; Karol and
Robertson, 2015). Literature suggests that a sit stand workstation (SSW) can assist in reducing
workplace sitting time, increase metabolic function and possibly reduce musculoskeletal disorder risk, for
employees within the workplace, (Karakolis and Callaghan, 2014; Neuhaus et al., 2014b; Thorp et al.,
2014). Whilst users have reported greater musculoskeletal comfort from use of height adjustable
workstation use over a short term period (Hedge, 2004), it is still not understood how longer term use is
perceived nor how it impacts on an individual’s health and safety (Callaghan et al., 2015). Additional to
this there is a current lack of evidence around users’ understanding of their musculoskeletal disorder risk
when seated compared to standing (Callaghan and McGill, 2001; Lehman et al., 2001; Vieira and Kumar,
2004). It is also unexamined within the literature what factors actually determine the initial adoption, and
ongoing or cessation of use for a SSW, as most published literature to date has been restricted to
introduction of SSWs within short term evaluation and research trial intervention environments (Alkhajah
et al., 2012; Chau et al., 2014a; Grunseit et al., 2013).
Finally, encompassing an ergonomics approach, whereby the issue of adoption and ongoing use of a
SSW is investigated using a wider systematic perspective, findings from this investigation will provide a
greater understanding of the range of workplace factors which might influence to be reported on, in
comparison to just the sitting and standing components (Huysmans et al., 2015).
Given the limited understanding of the experiences of both ongoing and ceased users of SSWs, the
purpose of this study is to investigate the ergonomic, safety and health related experiences of staff within
a university workplace who had previously used or are currently using a SSW. As limited qualitative
research is available within this area, individual interviews were conducted and a thematic analysis was
undertaken to provide insights into these key areas. Specifically this study examined the ergonomic,
safety and health factors associated with longer term or ceased SSW use.

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2. Methods
2.1 Study setting and design
The study setting was a specific school of a Victorian university which had a number of individuals using
SSWs. To be eligible for the study, participants must have previously used or be currently using a SSW
within their workspace, be employed by, or studying within the university, and be aged between 18-65
years. Participants consisted of both staff and student researchers and administrators who performed a
varying amount of their tasks at their desk. Current users were defined as a person who had adopted and
undertaken continual use of a SSW for at least three months. To be defined as a ceased user, the
participant was required to have used a sit stand workstation for a period of at least three months within
their current role and had made a decision to cease using it. The types of sit stand workstation used by
the participants were either an Ergotron Workfit A, Ergotron Workfit S, or Standing Kangaroo model.
These models can broadly be defined as pull-up, push down units, fitted to existing workstations. The
surface-space of these models is designed to only hold the monitor, keyboard and mouse, with limited
room for other items in the workspace.
In order to better understand the barriers and enablers within the organisation regarding sit-stand
workstation use, two key informants were interviewed. The key informants were employed in positions
which saw them undertake duties relative to the ergonomics, safety and health aspects of sit stand
workstation implementation and use for staff across the university.
This study was approved by the Latrobe University Human Research Ethics committee (S15/95), and all
participants provided written informed consent for participation in the study.
2.2 Users recruitment procedure
An email was sent to all staff and research degree students within a specific school of a Victorian
university, which had a number of individuals using SSWs, requesting their participation in the project.
Once recruited, participants were asked to engage in a semi structured individual interview with one of the
research team (BH).
Individual interviews were undertaken at the user’s or researcher’s workspace and were audio-recorded.
Interviews were conducted over a six week period between May and June of 2015.
2.3 Quantitative survey instrument and demographics
Musculoskeletal disorder and discomfort information was collected by the means of a body map on which
participants were asked to highlight any areas of regional discomfort, pain or injury both pre and post the
use of a sit stand workstation (Henderson, 2012). Results were aggregated into the following body
regions; neck, shoulder, upper back, low back, lower limbs, upper arms, elbows, forearms, wrist and
hands and feet. At the start of the interview, each participant provided information about their history of

29
musculoskeletal disorders and musculoskeletal discomfort prior to the use and since the implementation
and use of their SSW (Cameron, 1996). Data were analysed with Statistical Package for Social Sciences
(SPSS) version 21.0.
2.4 Qualitative data collection
2.4.1 Key informant interviews
Key informants within the workplace were interviewed to better understand the barriers and enablers
within the organisation, regarding SSW use (Kumar et al., 1993). Key informants were identified in a
phone discussion with the manager of the Health, Safety and Wellbeing unit within the university. The
nine predetermined domains within the interview schedule for the key informants were: Policies and
procedures regarding SSWs; Issues surrounding SSWs; Organisational barriers and enablers; Economic/
cost benefit analysis; Sourcing and installation of desks; Knowledge and understanding of ergonomic
factors when using a SSW; Usability of SSW; Understanding of OHS risk, and; Understanding of MSD
risk.
2.4.2 Individual current and ceased user interviews
The individual interviews for the current and ceased users took place to better understand the
ergonomics, safety and health factors associated with ongoing and ceased SSW use. From the
discussions amongst the research team, five predetermined domains within the interview schedule for the
ceased or current users were developed: Reasons for using a SSW; Knowledge and understanding of
ergonomic factors when using a SSW; Usability of SSW; Comfort when sitting and standing, and;
Understanding of MSD risk.
2.5 Qualitative data analysis
The qualitative data were analysed with the aim of better understanding both current and ceased users’
experiences and knowledge relative to the ergonomics, safety and health issues relative to SSW use
(Barnett-Page and Thomas, 2009). The qualitative research design of this project made use of a thematic
analysis approach (Braun and Clarke, 2006). The interviewing of participants individually to obtain
qualitative data occurred as a means to capture the possible relationships, thoughts and opinions of both
current and ceased SSW users (Verd, 2004). The semi-structured interview also aimed at exploring the
participants’ level of understanding around ergonomics, safety and health issues associated with using a
SSW in addition to their general thoughts, opinions and feelings of using a SSW. During and following the
interviews, field notes and observations were taken by the interviewer to both ascertain if data saturation
across the predetermined domains was occurring and to note relevant contextual and other observations
to inform the study outcomes (Guest et al., 2006).

30
The interview audio recordings were transcribed by an external provider. The lead researcher undertook a
review of the transcripts to ensure accuracy of the audio recordings (Braun and Clarke, 2006). In order to
establish the common factors and themes amongst the participants, specialised quantitative analysis
coding software platform (NVIVO version 10), was used (Welsh, 2002). A sample of the interviews were
reviewed and separately coded by another member of the research team. The research team had
numerous meetings to discuss and refine the potential themes arising from the research data (Braun and
Clarke, 2006). From this process, final agreement on the naming and relevant definition of themes took
place so that detailed thematic maps could be produced.
3. Results
3.1 Sampling and participants
A total of 24 participants (10 male and 14 female), comprising of 22 current and ceased users, and two
key informants, volunteered to participate in the study. Of the participants, 16 were current users (four
male and 12 female), and six were ceased users (five male and one female). The majority of the
participants (n=16) were employed in a full time capacity, with the remaining participants (n=6) working
between a 0.5 to 0.8 equivalent full time fraction. Participants were categorised as Administration (n=4),
Lecturer or above (n=14), Researcher (n=2), Research degree student (n=2). The key informants were
one female and one male in occupational health and safety roles which encompassed duties related to
SSW requests.
3.2 Quantitative data
The length of use or ceased use ranged between three months to four years, with a mean across all
participants being 19.6 months and a median of 18 months. Current users reported using a SSW for a
mean of 21.7 months, (range 5-48 months), with a median of 21 months, whist ceased users reported a
mean use of 14 months (range 3-24 months), and a median of 15 months, before cessation of use
occurred.
Descriptive musculoskeletal disorder and discomfort data obtained from the body map image is presented
in table one. Five participants reported no discomfort or pain to any region of their body.
Table one: Summation of participants reporting work related regional discomfort, pain or injury.
Region Neck Shoulder Upper
back
Low
back
Lower
limbs
Upper
arms
Elbows Forearms Wrist
and
hands
Feet
Sitting 8 10 5 7 0 1 1 3 3 1
Standing 3 4 2 7 1 0 1 2 2 5

31
Participants reported a higher level of musculoskeletal discomfort to the upper body from being in a
seated position, particularly the neck and shoulder regions. Participants reported that their feet were the
most likely region of the body to experience discomfort whilst performing work in a standing position.
3.3 Qualitative data
Upon analysis of the current and ceased sit stand workstation user interviews, a number of initial domains
were identified. These included associations with use, behaviours, usability and posture. After further
analysis a final thematic map was developed which encompassed three main themes: Personal
considerations for use/sustainability; Posture; and Usability. Within each of the identified themes there
were a series of associated factors. Figure one shows the final thematic map for the current and ceased
users.
Figure one: Final thematic map for current and ceased SSW users
3.4 Personal considerations for use/sustainability
When asked about their reasons for wanting to commence using a SSW, current and ceased users
provided a number of similar responses. Many reported that they had experienced pain or discomfort from
sitting at work and wanted to improve their posture, stand more, and decrease their time spent sitting in
the workplace. Many had the long term goal of improving their health in some capacity and felt that a
SSW could provide support for this. Participants provided their knowledge and understanding about the
perceived health benefits of using a SSW. Many saw the use of SSW as socially acceptable and
sustainable due to peer support as well as support from management to use a SSW.
Basically I know that sitting all day is not good for you and so when the opportunity presented a couple of years back
to get a sit-stand station I thought, well, it can't hurt to have one. At least then I've got the option to not sit. That was
pretty much the reason. It wasn't that I found that I was in pain or discomfort or anything sitting for long periods. I

32
just knew that it wasn't good for me so when you've got the option to do something about it; do it. Participant 11
(current user).
I’ve heard that sitting is bad for you, and I feel like a hypocrite telling people to stand up if I don’t. Obviously just
working in this kind of an environment you kind of - all the bigwigs in the corridor promote standing so we’re just
fitting in with culture I guess. Participant 9 (current user).
Those who have ceased using a SSW had similar reasons regarding their decision to start using one.
Just to try it and see if it would be a useful way for me to not sit down as much given all the propaganda, hype,
information… energy expenditure and health. Participant 16 (ceased user).
Ceased users offered a variety of reasons ranging from the usage gradually lessening over the day, to
perceived lack of efficiency/productivity, for not persisting with the SSWs.
….there’s a component of it just sort of fading away and me sitting more, and not really thinking about it. Participant
19 (ceased user).
I felt that I was far less efficient standing. Again it sounds really odd but I just felt like I couldn’t concentrate well
enough. Maybe I just feel better when I’ve got a lot more space, and so having the model that I had, it didn’t have a
lot of desk space as such, so I couldn’t spread out my gear. Participant 3 (ceased user).
All participants provided reflections on the personal considerations related to their use of a SSW.
Participants discussed the design and usability of the SSW, the time of day and the complexity of the
tasks to be undertaken, their ability to make decisions regarding when to undertake work in a standing
position, and their comfort and fatigue levels.
Most current users considered the time of day when considering undertaking work in a standing position.
Participants generally spoke about a preference for standing in the morning. Many users discussed a
decline in standing as the day progressed.
I tend to find that I use it first thing in the morning as soon as I get here. But I tend to - I probably use it half and half.
So over the course of an entire day there's just periods where I stand and periods where I sit. So I wouldn't stand all
morning or stand all afternoon or anything like that. Participant 11 (current user).
Task selection by both current and ceased users was a key consideration in whether one would use the
desk in a standing position. Many communicated that their preference was to work whilst standing for
tasks which required a lower level of concentration or where workflow was not impeded by the space
constrictions of the standing workstation.
I prefer to use it by task. I don't find it very good for writing and editing work… I don't have enough space around me
for my paper and other things, so I find it really good for obviously, video conferences, emails, tasks where I don't
need to refer to other publications or something. But I find for editing tasks - real thinking tasks where I need to draw
on other resources, I sit. Participant 15 (current user).
The only time I really used it for standing is when I didn’t need to think in a lot of detail, which seems really silly. But
I found that I couldn’t concentrate very well when I was standing to use it. But also if I needed any other materials.

33
So if I needed to read off a document or hard copies of things, then it wasn’t useful because there was limited space.
Participant 3 (ceased user).
In terms of productivity, participants’ views were mixed with no clear indication of decreasing or increasing
productivity when using the desk in a standing position.
I think productivity would be lower, because it’s inconvenient you know to have to change heights to be able to do
different tasks, or be able to read different pieces of paper. A lot of the tasks were neutral yeah, if it was just standing
stuff, that I didn’t need to refer to pages that were lower down, then it didn’t matter. Participant 18 (ceased user).
Many of the users reported an awareness of their own comfort and fatigue in both standing and sitting
postures despite most users reporting that they have never received or sought to understand basic
ergonomic and workplace injury risk principles. Postural awareness was mentioned by a few participants
which indicates that some have an understanding of appropriate office ergonomics and safe workstation
use.
….after a period of time my feet get sore. Then I get back to a sitting position and I sit for longer than I should and
then I remind myself again that I need to get back up into a standing position to do something. Participant 6 (current
user).
A number of the females participants reported footwear selection being a key consideration for enabling
work to be undertaken standing. This illustrates that participants not only value working in comfort and
possibly understand the implications on their body if they choose to wear what they consider inappropriate
footwear, but are also willing to implement a behavioural change to ensure they can work in a standing
position.
Sometimes it can be a little bit uncomfortable just on the soles of my feet. I typically now wear flat shows because
it's pretty uncomfortable to stand in high heels all day, or any kind of heel actually. The other thing I do is take my
shoes off sometimes, because it's more comfortable to stand in bare feet. So I think it makes me choose my shoes
differently, because I think standing in any kind of heel all day is not comfortable at all. Participant 20 (current user).
Elements of ergonomics, safety and health relative to SSWs were mentioned directly or indirectly. Many
of the users spoke about positive associations with their health and wellbeing status through using a
SSW.
Because of the ergonomics, because human beings aren't meant to sit as far as I'm concerned. The spine's not
designed for sitting; it's designed for standing and walking. People tend to get into bad postures when they're sitting.
It's just the nature of the beast and I'm sitting now and my shoulders slumped forward and arched back. The body's
not designed to sit. Participant 21 (current user).
Overall, users were quite forthcoming about their personal considerations for sustained use or not. Other
factors discussed by some participants included the positive psychosocial associations in using the
workstation, cognitive demands and mood status.

34
3.5 Posture
Associated with the personal considerations for use, all participants discussed a variety of factors
associated with their comfort and kinaesthetic awareness which has been brought together under the
theme of posture. To ensure ongoing feasibility of use, many mentioned behavioural change aspects such
as being dressed comfortably, but also the physical element of having good body positioning so that they
could undertake their tasks in comfortable standing posture at their discretion. Participants discussed the
reasons they would typically change back to working in a seated position, as primarily being related to
comfort and fatigue.
I think it’s just - it’s just postural I guess. I do tend to hunch a lot when I sit. So it’s just me being conscious about
my body getting into that position that prompts me to want to stand up a little bit more. The upper back, upper mid-
back I suppose, your shoulders as well as around the neck. Participant 17 (current user).
Many of the participants made mention of moving whilst standing with reference to discomfort from static
standing and the potential of this becoming a health issue.
I would say that I plant the feet and stand in that one position then basically after a little while, when it gets sore, I'll
move my feet around and come back to that position. Participant 6 (current user).
The opinions of users regarding their musculoskeletal disorder risk was somewhat varied when sitting or
standing, however there was a general sense that their risk of injury was higher when working in a seated
posture. Participants commented that the risks were highest for the neck, shoulder and back regions
when sitting.
Probably back, I guess, just from a postural perspective, you know, sitting all day can't be - it can't be good for you.
And, yeah, I'd say probably back, maybe neck depending on what you're doing, you know, if you're leaning over your
desk or writing all day kind of scenario. Participant 11 (current user).
When adopting a standing posture, participants spoke about their knowledge and understanding that
there might also be musculoskeletal disorder risks present to areas of the lower body. A lack of
understanding of what some of the risks are was evident within a number of the responses.
I’m not really sure what the risks are. Certainly in my experience it's been probably pooling of blood in your calves
and a bit of aching around your feet and ankles. But that’s all I really notice and I guess there’s probably some risks
to standing too much as well, perhaps lower back pain for some people, but it certainly hasn’t been something that
I’ve experienced. Participant 20 (current user).
Those who had ceased use of their SSW, provided various reasons as to why this was the case. Some
commented on anthropometric issues such as the uppermost height of the workstation not being
adequate for accommodating their personal use. Others questioned if there was value in using the SSW,
if static standing was adopted when operating in the standing position.
I also have issues with how good standing in one place for a long period of time is for people in terms of health. I’m
not too sure that that’s an ideal alternative to sitting, which is basically what you have to do at a standing desk. I

35
mean you can shuffle around a bit but - and I think in the past, probably in days gone by, people who had jobs where
they had to stand a lot or move around, nurses and waitresses and things like that, often used to have issues with
the lower limbs. That seems to - I don’t know where that’s gone these days, but I still think that maybe static
standing itself may not be ideal. Participant 19 (ceased user).
Other factors related to comfort included the effect that a warmer day might have on their time spent
standing, and the use of ergonomic office aids such as a gel mouse pad or keyboard support providing
assistance with comfort levels within their workspace.
3.6 Usability
Most participants provided lengthy commentary regarding the usability of the workstations. Nearly all
interviewees confirmed that they have never received any personalised formal training upon the
installation and setup of the SSW.
None. Not in regards to getting given a standing desk. Participant 1 (ceased user).
Yeah, we’ve done basic stuff in part of the induction when we first started the job but that was it. There’s this stuff
that’s floating around on the noticeboards… Participant 22 (ceased user).
A number of participants reported having a basic level of knowledge and understanding of the key
ergonomic considerations of using a SSW. There were a low number of participants who had not sought
to understand the requirements or key ergonomic principles linked to a safe workspace in order to
mitigate their exposure to musculoskeletal hazards through either internal or external organisational
resources. A small number of participants had spoken about undertaking internet searches to upskill their
knowledge and understanding.
I’ve never really thought about it. I guess I’m satisfied with my knowledge but in saying that I’m sure there’s probably
a lot more that I might need to know. Participant 12 (current user).
I thought I did but probably - well it’s probably really never been high on my list of concerns…. I’ve received no
formal training in how to use a standing desk and maybe I should have….we were just asked did we want one, and
they were installed, and that’s pretty much it. Not that they’re very technical or challenging to use, but you just kind of
make the assumption that you know how to use it. Participant 2 (current user).
A number of users ensured they took their comfort into account when it came to setting up their
workspace and using the SSW.
Haven’t been given any training at all or any advice about using the desk, I’ve just used my own common sense. If I
feel uncomfortable I sit down. I know that standing out all the time is not a great thing either. So I just use my own
common sense and listen to my body. But I haven’t actually been provided with any formal training or anything
whatsoever. Participant 20 (current user).
I just go with comfort like whatever feels comfortable I think. But there's no - I can't think of any particular way I
would set it up. Participant 4 (current user).

36
Aspects of adaptation to a workspace were spoken about by some current users, typically to improve
functionality. A number of current users were willing to modify their work behaviours and forgo some
functionality of their workspace so they could continue to use their sit stand workstation. Many users
believed that the positives of having the option to be able to operate across a working day between a
seated or standing position, outweighed the negative aspect of the loss of a fully functional workspace.
I find standing is fine, but it’s this style of desk whereby, as I said, you have nowhere to put paper at eye-level or
even reasonably close. It's got to be down on the desk so I don't find that useful but whereas I've seen different
standing desks that actually have space for you to put your paperwork, which is near your keyboard, and so it looks
like it's a more useable kind of set-up. But I don't go home from work every day feeling uncomfortable. If I did that I
wouldn't use it in the way that I use it. So it works for me but it's - I know that there are better systems than what I've
got and the ultimate would be to have an actual desk that moves up and down. Participant 4 (current user).
Of the ceased users, it was reported by some that the lack of usability and loss of workspace were key
factors in their decision to stop using the SSW and removing it from their workspace.
No that’s why I got rid of it. It was just taking up so much space and even when I had it in the lower position to sit,
you still had the keyboard in the way and it was just a nuisance. The particular model I had I thought it was easy
enough to lift to adjust the height of the unit, but just the space it gave you in regards to having – even where you
placed your mouse in regards to the keyboard or any documents that you needed were a bit of a challenge.
Participant 3 (ceased user).
Nearly all users conveyed both positive and negative factors regarding the evaluation of their workspace
modifications required to ensure they could undertake their work.
I think it's very easy to access and it's very easy to change it from a sitting to a standing point and you've got extra
space to put your notes and things everywhere in front of the computer so it's quite easy. Participant 4 (current
user).
Things fall off the side. There's not enough room for my documents right next to where I'm typing, and I don't like it
because it's not positioned well on my desk for where I need to stand. Participant 15 (current user).
Other factors which participants raised included furniture placement within the workspace, the
functionality of the modular style workstations, and the lack of a subject matter expert to ensure that their
workspace was safe and ergonomically friendly for use. Current users also expressed concerns about
having an optimum setup for their workspace so use could be ongoing and sustainable, to address issues
including accessories such as adequate cable lengths, additional furniture placement and overall
functionality of the workspace.
3.7 Key informant findings
A similar methodology was employed in regards to the analysis of the two key informant interviews where
three initial domains were identified. After further analysis, the final thematic map encompassed:
Considerations and concerns, and Policies and procedures. Figure two shows the final thematic map for
the key informants.

37
Figure two: Final thematic map for key informants
Key informants expressed a systematic approach regarding their considerations and concerns for the use
of the SSW. The key informants spoke about the concerns around the lack of education and
understanding of employees. Key informants were concerned that employees felt that using a SSW would
provide a health benefit in its own right without an understanding of the possible risks that might be
associated with use.
First of all I would ask the question why, why they need one and why they would like one. If it is because they've
had stated issues with their work situation I'd ask to go and see if their workstation setup is adequate because
sometimes there'll be something that's out of whack that might be causing an issue for them. (Key informant 2 -
Manager of health safety and environment (Faculty level).
Concerns were raised regarding risks within a work environment when a sit stand workstation is
implemented including ensuring the workspace was not impeded and that users are not adopting a static
standing posture.
There’s problems with static standing…it can be very fatiguing, so it’s almost like well I’ve got it, now I’m going to
stand here for eight hours a day. Well that’s not what they’re designed for, and I think that’s potentially one of the
things where people - it could create a problem where there wasn’t one before if people aren’t using it properly, so
that’s probably one of the risks. In terms of other OHS risks hopefully the risk assessment we do would eliminate
those risks, and so by the time people get to use it they understand that we’re suggesting that they sit and then
stand, and then sit and change their posture during the course of the day. (Key informant 1 – Senior OHS
consultant).
Discussions around the policies and procedures in place highlighted that whilst the key informants
provided advice and training to employees in regards to SSWs, it is not their final call in some instances to
give approval for an employee to install and use the workstation, as financial approval for the institution is
within each respective area.
I certainly don’t receive all requests for SSWs. If there is no underlying medical condition, health condition or
disability, it really is up to the local area as to whether they purchase it. They hold the budget for it. If a request
comes to me though we do an assessment, we obtain some medical information so that we understand what the

38
person’s condition is. And then we’ll make recommendations back to the treating practitioner about what we think is
suitable. You know we would sort of have a dialogue between - with the staff member and their practitioner, and
we’d pick something that was suitable. (Key informant 1 – Senior OHS consultant).
Finally, it was mentioned that staff have access to other workplace health and wellbeing options that can
establish a behaviour change to improve one’s health and wellbeing status.
I think it’s great to have the management on board, and sort of driving the issue and understanding that it could have
benefits. Listening to what people are saying, but also talking them through the practicalities because it’s one
strategy in a whole suite of strategies around keeping people fit and healthy at work. It’s one thing. And I don’t think
we can over-focus on it, we’re currently working on our Health and Wellbeing Program and trying to establish a very
significant physical health program for our organisation. And the SSW addresses one thing around sedentary work,
but we have other strategies that we can work on as well. (Key informant 1 – Senior OHS consultant).
Overall, the key informants provided a greater depth to their responses, which assisted in providing a
holistic picture of the organisation’s understanding of SSWs and how they can affect the worker, the
workspace and the work organisation.
4. Discussion
To our understanding, this is the first research project to assess the ergonomics, safety and health factors
associated with long term sustainability of use for SSWs within a workplace environment. These findings
included participants believing that the adoption and use of a SSW would provide a health benefit, and
that the use of the SSW in a standing position was typically associated with the time of day, task selection
and muscular comfort or fatigue factors. In comparison to previous qualitative research, the results of the
cohort examined are novel in relation to establishing a number of considerations SSW users put in place
to ensure ongoing sustainable use within a natural workplace environment. This is an original finding as
previous studies have investigated the experiences of users participating in a short term intervention
protocol, evaluation after short term use, or within a laboratory environment (Chau et al., 2014b; Grunseit
et al., 2013; Thorp et al., 2014), in contrast to participants within this study who have been using the sit
stand workstations for much longer than any previously researched populations.
Important insights were also obtained from the small number of now ceased users who participated in the
study. Participants who ceased use identified the lack of usability and the sit stand workstation as an
impediment in their workspace were key drivers for cessation, whilst key informants were able to provide
insights from a systematic perspective around organisational and environmental factors. Whilst only
limited quantitative data was collected, most participants reported a lower level of discomfort to the neck,
shoulder and upper back regions when working in a standing position.
Throughout the interviews, discomfort mitigation along with positive health and postural improvements
were raised by participants as reasons for initial uptake and use of a SSW. Participants reasons for
adoption and use were generally related to the musculoskeletal health benefits of operating a SSW. This

39
finding is similar to previous research which saw workers report similar health reasons for wanting to use
a SSW (Chau et al., 2014b).
Our research also found that a level of social acceptability and support from management was present in
the workplace in regards to health and wellbeing based initiatives which staff wished to utilise which
includes the uptake of using a SSW. This is similar to findings from previous research that undertook a
qualitative evaluation of sit stand desks in an Australian workplace (Grunseit et al., 2013; Wahlström,
2005). Surprisingly, the participants in our study did not talk specifically about sedentary behaviour and
cardio metabolic risk factors which is the focus for much of the current epidemiological research (van
Uffelen et al., 2010). This could be possibly due to a lack of user understanding and education within this
domain as this cohort were not provided with any formalised education regarding the potential health
benefits of using a SSW upon installation.
4.1 Personal considerations for use/sustainability
The findings highlight a number of notable personal considerations for use of a SSW, in addition to other
personal adaptations implemented over a longer term usage period. It was evident that many users had a
preference for using the workstation in a standing position in the early part of their workday and for tasks
that were considered lower in complexity. Chau et al. (2014b), reported similar findings with participant’s
usage patterns grouped into being either task based, time based or having no particular pattern over a
four week intervention period. Of the females interviewed in our study, nearly all discussed the need to be
wearing comfortable footwear in the workplace so that they could work in a standing. Whilst previous
research also touches upon this preference (Alkhajah et al., 2012), our findings revealed that many of the
female participants actually took into consideration the need for comfortable footwear in order to operate
in a standing position.
Whilst productivity within this study was not formally assessed, participants were asked to provide their
opinion about any perceived changes to their productivity since the adoption of using a SSW. The
responses from our interviews were mixed, however, task selection was widely discussed with many
users being very selective about what tasks they would undertake in a standing position. This supports
previous research questioning if the use of a SSW results in increased worker productivity due to the level
of variation and the ability for participants to select their use of the workstation in a seated or standing
position (Karakolis and Callaghan, 2014).
Our findings related to longer term sustainable use provide some similarities to those reported in a pilot
study by Alkhajah et al (2012), who found that self-reported health and work performance outcomes did
not change markedly after three months of SSW use. Whilst our findings saw longer term users indicate
that some level of adaptation has occurred to their workspace so that sustainable use is possible, a
number provided insights into being rather selective relative to what tasks are undertaken in a standing
positon. This demonstrates that users have been able to implement a protocol of using a SSW to suit their

40
individual needs so that sustainable use can occur, it does come with some adaptation possibly being
required at the expense of both the individual and the workspace.
Previous research has found that when workers receive training of instruction from an subject matter
expert such as an ergonomist, they were nearly twice as likely to use the SSW on a daily basis (Wilks et
al., 2006). Whilst in our study it was evident from the responses that participants received very minimal
guidance or training on what is considered a safe and ergonomically friendly workspace when using a
SSW, most generally conveyed that they were comfortable in setting up the workspace appropriately so
they could undertake their tasks in either a seated or standing position. These findings indicate that more
can be done to better prepare employees for safe operating use of a SSW. As such, the need for local
areas to integrate an ergonomics framework whereby staff are adequately educated on all aspects of their
work space through a subject matter expert is important, as this will ensure future successful
implementation and utilisation of SSWs (Karakolis and Callaghan, 2014). Also by doing this, it will likely
enable users to mitigate musculoskeletal disorder risk as safe workspace setup and design has been
conveyed to the prospective user (Wilks et al., 2006).
4.2 Posture
While participants reported being aware of their posture and comfort, a lesser number appeared to
understand the possible risks of prolonged standing or static posture. Upon weighing up whether a seated
or standing position carried a higher level of musculoskeletal disorder risk, the majority of users stated
that being in a seated position posed a higher risk, in particular to the lower back, neck and shoulder
regions, compared to the risk to the lower limbs when operating in a standing posture. The adoption of
various methods was undertaken within an individual’s workspace to ensure that their posture was
functional and comfortable for the task being performed. Aspects of behaviour change were discussed
relative to the domains of comfort, body awareness and positioning, standing and sitting posture. All of
these are deemed to be critical elements of safe and ergonomically friendly workspace which have been
conveyed in previous research findings (Cantley et al., 2014; Karol and Robertson, 2015; Toomingas and
Gavhed, 2008).
As discussed earlier, longer term users spoke about the duration they operated in a standing position
across a working day. Whilst this varied between those interviewed, no user formally adopted a ratio of
sitting to standing with their workstation, although many performed approximately half their working day in
the standing position. Many discussed the requirement to build up a level of conditioning to the lower
limbs by initially increasing the standing time at the early stages of use. As literature within the static
standing domain confirms that people who break up their sitting time with time spent standing can
improve their fatigue resistance across a working day, it is plausible to suggest that the implementation of
a gradual increase of time spent standing will aid lower limb conditioning and that this should be
encouraged (Callaghan et al., 2015). Further to this, a set of universal guidelines which encompasses a

41
ratio of sitting to standing based work should be implemented for users to follow as guidance (Thorp et al.,
2014).
4.3 Usability
With the immediate interface between the user and the equipment being very important, the usability and
workspace layout are seen as critical factors to ensure a level of worker acceptability and functionality
(Corlett, 2009). A number of users were willing to adapt their workspace without consideration of the
possible biomechanical and ergonomic implications for a functional workspace which may give rise to the
possibility of musculoskeletal discomfort and injury risk (Callaghan et al., 2015). This has possible
implications in regards to the task workflow factor, which many users, including most ceased users,
discussed as a limitation of the workspace. Our findings are supported by a previous study which reported
many of their cohort who trialled a similar workstation, had issues around the ergonomics factors of
design and its impediment on comfort, stability, anthropometry and loss of functional workspace (Chau et
al., 2014b). These factors can ultimately affect an individual’s safety and health (Macdonald, 2006;
Papadopoulos et al., 2010).
Overall, little thought was given by participants regarding the usability positives and shortfalls to their
workspace prior to installation and use. Subsequently, participants discussed a number of significant
issues and concerns when asked about the positive and negative factors related to using a modular SSW.
Individuals did report being able to logically resolve barriers to use by attempting to adapt the workspace
as required. Previous research has highlighted that individuals will consider the possible benefits and
issues associated with modifying their workspace so continuation of use can occur (Grunseit et al., 2013;
Wilks et al., 2006). In regards to the ceased users, the loss of functional workspace due to the design
and modified workspace layout was a key consideration with usage cessation. Similar issues were raised
by participants who used SSWs over a short term period which highlights the need for a holistic
assessment before implementation (Alkhajah et al., 2012; Chau et al., 2014b).
4.4 Key informants
The key informants discussed a number of related issues regarding the ergonomics, safety and health
associations with a SSW. They were well informed in regards to their knowledge base of the SSW domain
which supports recent findings of a cohort of occupational health and safety practitioners who discussed
the health risks, intervention strategies and influences related to occupational sitting (Gilson et al., 2012).
Their views were that a systematic approach is required with the implementation of SSWs, that addresses
the considerations and concerns, as well as the relevant policies and procedures so that an informed
decision can be made by the prospective user (Das and Sengupta, 1996).

42
4.5 Study strengths and limitations
This study has some notable strengths in that the majority of the cohort investigated had used the
workstations for more than three months and were ongoing SSW users within their work setting. Whilst
valuable insights were obtained from participants who had ceased use, the number of ceased users (n=6)
is low. Though small in number, important insights have also been obtained for a small number of now
ceased users, which demonstrates that not all uptake to using such a workspace is successful. Future
works in this area with a larger cohort would help follow on with what can be described as a preliminary
assessment of ceased SSW users.
5. Conclusions
In conclusion, this study has provided valuable insights into the ergonomics, safety and health domain
relative to longer term sit stand workstation use within a natural work environment. The information
obtained has practical relevance to organisations who are looking to implement sit stand workstations for
employees. A number of important personal, postural and usability factors related to the ergonomics,
safety and health domain have been identified and discussed relative to ongoing and sustainable sit stand
workstation users. It has been found that sustainability of use of a sit stand workstation is achievable,
however, it most likely comes with some element of adaptation for those wishing to use workstations of
this type of design within their workspace.

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