Breast cancer is the most common cancer in women the UK. In Scotland around 4,700 women are diagnosed each year. The risk of developing breast cancer increases with age, most cases (80%) occur in women over 50. Current estimates suggest that at least 23% of breast cancer cases could be prevented and are related to lifestyle choices including being overweight and physical inactivity.
ActWELL was a randomised controlled trial, funded by the Scottish Government, that aimed to lower breast cancer risk through lifestyle changes in women of breast screening age. The lifestyle programme was designed to be delivered by volunteers who supported women to make lifestyle changes, focusing on physical activity, diet and body weight.
In collaboration with the University of Dundee, NHS Scotland Breast Screening Programme (NHSBSP), leisure trusts and other academic institutions, Breast Cancer Now supported the delivery of ActWELL by providing a team of volunteer lifestyle coaches. It was believed that partnering with a voluntary organisation could potentially increase reach into local community settings.
The trial was delivered between May 2017 and October 2019.
- Volunteers received 2 days of bespoke training from the ActWELL trial team allowing them to deliver the lifestyle programme.
- Women attending routine NHS Breast Screening clinics in Grampian, Tayside, Lothian and Greater Glasgow and Clyde were offered the chance to find out more about ActWELL. Women aged 50 to 70 and classified as overweight were eligible to take part.
- Four leisure trusts (Sport Aberdeen, Dundee Leisure and Culture, Edinburgh Leisure and Glasgow Life) supported the delivery of ActWELL, providing meeting spaces in 12 leisure centres.
A total of 560 women were recruited to the study, of these, 279 received the ActWELL intervention and 281 received standard care (receiving a leaflet). Women in the ActWELL programme attended two face-to-face sessions in a leisure centre followed by up to nine telephone support sessions, over 12 months, with a volunteer. At 12 months, women who received ActWELL lost more weight and increased their steps more than the comparison group.
There was a great deal of interest in volunteering on ActWELL. In total 170 applications were received, so a role people are prepared to donate time to. Applications for the role came from a diverse range of professionals who had the appropriate skills and experiences required. This included health care professionals, sport and exercise coaches and those from education, psychology and counselling professions.
We had a dedicated team of volunteers, committed to seeing the trial through to completion. Volunteer retention on the project was 68%. Of the 66 applicants who received ActWELL training, 45 volunteers actively took on trial participants.
On average lifestyle coaches supported seven women on the trial, ranging from 3 to 15. Factors such as availability, changes to personal, family or work commitments and their own enjoyment contributed to the number of participants they took on.
Being involved In ActWELL had a positive impact on the volunteers. This included increased awareness of the link between lifestyle behaviours and breast cancer risk, and positive changes to their own lifestyle behaviours. They enjoyed being able to share their experience to support others, meet new people and supporting research into cancer prevention.
Volunteers were successful in supporting women to make lifestyle changes that could reduce the risk of breast cancer. ActWELL demonstrates what can be achieved through collaborative approaches and highlights the potential to address gaps in public health efforts.
The full trial results and can be found on the ActWELL website.
A summary of our key learnings and considerations for delivering similar projects was produced ‘A Guide to delivering behaviour change projects in community settings through volunteers’.
Amy Hickman is the Senior Public Health and Wellbeing Officer at Breast Cancer Now