|24 participants were interviewed by telephone using a semi-structured interview guide. The sample was selected to represent all study areas and a range of socio-economic backgrounds using SIMD|
|Views on the study and intervention|
• Most women recalled finding out about the study through ‘leaflets’, ‘cards’ or ‘posters’ at the mammography clinic – only a minority recalled any conversation about it.|
• Study information materials were felt to have been clear and helpful. The only area of uncertainty was around the term ‘lifestyle coach’, which conjured up expectations for some of a more personalised, intensive form of support.
• The mammography setting was felt to have been an appropriate recruitment channel
|Motives for participation||
• Motives for participation were both altruistic (to support worthwhile research, to help find out about preventing cancer) and self-help/improvement (particularly, to lose weight, and generally to improve health). Sometimes both types of motive were present, reinforcing each other. For some, Actwell had come along at a key moment (change of routine, big birthday, awareness of own mortality, family illness).|
• Breast cancer prevention was not necessarily a salient factor for many, and there was low awareness of BCN involvement.
|Acceptability and convenience||
• Research nurse appointments were felt to have been pleasant and well handled.|
• Venues for lifestyle coach meetings were mostly felt to have been appropriate, although some had found them difficult to get to, and the rooms available had not always been very pleasant.
• Telephone calls were mostly felt to have been acceptable and convenient, and of appropriate frequency and duration.
• Views on overall mix and timing of face-to-face meetings and telephone calls: mostly, participants felt this was about right, although some felt they would have welcomed more face-to-face support.
|Views on the lifestyle coaches||
• Generally coaches were highly regarded. Seen as pleasant, warm, positive, although one participant reacted negatively.|
• Usually coaches were perceived as empathetic, understanding, and non-judgemental, although some felt that ‘slim’ coaches did not necessarily understand the challenges faced by overweight women.
• Generally praised for quality of support provided, with some coaches being described as having particular insight and skill in knowing how to motivate change.
• Some interviewees had expected that coaches would have a background in lifestyle coaching or specialist knowledge (for example, concerning particular conditions and dietary needs). Some participants had not been aware at start that all coaches would be volunteers.
|Views on the intervention||
• Goal setting appeared generally to have worked well, with participants feeling they had been appropriately involved, and goals being perceived as realistic and manageable.|
• Varying views on the information and advice provided. In some cases, seen as not specific enough, or not telling participants anything new.
• For some participants, the move to telephone calls was disappointing as they lacked the rapport and accountability associated with face-to-face contact. Others, however, felt the phone calls provided sufficient support and encouragement.
• Participants generally appreciated using the pedometers (although they were difficult to wear, compared with fitbit-type watches). There were more mixed views on regularly weighing themselves, with some finding it helpful and others demotivating.
|Suggestions for changes and improvements to Actwell||
Many felt ‘nothing’ needed changing, but some suggestions were offered:|
• around a third would have welcomed more contact with lifestyle coach, either during or after the 12 month period.
• some suggested contact with other participants – ‘buddy’ system or an informal social group.
• some would have liked feedback on the blood tests at baseline and follow-up
|Barriers and facilitators to change (analysed in relation to the COM-B model)|
|Capability||• Health (conditions which affected mobility, recent surgery), life events such as Christmas and holidays, and stressful periods, could reduce capability and make participants fall back into old patterns of treats and comfort eating.|
• Work (for those still in employment), family caring commitments and looking after pets could reduce time available for activity and affect energy and motivation, but could also present opportunities for exercise.|
• Weather/lack of daylight and cost of accessing healthy food and leisure facilities were negative factors for some. Several commented on free activity options such as walking on beach.
• Could be both a positive and negative factor; some were strongly driven and self-motivated, others needed external boosts to motivation such as the regular contact with the coach. Personal goals, such as being fitter to play with grandchildren, were helpful.|
• Mixed experiences of family and friend support.