A Mixed-Methods Cluster Randomised Waitlist-Controlled Trial of a Goal-Based Behaviour Change Intervention Implemented in Workplaces

Abstract

Previous research suggests a goal-based intervention called ‘mental contrasting and implementation intentions’ improves participants’ health and wellbeing. The present study sought to extend these findings to workplaces in the United Kingdom. A mixed-methods cluster randomised controlled trial was conducted with 28 workplaces and 225 staff. All participants deliberated on wishes (potential goals) about improving their health and wellbeing. In the intervention arm, participants were guided to think about the benefits and obstacles to achieving a wish (mental contrasting) and to plan actions to overcome these obstacles (implementation intentions). The results showed no substantive effect of the intervention on average self-reported progress towards what they wished to do for their health and wellbeing four weeks later (mean difference on a 1–7 scale: −0.19; 95% credible interval: −1.08–0.71). Unexpectedly, anxiety increased, and we found evidence that might suggest people identifying as men or of Asian ethnicity made less progress in the intervention group. To explain the results, qualitative focus group data were analysed, guided by normalisation process theory (NPT) and the behaviour change wheel (BCW). Three key themes emerged: insufficient differentiation from other approaches using writing/drawing (NPT), a mismatch between an internal motivational intervention and external barriers (NPT/BCW), and poor timing of opportunities (NPT/BCW). The discussion explores how these results can enhance future workplace health and wellbeing initiatives.