Table 14 Summary of Mammographers’ experience of the ActWELL study

Initial responses to the study proposal

• In terms of response to the proposal of involving mammographers in study interest, the response was mixed. In one service, the staff team were excited to be involved in the study because they perceived this as a valuable opportunity for women which in turn may have a positive impact on attendance rates. In contrast, in another service, (one that had previously been involved in a pilot of the intervention), the champion described a reluctance on the part of colleagues to become involved again. However, she also remarked that this may simply have represented resistance to another change to routines.

Mammographers’ perceptions of the study purpose

• ActWELL champions understood and appreciated that the purpose of the study was to reduce women’s risk of breast cancer by addressing lifestyle factors. As such there appeared to be no resistance from mammographers towards the study premise, yet one champion, had reservations about the way in which women were approached about the study, demonstrated concerns about discussing such an emotive topic as cancer risk and linking this with weight in what is a very brief clinical appointment.

Embedding ActWELL introduction into practice

• Mammographers recognised that the key to implementing the ActWELL recruitment task was to make it part of the clinic practice routine and described ways in which this was achieved.

• Generally it was felt that, as the recruitment became embedded into practice, the impact on consultation times and overall smooth running of the service was manageable: “once we established a pattern for it, it was actually more achievable than we initially thought”

• It was noted, however, that there was limited time to answer any questions which women might raise without impacting on the very tight appointment schedule. For one interviewee, the concern about lack of time was bound up with and reinforced the concerns expressed in another service about the inappropriateness of telling women about the link between unhealthy lifestyle and cancer risk.

Barriers and challenges

• Generally, these were practical, with time pressures being most consistently identified as an issue which affected both staff and the women themselves: “it did feel a bit rushed, and it wasn’t fair on the ladies, but you can only do what you can with the time you are given”.

Perceptions of women’s response and information needs

• Despite concerns expressed by one mammographer that women might feel it inappropriate to have the issue of lifestyle and cancer risk mentioned during mammography, no mammographers mentioned in the interviews any instances of women feeling distressed, although it should also be noted that the tight timing of appointments meant there was limited time for staff to gauge how women felt.

• No mammographers felt that including the ActWELL recruitment in the screening process had impacted negatively on women’s willingness to attend for screening.

Modifications

• In terms of suggested modifications to the recruitment process itself, these were generally minor in nature.