Insight inTo Stress and POOping on Work TIME (ITS POO TIME): Protocol for a Web-Based, Cross-Sectional Study

Long occupational working hours and shift work are common in high-, middle-, and lower-income economies. Bowel movement frequency and stool form in occupational settings may be important markers of stressful working conditions as well as diurnal gut microbiota action, gastrointestinal discomfort, and disorders of gut-brain interaction (DGBI). Characterizing DGBI in shift and nonshift workers could help identify the impact of diurnal work patterns on workers' physical and mental health, including anxiety related to bowel movements.

This study aims to outline the Insight inTo Stress and POOping on work TIME (ITS POO TIME) protocol describing a web-based multimethods research project on DGBI, stool form and frequency, psychological factors, sleep, diet, and anxiety related to bowel movements in occupational settings by comparison to residential settings.

Study 1 comprises a web-based convenience sampling survey to acquire quantitative data from adults who are engaged in paid employment. We seek to assess occupational characteristics, organizational factors, as well as standardized questionnaires for stool form, DGBI assessed based on Rome-IV criteria, sleep, diet, bowel movement anxiety (ie, parcopresis), and distress. Study 2 is a qualitative study that asks open-ended questions about respondents' attitudes to defecation at work. Analyses for study 1 will explore rates of DGBI in shift versus nonshift workers and explore how occupational characteristics are associated with occupational bowel movement stool form and frequency. With regards to distress and parcopresis, study 1 will analyze how parcopresis, distress, and contamination fears are associated with stool form and frequency in occupational settings compared with residential settings. Study 1 is designed to have 90% power to detect a 5% difference in DGBI prevalence between groups at α=.05 based on the conservative estimate of 15% DGBI prevalence in shift workers and 10% DGBI prevalence in nonshift workers, with a final sample of 1967 required. Study 2 qualitative data will be analyzed using inductive thematic analysis to identify themes concerning feelings and attitudes about bowel movements in occupational settings.

The findings of ITS POO TIME will elicit important information on what factors are associated with bowel movements and stool form and frequency in occupational settings and identify associations pertinent to occupational health. Data collection commenced in January 2019 and finished enrollment in December 2023. Study 1 obtained 1872 responses and fell short of the desired sample size. Study 2 received 337 responses, and the primary results are expected to be published in 2025 and the qualitative results published in 2026.

The results of the research described in this research protocol will have direct implications for industry, employers, and policy makers concerning DGBI, stress, and worker health.