Table 16 Summary of coaches’ views on the Actwell training and intervention

Background

• The coaches had a range of backgrounds and experiences, including nursing, general practice, fitness coaching, voluntary work, education and nutrition. Some were retired while others were in work, sometimes also juggling other family commitments. Some had prior experience of breast cancer, either themselves or among their family and friends.

Perceptions of study and role

• The coaches clearly understood the prevention concept at the heart of ActWELL, and perceived that the aim of the study was to assess whether a lifestyle coach approach could encourage lifestyle changes, specifically relating to physical activity, diet, alcohol use and weight.

• Lifestyle coaches understood that the nature of their role was primarily “support and encouragement” for women to identify changes they could make for themselves, rather than to direct them to follow a particular plan of action.

Training

• Lifestyle coaches generally enjoyed and appreciated the training. For some with prior experience of this kind of work it was felt to be sufficient and appropriate. However, others noted the training to be intense and hurried for the amount of learning required. The use of role play elicited mixed responses.

Management of intervention procedures

• All coaches praised the support they had received from Breast Cancer Now (BCN). The manager in charge of ActWELL volunteers was described as helpful, supportive, quick to respond and efficient.

• The process was generally described as well managed and straightforward, and coaches particularly appreciated that there was flexibility to accommodate their particular requirements and circumstances. The types of queries which lifestyle coaches received typically concerned health problems experienced by intervention participants and the implications of these for their involvement in the study. Generally, lifestyle coaches found the process of scheduling appointments to be manageable and not too onerous.

• Some had found the paperwork (including record forms for intervention and research purposes) which they had to complete after each session and telephone call manageable and straightforward but other struggled.

• The process of arranging meeting venues in local leisure centres was mostly straightforward, with leisure centre staff generally being described as helpful and accommodating, albeit centralised booking systems sometimes made it difficult to speak directly to the venue. However, some issues were experienced regarding room availability and suitability, particularly where the only space available was in a public area.

• The process of scheduling and making telephone calls was generally experienced as unproblematic.

• A consistent theme across the interviews was the duration of the face to face appointments, with coaches finding that the appointments, particularly the first one, could take much longer than had been recommended in the training. This was for two main reasons. Firstly, coaches found that it was important to build a rapport with the participant, and this took time. Secondly, the requirement in the first face to face appointment to take the participant for a 10 min walk ate substantially more into the appointment time than anticipated.

• Lifestyle coaches were very positive about their experience of volunteering on the ActWELL programme, including speaking of their enjoyment of being in contact with and supporting participants.

• In terms of their routines, coaches were generally able to accommodate their ActWELL involvement, although it was acknowledged that the time commitment was substantial and in some cases had exceeded initial expectations. However, generally, lifestyle coaches noted that it was made clear to them that volunteering to be a coach would be a substantial time commitment, and those who were interviewed took this commitment seriously.

Participant interactions

• Overall, coaches felt a high level of confidence in carrying out their role, although some indicated nervousness and uncertainty in the initial stages. Opportunities to practise and gain experience were helpful for those who started with lower confidence but saw this grow over time.

• Coaches noted a generally good level of engagement in ActWELL participants, with most starting off very enthusiastic. Over time, coaches found that engagement in participants varied, particularly after the face to face appointments came to an end and the intervention moved on to telephone support. In some cases the process had been straightforward, with participants continuing to respond well to the programme in this second phase; however, in other cases the transition to telephone calls had been somewhat unsatisfactory.

• Another coach commented that most of their participants had lost a lot of weight before they had started on ActWELL, and so few lost further weight during the intervention.

• Multiple barriers and facilitators to participants’ progress within ActWELL were identified by coaches. Barriers reflected characteristics of participants’ lifestyles and routines, including the role of food in their lives; as well as their approach to, and understanding of ActWELL. Facilitators to progress were identified within the ActWELL programme and in participants themselves including their levels of self-motivation, and interest in physical activity, healthier diets and good health generally.

• Coaches had various suggestions for improving ActWELL and these focussed on the format and content of the programme and better supporting coaches to prepare for and deliver the intervention.