Implementation of Intelligent Physical Exercise Training at a Danish Hospital—A Qualitative Study of Employees’ Barriers and Facilitators for Participation
2.3. The Intervention
2.4. Sampling and Recruitment
2.5. Interview Process
2.6. Data Analysis
3.1.1. Psychological Capability
Nina: “(…) I was in favor of it in the beginning too. And I was very much like “come on friends, we’ll do it” and “we must all join” and organized one or the other department competition to see who could lose most weight and so on. Umm… But I don’t think that I will get them to participate in that again. Haha…”(Interview 7, l 122-125, TDF: Behavioral regulation)
Allison: “Yes, I felt a bit like I was used as a test animal. I was a part of an initiative to obtain research results.”(Interview 4, l 598-599, TDF: Knowledge)
3.1.2. Physical Capability
Allison: “It was simply too hard. Because… one would say that with the type of injury I have (…), it is really important for me to have a lot of stability exercises… (…) Even though there were, the exercises were too hard.”(Interview 4, l 29-31, TDF: Skills)
Amber: “I can also say that…, for example… I’ve got diagnosed (disease). So, I have simply been pleased by the fact that some people have gone to great lengths to find things for me, and I had special programs tailored for me.”(Interview 3, l 111-114, TDF: Skills)
3.2.1. Physical Opportunity
Nina: “But it just ended up with you suddenly being responsible for eight patients instead of four or something, right? Because one of your colleagues had to leave. (…) when you then were given the responsibility for someone else’s patients for an hour, during the visitation of these patients, it was difficult to have to follow up on eight patients (…) Those who are not part of the actual staffing and those who are not working in the care departments, they can find time for it and sort of structure it and plan it accordingly.”(Interview 7, l 23-33, TDF: Environmental context and resources)
Natalie: “I also think those who were training (…) were the quality nurse and the intro nurse. It was those people, who don’t have patients or not that many patients… or those with an intern, if you can put it that way.”(Interview 6, l 36-38, TDF: Environmental context and resources)
Megan: “But what we can see in this hospital is, that it is not busy, we do not have high occupancy, all the beds are not occupied every day. And we have not cut down in staffing, there has not been cutbacks in several years. And the vacant positions they have, has not increased a lot the last couple of years. On the contrary, almost no one has gotten all their staff hired (…) and because it has been busy, and COVID came along, and they are maybe tired. Then that exhaustion, is what we need to talk to them about. And that has something to do with staff management.”(Interview 8, l 164-170, TDF: Environmental context and resources)
3.2.2. Social Opportunity
Amber: “Yes, because I’ve actually heard something… someone saying “Well, I can’t go train because I have to look after yours. I can’t go”. It will very quickly create friction.”(Interview 3, l 181-183, TDF: Social influence)
Amber: “The fact that we are a large department, spread over many departments, that you actually also met each other in another setting. So, it benefited both yourself and the group. Someone you might not have seen in months, right? The thing about training together.”(Interview 3, l 49-52, TDF: Social influence)
3.3.1. Reflective Motivation
Natalie: “I also think that it is difficult that we now also have to do that. We are constantly pulled into this or that or the other project. And the managers keep saying: “It’s a good idea, and we would like to be contributing to that” and good God. But it’s just not always that the circumstances or the resources then follow (…). But the time is also not provided, even if it is supported by the section management and department management.”(Interview 6, l 255-260, TDF: Social/professional role and identity)
Nicole: “Then you have to go out yourself and make some kind of extra effort, you actually don’t want to. So, it just becomes very manipulative in one way or another and it appears as though we have to in order for us to attract new employees and… because we train during working hours. (…) The speed at which articles came out, to tell how crazy good we are here, because the management allows us to train. And then it’s all just chaos, and you can’t get anyone to take care of your patients and stuff like that.”(Interview 6, l 544-549, TDF: Optimism)
3.3.2. Automatic Motivation
Madison: “So maybe they should have been here more. Those who trained (the exercise experts). That is, in the morning and try to get people along or… walk around during the day and talk to people once in a while and drop by a little bit. They dropped by a few times, but it was very little. But stay here a little longer and try to pull people along a bit too, so that they… “give it a go” or “is there something that prevents you?”, “can we try that?”.”(Interview 5, l 134-138, TDF: Reinforcement)
Nicole: “But I also know, from the management. They also frequently tried to state that we should try to let people go down and try because it is important that you participated. But then there was such an obvious irritation… and then again, we also think it is annoying when you get more tasks.”(Interview 6, l 73-76, TDF: Emotions)
Marc: “But among those who are still in, there is some kind of dynamic and joy. There is… you do things, the task in a different way. So, in reality I think, that this is one of the really big benefits.”(Interview 3, l 507-510, TDF: Optimism)
Amber: “Well, our manager led by example. And you also trained together with them occasionally, and it was really nice to meet your manager in a different way.”(Interview 3, l 546-548, TDF: Social/professional role and identity, Emotions)
4.1. Structure and Involvement
4.2. Work Culture
4.3. Health Ambassadors as Change Agents
4.4. Implications for Occupational Health Practice
4.5. Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
- What is the culture in the department in relation to physical activity during working hours?
- What type of culture is required in the department to support continued physical activity during working hours?
- What are the experiences of employees and middle managers during the implementation process?
- What do middle managers experience as barriers and motivation during the implementation process?
- Do the individuals like how the physical activity is structured?
- Who are the various participants (the managers specifically/the change agents/senior management)?
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|Interviewer||Informant’s Position||Informant’s Participation in the Project|
|Mary||Single (planned as focus group)||Project manager|
2 master’s students
|Manager||Did not participate|
|Michael||Single (planned as focus group)||Project manager|
2 master’s students
|Manager||Participated during most of the project but had to stop due to injury|
|Focus group||Project manager|
1 master’s student
|Administrative staff (n = 3)|
Manager (n = 1)
|Participated through the entire project|
two single interviews
1 master’s student
|Nursing staff (n = 1)|
Administrative staff (n = 1)
|1 stopped mid-project due to injury.|
1 stopped participation due to time pressure.
|Madison||Single||2 master’s students||Manager||Participated through the entire project|
|Two single interviews||2 master’s students||Nursing staff||1 participated through the entire project. 1 stopped mid-project.|
|Nina||Single by phone||2 master’s students||Nursing staff||Participated twice|
1 master’s student
|Manager||Did not participate|
|TDF Domain||COM-B Factor||Subtheme|
Memory, attention, and decision processes
|Capability||Sharing of knowledge and information|
|Environmental context and resources|
|Opportunity||Administration and structure|
Beliefs about consequences
Beliefs about capabilities
Social/professional role and identity
Purpose and objective
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Pultz, C.J.; Lohse, T.M.; Justesen, J.B.; Særvoll, C.A.; Møller, S.F.; Lindegaard, B.; Fischer, T.K.; Dalager, T.; Molsted, S. Implementation of Intelligent Physical Exercise Training at a Danish Hospital—A Qualitative Study of Employees’ Barriers and Facilitators for Participation. Int. J. Environ. Res. Public Health 2023, 20, 7085. https://doi.org/10.3390/ijerph20227085
Pultz CJ, Lohse TM, Justesen JB, Særvoll CA, Møller SF, Lindegaard B, Fischer TK, Dalager T, Molsted S. Implementation of Intelligent Physical Exercise Training at a Danish Hospital—A Qualitative Study of Employees’ Barriers and Facilitators for Participation. International Journal of Environmental Research and Public Health. 2023; 20(22):7085. https://doi.org/10.3390/ijerph20227085Chicago/Turabian Style
Pultz, Christina Juul, Thea Mundt Lohse, Just Bendix Justesen, Charlotte Ahlgren Særvoll, Sofie Fønsskov Møller, Birgitte Lindegaard, Thea K. Fischer, Tina Dalager, and Stig Molsted. 2023. "Implementation of Intelligent Physical Exercise Training at a Danish Hospital—A Qualitative Study of Employees’ Barriers and Facilitators for Participation" International Journal of Environmental Research and Public Health 20, no. 22: 7085. https://doi.org/10.3390/ijerph20227085