RESEARCH ARTICLE Open Access
Na ional policies o he p omo ion o
physical ac i i y and heal hy nu i ion in
he wo kplace con ex : a beha iou change
wheel guided con en analysis o policy
pape s in Finland
Tuija Seppälä
1*
, Nelli Hankonen
1
, E eliina Ko kiakangas
2
, Johanna Ruusu uo i
1
and Jaana Lai inen
2
Abs ac
Backg ound: Heal h policy pape s dissemina e ecommenda ions and guidelines o he de elopmen and
implemen a ion o heal h p omo ion in e en ions. Such documen s ha e a ely been in es iga ed wi h ega d o
hei assumed mechanisms o ac ion o changing beha iou . The Theo e ical Domains F amewo k (TDF) and
Beha iou Change Techniques (BCT) Taxonomy ha e been used o code beha iou change in e en ion
desc ip ions, bu o ou knowledge such “ e o i ing”o policy pape s has no p e iously been epo ed. This s udy
aims i s o iden i y a ge s, media o s, and change s a egies o physical ac i i y (PA) and nu i ion beha iou
change in Finnish policy pape s on wo kplace heal h p omo ion, and second o assess he sui abili y o he
Beha iou Change Wheel (BCW) app oach o his pu pose.
Me hod: We sea ched all na ional-le el heal h policy pape s e ec ual in Finland in Augus 2016 ocusing on he
p omo ion o PA and/o heal hy nu i ion in he wo kplace con ex (n= 6). Policy ecommenda ions a ge ing
employees’nu i ion and PA including seden a y beha iou (SB) we e coded using BCW, TDF, and BCT Taxonomy.
Resul s: A o al o 125 ecommenda ions we e coded in he six policy pape s, and in wo addi ional documen s
e e enced by hem. Psychological capabili y, physical oppo uni y, and social oppo uni y we e equen ly iden i ied
(22%, 31%, and 24%, espec i ely), whe eas physical capabili y was almos comple ely absen (1%). Th ee TDF
domains (knowledge, skills, and social in luence) we e obse ed in all pape s. Mul iple in e en ion unc ions and
BCTs we e iden i ied in all pape s bu se e al ecommenda ions we e oo ague o be coded eliably. In luencing
indi iduals (46%) and changing he physical en i onmen (44%) we e ecommended mo e equen ly han
in luencing he social en i onmen (10%).
Conclusions: The BCW app oach appea ed o be use ul o analysing he con en o heal h policy pape s. Paying
mo e a en ion o unde lying assump ions ega ding beha iou al change p ocesses may help o iden i y neglec ed
aspec s in cu en policy, and o de elop in e en ions based on ecommenda ions, hus helping o inc ease he
impac o policy pape s.
Keywo ds: Policy pape s, Heal h p omo ion, Wo kplace, Nu i ion, Physical ac i i y, Seden a y beha iou ,
Mechanisms o ac ion, Beha iou change echniques
* Co espondence: [email p o ec ed]
1
Facul y o Social Sciences, Uni e si y o Tampe e, Linna, -33014 Tampe e, FI,
Finland
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Seppälä e al. BMC Public Heal h (2018) 18:87
DOI 10.1186/s12889-017-4574-3
Backg ound
The e is some e idence o sugges ha heal h beha iou
in e en ions ha a e designed on he bases o beha -
iou al heo ies a e mo e e ec i e han hose ha a e no
[1, 2]. Such in e en ions allow mo e sys ema ic and
e idence-based ways o iden i ying ele an beha iou al
de e minan s and app op ia e in e en ion s a egies [3],
as well as mo e e ec i e e alua ion because he p o-
posed mechanisms by which hey ope a e a e made
explici . The same may be ue o heal h policy. The e-
o e, go e nmen s ha e displayed an inc easing in e es
in u ilizing beha iou al scien i ic e idence when design-
ing public policy [4]. Heal h policy is de ined by he
Wo ld Heal h O ganiza ion as “decisions, plans, and ac-
ions ha a e unde aken o achie e speci ic heal h ca e
goals wi hin a socie y”[5]. Policies a e a means o gene a -
ing and/o suppo ing he implemen a ion o heal h beha -
iou change in e en ions [6], which a e a se o ac i i ies
designed o b ing abou change [3]; hus policies a e
c ucial o he in e en ions’implemen a ion and ou -
comes [3, 7–9].Policypape sa eachannel odis-
semina e ecommenda ions and guidelines o heal h
beha iou change, such as na ional nu i ion ecom-
menda ions. Mechanisms o change desc ibed o im-
plied in policy pape s ha e no been s udied o ou
knowledge. Such an analysis would be essen ial o
iden i y gaps wi h ega d o beha iou al science e i-
dence in policy ecommenda ions.
The Beha iou Change Wheel (BCW) [10] and Theo -
e ical Domains F amewo k (TDF) [11, 12] a e po en ial
ools o such analyses. These amewo ks ha e been u i-
lized o e ospec i ely analyse he elemen s o planned
and implemen ed in e en ions [13, 14], bu o ou
knowledge such “ e o i ing” o policy pape s has no
been comp ehensi ely epo ed. I sui able o policy
pape analysis, hese amewo ks may aid in iden i ying
impo an con en o policy pape s wi h ega d o beha -
iou change, and may o e ools o u he de elop pol-
icymaking, and implemen policy in o p ac ice.
BCW is a heo y- and e idence-based model o cha -
ac e izing and designing beha iou change in e en ions
[16] (see Michie e al. [10, 15] o de ailed desc ip ion o
he model). BCW aims o be a comp ehensi e and
cohe en amewo k ha links in e en ions o an o e -
a ching model o beha iou , COM-B (capabili y (C),
oppo uni y (O), mo i a ion (M), and beha iou (B)).
COM-B pos ula es ha h ee ac o s a e necessa y and
su icien p e equisi es o he pe o mance o a speci ied
oli ional beha iou : psychological and physical capabil-
i y (i.e. he indi idual’s psychological and physical cap-
aci y o engage in he ac i i y conce ned, including he
necessa y knowledge and skills), social and physical
oppo uni y (i.e. all he ac o s ha lie ou side he indi-
idual ha make he beha iou possible o p omp i ),
and e lec i e and au oma ic mo i a ion (i.e. all he b ain
p ocesses ha ene gize and di ec beha iou , including
goals, emo ional esponses, analy ical decision-making,
and habi ual p ocesses). Fu he mo e, oppo uni y and
capabili y can in luence mo i a ion, and beha iou
migh in luence all he o he componen s. [10, 15] To be
e ec i e, beha iou change in e en ions should a ge
hose componen s ha a e mos likely o in luence he
a ge beha iou o he a ge popula ion in a speci ied
con ex [3]. Fo example, a wo kplace in e en ion o
educe seden a y beha iou should a ge capabili y and
oppo uni y i he a ge employees a e mo i a ed o add
physical ac i i y du ing he wo kday bu he wo k en i -
onmen does no suppo hei beha iou change and
hey do no know how o use he new s anding desks.
BCW ecognizes nine non-o e lapping ca ego ies o ac i -
i y aimed a changing beha iou , called in e en ion unc-
ions (IF) (educa ion, pe suasion, incen i iza ion, coe cion,
aining, es ic ion, en i onmen al es uc u ing, model-
ling, and enablemen ), and se en non-o e lapping policy
ca ego ies (PC) (communica ion/ma ke ing, guidelines,
iscal policy, egula ion, legisla ion, en i onmen al/social
planning, and se ice p o ision) ha enable o suppo
hese IFs [10, 15]. IFs may be conduc ed by using a ious
beha iou change echniques (BCT) [15, 16]. Fo example,
educa ional in e en ion may include ins uc ions on how
o pe o m he beha iou , demons a ion o he beha iou ,
and beha iou ehea sal.
The BCW app oach can be used o bo h de elop and
“ e o i ”in e en ions [10]. COM-B helps designe s and
e alua o s o in e en ions o assess whe e he in e en-
ion is o should be a ge ed. The di e en ia ion o IFs
helps o selec o e alua e possible means o beha iou
change. TDF ex ends he COM-B analysis and helps o
e alua e he heo e ical bases o planned and conduc ed
in e en ions [11]. TDF aims o cap u e he op imal
s uc u e, con en , and labels o ela ed heo e ical con-
s uc s, and he mos ecen e sion o TDF includes 14
domains [10]. Theo e ical domains can be linked o a
speci ic componen o COM-B [10]. Fo example, heo -
e ical cons uc s ela ed o social in luences (one o he
14 heo e ical domains), such as social suppo and
g oup iden i y, a e ele an o in luencing he social
oppo uni y componen o beha iou .
Wo kplace heal h p omo ion (WHP) is a opical con-
ex in which o in es iga e possible gaps wi h ega d o
beha iou al science e idence and policy ecommenda-
ions and o analyse he sui abili y o BCW and TDF o
policy pape analysis. In Finland, esea che s and po-
licymake s alike pe cei e wo kplaces as p ominen si es
o heal h p omo ion [17–19]. Nega i e heal h de elop-
men s, such as inc easing obesi y and dec easing phys-
ical condi ion, in andem wi h p essu e o ex end wo k
ca ee s, a e pe cei ed o equi e in es men in changes
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 2 o 9
in employees’heal h beha iou [20]. Physical ac i i y
(PA) is pe cei ed as especially impo an in he s a egy
pape s. Reducing excessi e seden a y beha iou (SB) has
ecen ly also been aised as one o he key issues in
WHP [21], and Finland is one o he i s coun ies o
launch a na ional s a egy o he educ ion o SB. Add-
i ionally, ca e ing se ices a e ocus o na ional policy
and WHP, as hey ha e an essen ial ole in heal hy nu i-
ion du ing wo king hou s [22].
Resea ch e idence sugges s ha heal hy beha iou s a e
ela ed o be e wo k abili y and sa e y a wo k [23–25].
Se e al s a egy pape s he e o e highligh he impo -
ance o close collabo a ion be ween occupa ional heal h-
ca e (OHC) and wo kplaces o he p omo ion o wo k
abili y and he educ ion o disabili y a wo k h ough
heal h beha iou changes [19, 26]. In Finland, employe s
a e esponsible o employees’heal h and sa e y a wo k,
and hey a e obliged o a ange OHC o employees.
WHP is conduc ed in collabo a ion among employe s, em-
ployees, heal h and sa e y o ganiza ions, and OHC [27].
Thus i can be sugges ed ha policy pape s should o e
guidelines and ecommenda ions a he o ganiza ional le el
o p omo e heal h. I seems, howe e , ha he implemen a-
ion o policy pape s may no ha e succeeded op imally, as
e iews o WHP in e en ions ha e ound a bes mode a e
posi i e e ec s on nu i ion, PA, and SB, and he conclu-
sions a e limi ed by he low quali y and numbe o epo ed
in e en ions [21, 28–36].
In his s udy we in es iga e he kinds o mechanism o
ac ion desc ibed o implied in Finnish heal h policy
pape s ha aim o p omo e heal hy nu i ion and PA,
and educ ion o SB in he wo ksi e. Mo e p ecisely, we
explo e which mechanisms o ac ion o in e en ion
s a egies, as cha ac e ized by COM-B, TDF, IFs, and
BCT Taxonomy, a e emphasized o lacking in policies
and whe he hese di e be ween heal hy nu i ion and
PA. We also e alua e, he ex en o which he policy
ecommenda ions a ge he indi idual le el, he com-
muni y le el, o he en i onmen . As a seconda y pu -
pose, we assess whe he he BCW app oach, including
COM-B, TDF, IFs, and BCT Taxonomy, a e sui able o
analysing policy pape s.
Me hods
Ma e ials and da a selec ion
We sys ema ically sea ched he websi es o na ional min-
is ies and esea ch ins i u es wo king unde minis ies
o all na ional-le el heal h policy pape s ega ding he
p omo ion o heal hy nu i ion and PA in Sep embe
2016. The inclusion c i e ia we e ha he policy pape s
should: 1) be a he na ional le el (i.e. no local o in e -
na ional); 2) be ela ed o heal h (e.g. no en i onmen al
policy); 3) be he mos ecen e sion o he policy pape ,
o ela ed o an ongoing policy p og amme a he ime
o he sea ch; 4) include nu i ion and/o physical ac i -
i y; 5) include, bu no necessa ily be es ic ed o, a
wo kplace con ex . Using hese c i e ia, six policy pape s
we e ound. We also analysed he con en o all he
o he pape s (Re [1] and Re [2] in Table 1) ha we e
e e ed o in he policy ecommenda ions o he se-
lec ed pape s, and ha ocused on heal hy nu i ion o
PA in he wo ksi e. Finally, we consul ed clinical p ac ice
guidelines and documen s (Tec 1, Tec 2 and Tec 3 in
Table 1) ha desc ibed he con en o he ecommended
ools (e.g. mo i a ing in e iew; physical ac i i y p e-
sc ip ion). The pape s and documen s a e summa ized
in Table 1. Each pape and da a uni selec ion (i.e.
ecommenda ion) is desc ibed in Addi ional ile 1.
Da a uni selec ion was independen ly conduc ed by
wo code s (TS and EK). A e his independen selec-
ion, he code s compa ed da a se s and made su e
ha all ecommended means o change he a ge
heal h beha iou s we e included and ha e e y ec-
ommenda ion was only included once pe pape in
he da a se .
Coding
We buil a coding ma ix based on COM-B, TDF, and
BCTs. The coding ins uc ions a e p esen ed in Add-
i ional ile 2. The i s code iden i ied he a ge heal h
beha iou : nu i ion, o PA including SB. The second
code iden i ied he a ge : indi idual (i.e. indi idual be-
ha iou ), en i onmen (i.e. physical en i onmen ), o
communi y (i.e. social en i onmen ) (examples a e
p esen ed in Table 4). This s udy only includes policy
ecommenda ions a ge ed di ec ly o indi ec ly a
employees h ough he physical o social en i onmen
(examples a e p esen ed in Tables 2 and 3); ecommen-
da ions solely a ge ing p o ide s o he sys em, wi hou
any ob ious link o indi idual beha iou change, a e
excluded (e.g., “Mul i-p o essional collabo a ion is en-
hanced a egional le el”). In his way we could ocus on
he ele an a ge popula ion in espec o ou a ge
beha iou (i.e. nu i ion, PA, and SB o employees).
Nex , he codes o he BCW app oach we e iden i ied:
COM-B componen s (code 3), TDF (code 4), IFs (code
5), and BCTs (code 6). The ecommenda ions ha we e
oo gene al o ague o be eliably coded we e coded
“ oo ague o be coded”.
Policy pape s we e coded one by one, and consis ency
o coding was secu ed h ough compa ison. The i e a i e
coding p ocess aimed o consensus among he code s
h ough he compa ison o independen coding (TS,
EK, NH), discussion, and he consul a ion o a ailable
ma e ials such as de ini ions, examples, p e ious s ud-
ies, and coding p inciples. Unclea cases we e u he
discussed wi h esea che s amilia wi h he ame-
wo ks in use and coding.
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 3 o 9
Resul s
The esul s and examples om he da a in espec o
COM-B and TDF a e p esen ed in Table 2. Mo e han
hal (55%) o he ecommenda ions we e ca ego ized as
oppo uni y (31% physical and 24% social oppo uni y).
Psychological capabili y was also common (22%), bu
men ions o physical capabili y we e almos comple ely
absen (1%). One i h o he obse a ions we e coded as
e lec i e (16%) and au oma ic (6%) mo i a ion. In line
wi h his, en i onmen al con ex and esou ces (25%),
social in luences (20%), and knowledge (14%) o med he
majo i y o he heo e ical domains iden i ied. None o
he domains was absen , bu social ole and iden i y
(n= 2), goals (n= 4), op imism (n= 1), and emo ion
(n= 2) we e ela i ely a e.
Small di e ences in COM-B aspec s and TDF domains
we e obse ed in ela ion o he ype o beha iou : he
mos equen code o nu i ion was psychological cap-
abili y (28%), which was less common o PA (18%). The
mos common COM-B mechanism o PA was physical
oppo uni y (27%), which was almos as equen ly coded
o nu i ion (24%). The di e ence was mainly cons i-
u ed by wo domains: knowledge (17%) and memo y,
a en ion and decision p ocesses (7%) we e coded sligh ly
mo e equen ly among ecommenda ions o nu i ion
han o PA (13% and 0% espec i ely). Resul s in e ms
o nu i ion and PA a e p esen ed in Addi ional ile 3:
Table S1.
Resul s conce ning IFs and BCTs a e p esen ed in
Table 3. Se en een pe cen o he ecommenda ions
we e gene al and included only wha bu no how (e.g.
“employees a e ac i a ed o sel -moni o ...”); in hese
cases no IF was coded. All pape s ecommended a ange
o in e en ions. The mos equen ly coded IFs we e
en i onmen al es uc u ing (29%), educa ion (23%), and
enablemen (21%). All nine IFs we e iden i ied bu ,
modelling (n= 1), aining (n= 2), coe cion (n= 2), and
es ic ion (n= 5) we e ela i ely a e. Educa ional in e -
en ions we e iden i ied somewha mo e equen ly o
nu i ion (31%) han o PA (23%). In o al, 31 di e en
BCTs we e iden i ied. Addi ional ma e ial o p o es-
sionals (see Table 1) was consul ed du ing he coding o
Table 1 Selec ed p ima y and seconda y policy pape s and sou ces o echnical e ms
Policy pape Publishe Yea Pages Ta ge
1. P inciples o good occupa ional
heal hca e p ac ice guide
Minis y o Social A ai s and
Heal h/Finnish Ins i u e o
Occupa ional Heal h
2014 317 OHC p o essionals
2. Na ional nu i ion ecommenda ions Na ional Nu i ion Council 2014 60 Heal hca e, ca e ing and ood indus y
p o essionals, au ho i ies, and public
heal h o ganiza ions
3. Guidelines o he wo king g oup o
moni o and de elop mass
ca e ing se ices
Minis y o Social A ai s and Heal h 2010 82 Adminis a ion, p i a e sec o , social
pa ne s, NGOs
4. Na ional s a egy o physical ac i i y
p omo ing heal h and well-being 2020
Minis y o Social A ai s and Heal h 2013 62 Na ional and local ac o s
5. Ac ion plan o he Na ional Obesi y
P og amme 2012–2015
Na ional Ins i u e o Heal h
and Well-being
2013 59 S a e and municipal adminis a ion, heal hca e,
ea ly childhood educa ion, educa ion, spo s
depa men , echnical and communi y planning,
educa ional o ganiza ions, NGOs, de ence o ces,
employe s and ade unions, ood indus y, ade,
es au an s and ca e ing, media, esea ch ins i u ions
6. Na ional s a egy o he educ ion
o seden a y beha iou
Minis y o Social A ai s and Heal h 2015 44 Child en, adolescen s, pa en s, ins uc o s, eache s,
day ca e, schools, municipali ies, s uden s,
employees, s udy communi ies, wo k communi ies,
aged, ca e se ices
Re [1]. Na ional ac ion plan o walking
and cycling 2020
Finnish T anspo Agency 2012 76 S a e, municipal and p i a e sec o ac o s
Re [2]. Recommenda ions o physical
ac i i y p omo ion in municipali ies
Minis y o Social A ai s and Heal h 2010 24 Municipali y managemen , po s depa men ,
social and heal h depa men , you h depa men ,
cul u e and lib a y depa men , echnical depa men s
6. Tec 1. Clinical p ac ice guidelines
o physical ac i i y
Finnish Medical Socie y Duodecim 2016 27 Heal hca e p o essionals
7. Tec 2. Clinical p ac ice guideline
o obesi y ca e
Finnish Medical Socie y Duodecim 2013 27 Heal hca e p o essionals
Tec 3. Physical ac i i y p esc ip ion UKK Ins i u e 2013 23 Heal hca e p o essionals
Policy pape s 1–6 a e he p ima y pape s in es iga ed. Pape Re [1] was e e ed o in pape 4, and pape Re [2] was e e ed o in pape s 4 and 5. The con en
o echnical e ms p esen ed in policy pape s was checked in he documen s Tec 1, Tec 2, and Tec 3
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 4 o 9
echnical e ms, e en hough he ecommenda ions
ne e ci ed his ma e ial. Th ee BCTs we e iden i ied in
all pape s: ins uc ions on how o pe o m he beha iou ,
social suppo (unspeci ied), and in o ma ion abou
heal h consequences (see Addi ional ile 4: Table S2).
The majo i y o iden i ied BCTs belonged o he BCT
clus e s an eceden s (n= 55), social suppo (n= 22),
and shaping knowledge (n= 21). No BCTs we e iden i-
ied om he BCT clus e s scheduled consequences o
co e lea ning.
In e ms o socio-ecological le els, he p ima y a ge s
o ecommenda ions a e p esen ed in Table 4. The
majo i y o ecommended ac ions o employee heal h
beha iou change a ge ed indi idual beha iou (46%)
and sugges ed changes o he en i onmen (44%); only a
mino i y sugges ed changes o he communi y (e.g. cul-
u e) (10%). The ela i e equency o he en i onmen
was somewha highe in ela ion o nu i ion (47%) han
o PA (30%). Communi y- a ge ed ecommenda ions
we e a e in nu i ion- ela ed (n= 2) bu sligh ly mo e
equen in PA- ela ed (14%) ecommenda ions. Resul s
om each policy pape a e p esen ed in Addi ional
ile 5: Table S3.
Discussion
The in es iga ed policy pape s emphasized oppo uni y
and psychological capabili y in he p omo ion o PA and
heal hy nu i ion, whe eas ecommenda ions ocusing
on physical capabili y we e almos absen . PA skills a e
an essen ial pa o basic educa ion in Finland, and on
a e age ci izens can be es ima ed o ha e su icien skills
o engage in heal h-p omo ing PA. On he o he hand,
he skills needed o p epa e heal hy meals ha e a mino
ole in basic educa ion. The indings also sugges ha
ecommenda ions a e based on o aligned wi h a limi ed
se o heo ies o beha iou change. Al hough emo ions
[37, 38], op imism [39, 40], and iden i y [41] ha e all
been ound o be associa ed wi h heal h beha iou s, hey
we e only iden i ied in one o wo pape s.
All pape s ecommended mul iple IFs, bu only educa-
ion,enablemen , and pe suasion we e iden i ied in all
eigh pape s and en i onmen al es uc u ing in all bu one.
WHP s udies ha e shown suppo o mul icomponen in-
e en ions, e en hough mos ha e been educa ional and
en i onmen al in e en ions [21, 28–30, 33–35, 42]. Fu -
he mo e, ecommenda ions a ge ing he communi y we e
uncommon, and nea ly absen o nu i ion. This is a clea
Table 2 Iden i ied mechanisms o ac ion ecommended in heal h policy pape s
Mechanisms o ac ion
COM-B N (%) TDF N (%) Example
Psychological capabili y 34 (22) Knowledge 27 (14) Employees a e gi en w i en ins uc ions, handou s, and ma e ial o heal h p omo ion.
Skills 12 (6) A cus ome needs o be guided in pu ing oge he a ecommended meal.
MAD 7 (4) Heal hy choices a e posi ioned so ha hey a e easy o selec om he se ice line.
BR 6 (3) Recognize you habi s by measu ing you ac i i y and s eps.
Physical capabili y 2 (1) Skills 2 (1) The OHC p o essional makes su e ha an employee has he knowledge and skills
needed o heal h and sa e y a wo k and o he p omo ion o wo k abili y.
Physical oppo uni y 47 (31) En . 48 (25) Local ac o s enhance oppo uni ies o a ying wo king pos u es by ac i a ing
u ni u e and equipmen .
Social oppo uni y 37 (24) Social In luences 38 (20) In luencing pe sonal heal h- ela ed a i udes, li es yles, and isk beha iou by discussion.
Re lec i e mo i a ion 24 (16) S/P id 1 (1) Semina o ganize may encou age he audience in o a s anding o a ion - you can
be he T endse e oo!
B Cap 6 (3) Moni o ing and e alua ion o employee li es yle choices.
Op imism 1 (1) Posi i e aspec s and e en small ad ances a e always iden i ied i s .
B Con 17 (9) Physically ac i e li es yle and heal hy nu i ion a e highligh ed as a pa o heal h
and well-being.
In en ions 8 (4) Needs o change a e iden i ied as pa o li es yle counselling.
Goals 4 (2) De ine he goals o physical ac i i y.
Au oma ic mo i a ion 10 (6) S/P id 1 (1) Public sec o employees also need o lead by example in he p omo ion o walking
and cycling.
Op imism 0 (0) -
Rein o cemen 9 (5) Food mus also be as y and se ed in an appealing manne .
Emo ion 2 (1) The physically inac i e a e enabled o expe ience physical ac i i y as a sou ce
o pleasu e.
To al 154 (100%) To al 189 (100%)
Numbe s a e equencies. Numbe s in pa en heses a e pe cen ages. TDF domain abb e ia ions: MAD memo y, a en ion, and decision p ocesses; BR beha iou al
egula ion; En . en i onmen al con ex and esou ces; S/P id social/p o essional ole and iden i y; B Cap belie s abou capabili y; B Con belie s abou consequences
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 5 o 9

Table 3 Iden i ied IFs and BCTs ecommended in policy pape s
In e en ion unc ion N (%)
Educa ion 27 (23) Pe suasion 15 (13) Incen i iza ion 6 (5) Coe cion 2 (2) T aining 2 (2) Res ic ion 5 (4) En . es uc u ing 34 (29) Modelling 1 (1) Enablemen 24 (20) To al 116 (100%)
BCTs Examples N (%)
Goal-se ing (beha iou ) Goals and ac ions a e eco ded in pe sonal heal h plans in o de o impo ance. 3 (2)
Goal-se ing (ou come) Goals and ac ions a e eco ded in pe sonal heal h plans in o de o impo ance. 1 (1)
Ac ion-planning Employees a e gi en a copy o he pe sonal heal h plan. 2 (1)
Disc epancy be ween cu en beha iou and goal Poin ing ou he disc epancy be ween cu en beha iou and impo an goals o he pa ien is aimed a . 3 (2)
Beha iou al con ac Goals and ac ions a e eco ded in pe sonal heal h plans in o de o impo ance. 1 (1)
Moni o ing o beha iou
a
Achie emen o goals needs o be moni o ed. 3 (2)
Feedback on beha iou Moni o ing and e alua ion o employee li es yle choices. 3 (2)
Sel -moni o ing
a
Cus ome s a e suppo ed in sel -moni o ing. 1 (1)
Sel -moni o ing o beha iou Fo example, a ood dia y can be used o planning, ollowing, and moni o ing a die . 4 (2)
Social suppo (unspeci ied) Encou agemen o make heal h p omo ing choices. 18 (11)
Social suppo (emo ional) The pa ien is no c i icized bu unde s anding o hei eac ions is shown and emo ions a e accep ed. 4 (2)
Ins uc ions on how o pe o m he beha iou In o ma ion can be gi en by p esen ing model meals ha a e compiled o day supply. 20 (12)
In o ma ion abou an eceden s Fac o s and esou ces suppo ing he change a e iden i ied. 1 (1)
In o ma ion abou heal h consequences Physically ac i e li es yle and heal hy nu i ion a e highligh ed as a pa o heal h and well-being. 11 (7)
Demons a ion o he beha iou Supe iso s, lead by example. 2 (1)
P omp s/cues The hea symbol helps o selec sui able oods o he ecommended die . 3 (2)
Beha iou al p ac ice/ ehea sal Fo example, selec ing heal hy oods can be ehea sed in p ac ice. 7 (4)
Beha iou subs i u ion Ins ead o si ing, a ious ac i i ies can be done while s anding o ligh ly mo ing. Lunch, co ee b eaks and sc een wo k also wo k well while s anding. 2 (1)
Habi o ma ion Con inue o conduc he change pe sis en ly, because new habi s u n in o p ac ice wi hin couple o weeks o mon hs. 5 (3)
Habi e e sal Change you daily ou ines one by one so ha you educe seden a y beha iou and ake b eaks du ing long seden a y pe iods. 1 (1)
Gene aliza ion o a ge beha iou Change you daily ou ines one by one so ha you educe seden a y beha iou and ake b eaks du ing long seden a y pe iods. 1 (1)
Ma e ial incen i e A ax- ee compensa ion o commu ing by bicycling paid by he employe . 4 (2)
Social ewa d Moni o ing and e alua ion o employee’s li es yle choices. 1 (1)
Reduce nega i e emo ions Change you ou ines one by one. Keep changing pe sis en ly. Be mode a e in e e y hing. Hea y wo k migh wa an a es by si ing o e en lying down. 3 (2)
Res uc u ing he physical en i onmen Heal hiness o ca e ing o mee ings is impo an o ake in o accoun . 38 (24)
Res uc u ing he social en i onmen W i e down ules o educ ion and b eaking o seden a y beha iou oge he wi h di e en s akeholde s in he wo k communi y. 11 (7)
A oidance o exposu e o cues o he beha iou A oidance o exposu e o unnecessa y emp a ions (e.g.ene gyin ensi e snack oods a e no pu chased o he home). 1 (1)
Adding objec s o he en i onmen Local ac o s enhance oppo uni ies o a ying wo k pos u es by ac i a ing u ni u e and equipmen . 4 (2)
Iden i ica ion o sel as ole model Semina o ganize may encou age he audience in o s anding o a ion - you can be he T endse e oo! 2 (1)
Incompa ible belie s Poin ing ou he disc epancy be ween cu en beha iou and impo an alues o he pa ien is aimed a . 1 (1)
Ve bal pe suasion abou capabili y Iden i ica ion and ein o cemen o pe sonal s eng hs a e aimed a . Posi i e aspec s and e en small ad ances a e always iden i ied i s . 2 (1)
To al numbe o obse ed BCTs 163 (100%)
Numbe s a e equencies. Numbe s in pa en heses a e pe cen ages.
a
Mo e gene al o mula ion han in BCT Taxonomy ( 1)
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 6 o 9
limi a ion, as e idence sugges s ha social en i onmen is
impo an in WHP [43].
In o al 31 BCTs we e iden i ied. The mos equen ly
iden i ied BCTs we e in o ma ion abou heal h conse-
quences,ins uc ions on how o pe o m he beha iou ,
es uc u ing he physical en i onmen , and social sup-
po . The indings imply ha policy pape s ely hea ily
on he assump ion ha p o iding in o ma ion abou
heal h consequences and en i onmen al changes a e he
mos e ec i e ools. Howe e , he e is e idence o show
ha heal h beha iou s a e mo i a ed by a b oade ange
o pe cei ed bene i s han heal h alone [44]. In ligh o
beha iou al science e idence, some clea misunde s and-
ings we e also iden i ied. Fo example, an unde lying as-
sump ion in some ecommenda ions was ha p o iding
in o ma ion o employees was a su icien s a egy o
p omo e beha iou change. Fu he , social suppo was
almos en i ely limi ed o encou agemen and counsel-
ling om heal hca e p o essionals, and men ions o
p ac ical suppo we e also absen despi e e idence sug-
ges ing ha o he sou ces o social suppo a e also
bene icial o WHP [21, 36]. Finally, o PA and nu i ion
beha iou s, con ol- heo y ela ed BCTs (e.g. goal se -
ing, sel -moni o ing, e iewing goals) ha e been iden i-
ied as e ec i e [45], bu hese ecei ed only mino
emphasis in he policy pape s in es iga ed.
As his was among he i s s udies using BCW and
he e o i app oach o policy pape s, he e we e some
newly encoun e ed challenges in he analysis. Fi s , in
mos cases, COM-B componen s and TDF domains
we e insepa ably linked o he ecommended IF. Fo ex-
ample, ecommended changes in physical en i onmen
we e mapped on o physical oppo uni y and en i on-
men al con ex and esou ces. Howe e , in some cases
IFs we e oo ague o be coded bu he TDF componen
was codable (e.g. “The physically inac i e a e enabled o
expe ience physical ac i i y as a sou ce o pleasu e”).
Second, in some cases; he TDF domains en i onmen al
con ex and esou ces and social in luences appea ed o
o e lap. Fo example, we pe cei ed ha changes in
o ganiza ional p ac ices included cons uc s om bo h
domains, and we coded acco dingly. Mo eo e , we ca e-
go ized modelling o non-human models (i.e. a pla e
model) o he less op imal domain knowledge because
he cons uc modelling is de ined as an in e pe sonal
p ocess in TDF. Thi d, he BCW app oach is g ea ly
applicable o he assessmen o indi idual-le el in e en-
ions, bu i s cu en e sion has limi a ions in desc ib-
ing mid-le el in e en ions conduc ed in o ganiza ions.
Fo example, hese in e en ions migh include changes
in o ganiza ional s a egy, cul u e, o leade ship, which
a e all subs an ial elemen s o WHP [46]. In his s udy,
he IF code o his le el, en i onmen al es uc u ing,
migh no su icien ly di e en ia e be ween he speci ic
cha ac e is ics o such ac i i ies. Fou h, he coding o
BCTs was e y challenging, mainly due o he unspeci ic
con en o he policy pape s. Fu he mo e, we coded
di e se ac ions as he BCT es uc u ing he physical
en i onmen , such as changes in se ices, p icing (when
coding he “ma e ial incen i e”o “ ewa d”was no
app op ia e), placemen , and a ailabili y. This BCT could
be u he di ided o be e e lec he ac ual con en o
en i onmen al es uc u ing.
This s udy has some limi a ions. Fi s , we only in es i-
ga ed ecommenda ions a ge ing employee beha iou
change, and excluded ecommenda ions ocusing on
p o ide s and sys ems ha had no ob ious link o em-
ployee beha iou change. Second, he pape s included
e e ences o u he complex in e en ions, such as
counselling by a nu i ion he apis , which we e likely o
include a la ge numbe o BCTs; bu since hese we e
no speci ied in he policy documen s, hey we e no
coded. Thus ou esul s may ep esen conse a i e
es ima es o he p esence o IFs o BCTs. Finally, he
“dose”o olume o he sugges ed policies is no di ec ly
de i able om ou calcula ions. Howe e , he policy pa-
pe s hemsel es could be qui e ague on he sugges ed
ela i e olumes.
This s udy has some p ac ical implica ions o de el-
oping policy pape s. Fi s , he design o e ec i e na ional
policy in ol ing any beha iou change may bene i om
a comp ehensi e beha iou al analysis [10] o bo h he
a ge popula ion and he policy p o ide s and imple-
men e s, and om a consul a ion o scien i ic e idence
o iden i y e ec i e in e en ions. This in o ma ion, in-
cluding he assumed mechanisms o ac ion a play, could
be explici ly con eyed in he policy pape , which would
aid bo h e alua ion and implemen a ion. This migh
Table 4 Iden i ied a ge s in policy ecommenda ions
Ta ge Examples To al(%) Nu .(%) PA(%)
Indi idual Use s ai s whene e possible.
Moni o ing and e alua ion o employee’s li es yle choices.
57 (46) 39 (50) 46 (55)
Communi y Re hink mee ing p ac ices o educe seden a y beha iou a you wo kplace. 13 (10) 2 (3) 12 (14)
En i onmen Heal hiness o ca e ing o mee ings is impo an o ake in o accoun . 55 (44) 37 (47) 25 (30)
To al 125 (100%) 78 (100%) 83 (100%)
Numbe s a e equencies. Numbe s in pa en heses a e pe cen ages. Nu . nu i ion, PA physical ac i i y. The o al is smalle han he sum o Nu . and PA because
pa s o he ecommenda ions (i.e. ocusing on ou comes o heal h beha iou in gene al) we e double coded
Seppälä e al. BMC Public Heal h (2018) 18:87 Page 7 o 9
include balancing and coo dina ing o ac i i ies ha
should ideally be implemen ed in conso wi h each
o he o he desi ed impac . Second, ecommenda ions
should be clea in e ms o who is supposed o deli e
wha o whom and how. Almos a i h (17%) o he ec-
ommenda ions ailed o explica e he means o achie -
ing he de ined goals. Such lack o speci ici y p o ides
li le p ac ical guidance o WHP, and migh impai he
quali y o in e en ions based on he ecommenda ions
[3]. On he o he hand, i may be a gued ha he unc-
ion o policy pape s is no o s ipula e pa icula ac i e
ing edien s o in e en ions, as i migh be di icul o
speci y in e en ion con en s o all he di e en con-
ex s in na ional-le el policy pape s. Howe e , in line
wi h ecen ly acknowledged calls o employ beha iou al
science mo e e icien ly in public policy [4], his may be
exac ly wha policy pape s should mo e owa ds: be e
speci ying cou ses o ac ion ha ha e a s ong e idence
base, lea ing less oom o in e p e a ion among he
in e en ion’s de elope s.
Sugges ions o u u e esea ch include simila ana-
lyses o WHP policy pape s in o he coun ies, as well as
o o he policies. Policy pape s may cu en ly unde use
beha iou change science, elying mos ly on in o ma ion
p o ision. Fu he mo e, i would be impo an o s udy
uppe - o sys em-le el ecommenda ions and map hose
on o he beha iou change in e en ions sugges ed in
policy pape s. I has been a gued, o example, ha con-
se a i e poli icians may emphasize s a egies ha place
esponsibili y a he le el o indi iduals and a ional
choices, and ha libe al o le -wing poli icians may a -
emp o in luence policies h ough s onge go e nmen
egula ion [47]. Thus in u u e such an analysis would
enable he empi ical in es iga ion o longi udinal changes
in he assumed unde pinnings o beha iou and he p e-
e ed change s a egies in policies, bo h wi hin pa icula
coun ies and in c oss-na ional compa isons.
Conclusions
Ou analysis shows ha amewo ks ini ially de eloped
o he planning and assessmen o beha iou change
in e en ions and implemen a ion can be used o assess
he con en o policy pape s on heal h p omo ion. Re o-
i ing e ealed he s eng hs, limi a ions, and de elop-
men needs o policy pape s and sugges ed ini ia i es o
u he de elopmen o he BCW app oach.
Addi ional iles
Addi ional ile 1: Desc ip ion o selec ed policy pape s and da a uni
selec ion s a egy. (DOCX 20 kb)
Addi ional ile 2: Coding ins uc ions. (DOCX 19 kb)
Addi ional ile 3: Table S1. Iden i ied mechanisms o ac ion o
nu i ion and PA ecommended in heal h policy pape s. (DOCX 17 kb)
Addi ional ile 4: Table S2. Iden i ied in e en ion con en
ecommended in policy pape s o nu i ion and PA. (DOCX 22 kb)
Addi ional ile 5: Table S3. F equencies o di e en a ge s in
ecommenda ions o each policy pape . (DOCX 14 kb)
Abb e ia ions
BCT: Beha iou change echnique; BCW: Beha iou Change Wheel; COM-
B: Capabili y-oppo uni y-mo i a ion-beha iou ; IF: In e en ion unc ion;
OHC: Occupa ional heal hca e; PA: Physical ac i i y; PC: Policy ca ego y;
SB: Seden a y beha iou ; TDF: Theo e ical Domains F amewo k;
WHP: Wo kplace heal h p omo ion
Acknowledgemen s
No applicable.
Funding
This s udy was suppo ed by he S a egic Resea ch Council o he Academy
o Finland (g an numbe 303430). NH was suppo ed by an Academy o
Finland Resea ch Fellowship (g an numbe 285283).
A ailabili y o da a and ma e ials
The o iginal policy pape s analyzed a e publicly a ailable on he websi es o
he ins i u ions in ques ion, bu copies ha e been sa ed on he
P omo@wo k websi e [h ps://www. l. i/ u kimushanke/p omo-a -wo k/
kansallis en-suosi us en-analyysi-kay ay ymis ie eellises a-nakokulmas a/] o
ee download. The da a se s analyzed du ing he cu en s udy a e a ailable
om he co esponding au ho on eques .
Au ho s’con ibu ions
NH and TS had he basic idea o his s udy and we e in ol ed in he
de elopmen o he p o ocol, wi h addi ional suppo om JL and JR. TS
collec ed all he da a, and TS analysed he da a wi h suppo om EK and
NH. TS, NH, and EK we e in ol ed in he da a in e p e a ion. TS w o e he
d a o he manusc ip . All au ho s we e in ol ed in he c i ical e ision o
he pape o in ellec ual con en and i s inal app o al be o e submission.
E hics app o al and consen o pa icipa e
No applicable.
Consen o publica ion
No applicable.
Compe ing in e es s
EK and JL wo k a he Finnish Ins i u e o Occupa ional Heal h. JL was a
membe o expe g oups in ol ed in p epa ing policy pape s analysed in
his s udy. JL did no pa icipa e in he analyses in his s udy. EK was no
in ol ed in p epa ing he policy pape s analysed in his s udy.
Publishe ’sNo e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in
published maps and ins i u ional a ilia ions.
Au ho de ails
1
Facul y o Social Sciences, Uni e si y o Tampe e, Linna, -33014 Tampe e, FI,
Finland.
2
Finnish Ins i u e o Occupa ional Heal h, -00251 Helsinki, FI, Finland.
Recei ed: 20 Feb ua y 2017 Accep ed: 6 July 2017
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