POINT OF DECISION PROMPTS AND SIGNPOSTING FOOTPRINTS IMPROVE STAIR USE IN A UK CITY CENTRE OFFICE.

Editor,

Physical inactivity is a public health priority, with sedentary behaviour and lack of physical movement major contributory factors to serious illness, including coronary heart disease (CHD), stroke, Type 2 diabetes and breast and bowel cancer (1). Small bouts of physical activity may be an effective way to reach recommended physical activity levels (2). Stair use is easily integrated into daily activities and associated with health benefits (3). We compared upward and downward stair and elevator journeys before and after the introduction of a multicomponent intervention consisting of point-of-decision prompts (PODPs) and signposting footprints at a city centre office in Northern Ireland.

Using a before-and-after study design, measurement of people using the elevator and stairs originating or terminating on the ground floor were made for a period of a working day (9 hours 10 minutes) over three days (Monday 8am-1pm, Thursday 1pm-3pm and Tuesday 3pm-5.10pm) during a typical working week prior to the intervention. Measurements were repeated under identical circumstances four weeks and six months after introduction of the intervention. The setting was a six-story office building in the city centre of Belfast, Northern Ireland. Seven PODPs with simple messages, bright colours and bold text were designed and placed 10cm above the two elevator call buttons on each floor (Figure 1). Green footprints with a “Take the Stairs” message were stuck to the floor and stairwell entry door to increase visibility of the stairs and direct staff to take the stairs (Figure 2). Absolute and relative differences between pre-and post-intervention elevator and stair use were determined and chi-squared tests used to test for significant differences.

Fig 1.

Example of Point of Decision Prompt (PODP) used above elevator call buttons.

Fig 2.

Signposting footprints used on the floor and stairwell door.

There were 6383 total observations, 2205 prior to intervention and 2179 four weeks post-intervention and 1999 six months post-intervention. Total stair journeys increased significantly from 16.6% to 30.2% (82% relative, 14% absolute increase, p<0.0001) four weeks post-intervention and remained significantly higher at 29.2% six months post intervention (77% relative, 13% absolute increase, p<0.0001). There was no significant reduction in total stair journeys between four weeks (30.2%) and six months post intervention (29.2%) (p = 0.49). Staff were over twice as likely to use the stairs four weeks after the intervention (Odds Ratio total journeys 2.2 [1.9 -2.5]) and six months after the intervention (Odds Ratio total journeys 2.1 [1.8 - 2.4]) compared to pre-intervention.

Most previous studies on interventions to increase stair use in workplaces involve PODPs alone with stair climbing increasing between 0.3% and 10.6% following introduction (4). There are few studies of multicomponent interventions involving motivational POPDs and directional signs (e.g. footprints) in UK workplaces. We found a simple, inexpensive multicomponent intervention comprising motivational PODPs and floor-based directional footprints produced significant increases in stair use in a UK office building. The relative increase (82%) was much greater, and the absolute increase similar (11.8%), to previous studies (2). Journeys were over twice as likely to be taken using the stairs post-intervention. This simple effective intervention has potential for use in other buildings.