Workplace sedentary behavior (SB) is associated with poorer health and work-related outcomes, such as musculoskeletal disorders, reduced mental and occupational well-being, job dissatisfaction, and fatigue [1-4]. According to the World Health Organization, the workplace is one of the main settings to reduce SB in the adult population [5], with office workers, who spend an average of 77% of their working day sitting [6], being a key target group [7]. After the COVID-19 pandemic, hybrid work, alternating work in the office and at home, has become the new work paradigm for many desk-based jobs [8-10]. Hybrid work results in even higher levels of SB than working solely in the office [11], increasing the risk of musculoskeletal health problems, mental health issues, and reduced work productivity [11,12].

Developing strategies to reduce and break up workplace SB, replacing it with activities other than sitting, such as walking or standing, has been the focus of recent studies [13,14]. In particular, the use of digital strategies in desk-based jobs (eg, delivered via mobile phone, activity tracker, or desktop computer) has the potential to provide scheduled prompts, deliver information, give automated tailored feedback, and mediate organizational support and social influences [15]. Recent evidence has highlighted the capability of digital interventions to reduce workplace SB and its associated harmful effects on health and work-related outcomes among office workers [16-18]. However, this research has focused on the traditional office environment, with a dearth of research available on the use of digital interventions to reduce of employees’ SB while working remotely or undertaking hybrid work [19,20].

Multicomponent digital interventions that combine environmental and organizational changes and provision of information and counseling have been reported as more effective than single-component interventions in reducing occupational SB among office workers [16,21]. In addition, the grounding of interventions in a theory of behavior change is key in the success and behavior maintenance of multicomponent interventions [22-24]. Given the limited evidence base on the effectiveness of interventions targeting hybrid work, it is crucial to develop multicomponent digital interventions grounded in sound theory of behavior change to reduce occupational SB among home office workers.

To contribute to a successful implementation of an intervention and, thereby, to its effectiveness, involving stakeholders such as researchers, experts in the addressed topic, and the target population in the development of interventions is necessary to identify needs, priorities, and potential solutions [25]. A previous qualitative study identified which factors influenced employees’ ability to reduce SB when working from home from the employers’ perspective, whereas additional qualitative evidence identified the factors influencing the reduction in SB from the employees’ perspective [26]. This study aimed to go beyond the existing research gaps to incorporate expert opinions to gain a complete picture of all stakeholders and reach consensus on the feasibility of digital work strategies to reduce SB in a home office context. Therefore, the aim of this study was to reach expert consensus on the most feasible and usable digital work strategies as a delivery method to reduce SB in a home office context.

A modified Delphi study was used to elicit a consensus from a spectrum of experts in the field of occupational health. It is a flexible approach combining quantitative and qualitative data. Qualitative data can be collected before, after, or between Delphi rounds [27,28]. This study encompassed 3 survey rounds and subsequent web-based focus group sessions. This study is part of the initial modeling of a multicomponent intervention and of a larger European project (ie, the Click2Move program) aimed at tackling the challenge of occupational sedentarism in hybrid office workers.

This study was based on the recommendations of the Conducting and Reporting Delphi Studies guidelines [29] and the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist [30].

This project was approved by the Research Ethics Committee of the University of Vic–Central University of Catalonia (250/2023). This study was conducted in accordance with relevant guidelines and regulations. The invitation email contained general information about the study and a link with further details of the participant information statement, including assurances of anonymity and confidentiality and emphasizing that participation was completely voluntary and participants could withdraw at any time without any consequences. In compliance with ethical research practices, digital informed consent was obtained from all participants before initiating the survey. No incentives were provided to the participants for their involvement.

International experts (N=57) identified as leading or established researchers in the field of occupational health (with a specific focus on modification of physical activity [PA] behavior in the workplace), well-being, or computer- or desk-based jobs specialists identified by the research team were invited via email to participate. The experts were selected through a search of published articles that identified highly active authors in the field, whereas the job specialists were identified from professional networks of the involved institutions. The exclusion criterion was not being able to understand and communicate in English.

To maximize participation in the Delphi survey, a reminder email was sent within 1 week. After completing the 3 Delphi rounds, participants who signed the informed consent form for the Delphi study (29/57, 51%) were invited via email to participate in a focus group.

Study uptake was calculated as the proportion of participants who accessed the round 1 Delphi survey to that of all potential participants identified. Retention rate referred to the proportion of completed responses for each round and participation in the focus groups. In round 1, responses to the Likert scale in the highly feasible or highly useful category (score from 7 to 9) were calculated. The median and mean absolute deviation from the median (MAD-M) for each item were also reported to assess the strength and extent of agreement. Medians of 7 to 9 were defined as strong support, medians of 4 to 6 were defined as moderate support, and medians of 1 to 3 were defined as no support. The MAD-M describes the variation in the median values [36]. In round 2, we calculated the weighted average ranking for each item to determine the most highly ranked work strategies and BIT elements for reducing SB among home office workers. The respondents’ most preferred choice had the largest weight, and the least preferred choice had a weight of 1. For achieving consensus, the order-weighted average process was followed through the aggregation of the strategies evaluated in the previous round to be validated in round 2 [37]. Items that achieved consensus were those that were ranked with a weighted average above the median. The additional items that emerged from round 1 were assessed through a 9-point Likert scale in round 2, and the median and MAD-M were calculated. In round 3, the matched items for each work strategy and BIT element were reported, as well as the percentage of respondents.

The focus group analysis was conducted using the principles of reflexive thematic analysis [38,39]. First, a researcher (IPS) familiarized themselves with the data, reading and rereading carefully each transcript to obtain a general impression of the main opinion of the experts and identify repeated concepts. Subsequently, according to the subjectivity of the researcher, an initial open coding process was generated from interesting features and relevant data searching for evidence for themes, namely, patterns of shared meaning underpinned by a central organizing concept. Reflexive thematic analysis was approached in an inductive, semantic, and realistic way. In other words, the construction of codes and themes was directed by the content of the data but not by a topic summary. Codes, concepts, and the core category were recoded and relabeled if necessary after each step until the codes provided the intended depth of the insights. The analytic outputs obtained from the codes and through the active engagement of the researcher with their data were then conceptualized in potential themes and subthemes. Finally, the themes were reviewed, defined, and named. At the end of each step, data were shared with an experienced supervisor (CV-C) for reflecting on how the data were initially coded and consider things that might have been overlooked. MAXQDA 2022 (VERBI GmbH) was used for the analysis.

To ensure a robust analytical process, we considered key aspects of quality and rigor. The first aspect was reflexivity, which involves critical reflection of researcher perspectives and its integration within the analysis and interpretation of the data to develop themes [40]. The study team comprised researchers with expertise in PA and SB in the workplace who have experienced working from home since before or after COVID-19 pandemic. IP-S, who carried out the analysis, is a Spanish physiotherapist and osteopath PhD student who has been working from home for 3 years; CV-C, the supervisor during the analysis, is an experienced nutritionist with a background in health promotion and qualitative research who has been working from home since the COVID-19 pandemic. Second, confirmability, the objectivity of the findings [41], was attained through a critical friend approach whereby an experienced supervisor reviewed interpretations and introduced alternative perspectives, increasing objectivity and confirming the accuracy of the findings. Third, dependability, the reliability and consistency of the study [41], was attained through detailed research procedures (ie, rigorous data collection techniques and well-documented procedures and analyses). Credibility was then built on the reflexivity and triangulation of the data, incorporating more than one researcher in the analysis process [42]. Furthermore, a critical friend approach was used whereby an experienced qualitative researcher, CV-C, critically analyzed the preliminary themes and ensured that the selected quotes provided support for the themes developed. Finally, transferability was enhanced through the transparent and detailed descriptions of the participants and research process [42].

A total of 51% (29/57) of the invited experts expressed their interest in participating in the study through the digital informed consent form. Of these 29 participants, 27 (93%) completed the first round, 25 (86%) completed the second round, and 19 (66%) completed the third round. Of those 29 participants, 15 (52%) joined the focus groups.

Most of the first-round Delphi respondents and focus group participants identified as women (16/27, 59% and 8/15, 53%, respectively), with 48% (13/27) of first-round respondents aged between 36 and 45 years.

A wide variety of countries across Europe were represented. However, non-European countries such as Australia (5/29, 17% of the participants) were also represented.

This study achieved international expert consensus on 18 potentially feasible work strategies to reduce home office SB delivered through 16 potentially useful digital elements. These results seem to be transferable to both office and home settings based on experts’ responses. Moreover, the experts highlighted the importance of multiple factors (ie, social, individual, and environmental) working in tandem to facilitate and maximize the strategies’ implementation, as well as to achieve behavior change.

Wrist-based activity trackers were identified by most of the experts (12/19, 63%) as useful for self-monitoring activity and SB. Previous research has highlighted the feasibility and usability of these devices for self-monitoring SB as well as workers’ acceptability of these approaches in the office context [43,44]. In addition, these strategies have demonstrated effectiveness in reducing SB in such settings [44]. Some studies have highlighted limitations in recognition of postures and step detection when using wrist-based devices compared to leg-based devices [45-48]. However, few experts considered leg-based activity trackers for self-monitoring activity and SB due to the discomfort they may cause. This suggests that future interventions incorporating activity trackers with the aim of reducing SB should first validate the devices for their subsequent implementation and effectiveness evaluation in home office settings.

In the literature, computer visual feedback on activity patterns is considered to be an enabling factor for increasing motivation and awareness among office workers [49]. However, experts preferred smartphone apps as they are able to provide real-time feedback on activity progress. In addition, feedback may be an indication of progression toward a defined goal [43]. In this study, experts stated that smartphone apps could be a useful tool for setting tailored goals. Evidence has demonstrated the effectiveness of smartphone apps in reducing SB and promoting PA in office settings [16]. Hence, smartphone apps may be a potential mode of delivery for setting tailored goals and providing feedback on the move, which should be evaluated in future home office environment interventions.

Previous research has demonstrated that short activity breaks (ie, walking) every 30 minutes result in reductions in office SB time [50] but also in reductions in fatigue and improvements in energy and mood [51]. However, in this study, experts considered breaks every 60 minutes more feasible. According to recent literature, a possible explanation may be related to the fact that workload and time pressure were identified by employees as the most common barriers for reducing and breaking up SB [52], making it difficult to stop more frequently. Moreover, replacing SB with active working tasks (eg, incidental moving while reading and answering calls) may overcome these barriers [49]. Working remotely increases opportunities to perform active tasks or even other light-intensity PA that may increase the potential benefits of reducing SB and its harmful health effects among office workers [9,10,53]. Experts reflected on the importance of providing clear instructions and modeling through video demonstrations as a key digital element to enhance active breaks among employees when working from home. This may have implications for future studies evaluating the most effective active break duration through video demonstrations and the implications of these breaks regarding SB time and its health effects in home office contexts.

On the basis of experts’ responses, there is a literacy gap between the terms PA and SB, with activity trackers largely focused on PA instead of SB [52]. Therefore, educational material may be a key aspect to increase knowledge for behavior change and reduce the lack of understanding of SB and its subsequent health implications, which was highlighted by experts. Educational material is an essential and effective strategy for workers to increase awareness of SB’s health consequences [52,54]. In our findings, a combination of media was preferred to deliver information to increase awareness and knowledge. Therefore, it is recommended that future studies include educational material to increase knowledge and awareness among home office workers.

Despite the relevance of knowledge and awareness to achieve behavior change, social and organizational support is a factor noted by workers in the current literature for facilitating and encouraging movement in the workplace [55-57], as well as by managers in the home office setting [26]. Home office work is more related to negative emotions than office work due to the isolation and loneliness; therefore, social support is even more important in this context [58]. Gamification features, including social challenges, were identified as a useful digital element to deliver strategies such as awards, rewards, or incentives to achieve goals or recommendations for reducing SB among home office workers. This strategy could provide social support and motivation. Motivational messages from managers are also an organizational support strategy, which experts suggest could be delivered through smartphone apps. Thus, future studies should evaluate the acceptability of these social and organizational strategies among both managers and employees, as well as their effectiveness in the home office context.

Environmental work strategies such as standing desks, height-adjustable desks, or workstation accessories were mostly not matched with any digital element. Moreover, experts recognized work strategies such as height-adjustable desks as unfeasible in the home office environment, primarily due to the associated costs. Recent evidence has demonstrated the high cost of such desks (eg, standing desks or height-adjustable desks) compared with nondesk interventions [59]. Workstation accessories (eg, desk platforms) or relocation of office supplies are less expensive strategies [60] that were deemed more feasible and usable by experts and may be implemented in home office settings. Therefore, home office interventions may include environmental work strategies in a similar way to office interventions but with a lower associated cost.

On the basis of the findings presented in this paper, physical environmental strategies need to work in tandem with social support and individual strategies to achieve behavior change. A recent systematic review showed that theory-based interventions, a relevant step in multicomponent intervention development [25], that include social, physical, and individual elements are more effective than non–theory-based interventions [21]. Furthermore, stakeholder engagement (eg, consultation or coproduction among researchers, experts on the topic, and the target population) should be encouraged throughout the development process [25]. Recent studies have highlighted the need for a top-down approach whereby managers should provide support to employers [26]; hence, the implementation of strategies should be an organizational initiative. Although evaluating effectiveness on outcomes has traditionally been the primary focus of interventions in this discipline, in particular to encourage their adoption in the real world, the feasibility, acceptability, cost-effectiveness, and scalability of interventions is increasingly important to ensure the translation of findings from research to practice [25,61]. This study provides new insights for future research on the design of home office interventions aimed at reducing SB based on the learned experiences of occupational health experts. However, we were not able to cover the entire audience’s perspective, so new qualitative studies exploring the perspectives of different stakeholders (eg, end users) may further inform about the feasibility and usability of digital workplace strategies.

In addition, experts considered that no adaptations would be needed to transfer these home office strategies to hybrid work, the current modus operandi for many desk-based workers. However, the experts who participated in this study were mainly from high-income countries; therefore, such perceptions may vary among people from other regions. Hybrid work presents opportunities for promoting PA by providing flexibility to integrate occupational, leisure, lifestyle, and incidental activities [9] but also for improving health and well-being [62]. Hence, the results of this study may be transferable to hybrid work in high-income countries, whereas hybrid work should receive greater consideration in future interventions given cultural variability.

The main strength of this study is the novelty of the home office context to deliver strategies for reducing SB through digital elements. The fact that focus groups were conducted after a Delphi study enabled us to elicit additional views and opinions on the Delphi results from the experts’ perspectives, consolidating the consensus. Nevertheless, we did not share the analytical categories, interpretations, or conclusions from the thematic analysis with the experts, which may affect the analysis’s credibility. The entire study was conducted in a rigorous manner, with high participant response rates and representation from international experts. However, some strategies may have been overlooked due to the nonsystematic search approaches used, and most of the international experts were from high-income countries, limiting the applicability of these findings to those communities. Some other limitations were present in the study. First, despite the rigor in the methodology used to engage experts, not all responses were complete, meaning that data were sometimes missing from some questions. Second, as is the case in any Delphi survey, the data gathered were based on subjective opinion and the expertise of the participants. Third, experts acted as representatives of the stakeholders; thus, the inclusion of other stakeholders such as end users would also have been important to address other, more diverse perspectives.

This study presents the consensus of international experts on feasible work strategies and useful digital elements as a mode of delivery of these work strategies to support the reduction in SB in home office or hybrid contexts. Consensus was achieved on 18 work strategies and 16 BIT elements. Future interventions should implement and evaluate the effectiveness of these strategies but also their feasibility and acceptability in home office settings.