Preactive Telephone Coaching and Tailored Support is a proactive intervention provided to older people who report multiple long-term conditions and moderate levels of activation, rather than any expression of specific or immediate clinical need. Therefore, the process by which people become engaged (or not) is important.
There was a basic understanding that the invitation to health coaching was linked in some way to people completing questionnaires as part of our cohort for older people. Invitation letters were sent via the patient’s practice, and this led a number of people to feel they had been‘specially selected’by their GP.
One lady invited to take part reported asking her GP about how it might benefit her and the GP saying he did not think it would:
. . . whilst I was with [my] doctor, I mentioned it and he said oh he didn’t think it would be of any use to me because my cholesterol’s fine, my blood pressure’s fine and he said I don’t seem to put weight on from the dieting point of view.
PROTECTS 16, F69
TABLE 56 Participant characteristics: PROTECTS qualitative interviews
Interview ID PROTECTS ID nsessions completed Health coach (initials) Age (years) Sex Marital status Number of LTCs Baseline scores PAM Probable depression (MHI-5) 1 767 6 JN 73 Male M 11 3 Yes 2 1721 6 JJ 77 Female S (D) 10 3 Yes 3 1462 6 JN 76 Female M 3 3 0 4 1451 6 JJ 67 Male M 6 3 Yes 5 958 6 JN 68 Female M 4 3 0 6 2885 6 SW 69 Female S (D) 2 2 Yes 7 2147 6 SW 73 Male M 6 3 0 8 1068 6 JN 73 Female 5 2 0 9 1264 6 JN 73 Female S (D) 15 3 0 10 1053 6 JJ 74 Female 8 2 Yes 11 974 6 JN 86 Male 5 3 0 12 3372 6 SW 80 Female 2 3 Yes 13 1315 6 JN 80 Female 8 2 0 14 2552 6 JN 69 Female 4 3 Yes 15 2038 6 SH 85 Male S (W) 10 2 Yes 16 134 6 SH 69 Female 3 3 Yes 17 3064 6 SH 80 Male M 5 4 0 18 3517 2 SH 70 Female 14 3 0 19 1946 2 SH 77 Female 4 3 Missing 20 848 3 JJ 83 Female 11 2 1 21 1865 0 – 90 Female S (W) 6 3 0 22 3666 0 – 80 Female S 9 3 1
D, divorced; ID, identificiation; LTC, long-term condition; M, married; S, single; W, widowed.
MHI-5: categorised as 0/1 (likely mood disorder) from initial scores 0–60 depressed/61–100 not depressed.
club and lost 5 lbs. She had previously discussed weight loss with her GP and was upset that many of her clothes no longer fitted her.
Many people were not entirely sure how it would help them, but chose to participate and remain in the study for a variety of reasons, including altruism; some people were keen to take part in something specifically designed for older people and many had been part of research studies previously (with Salford being particularly active in recruiting patients though its Citizen Scientist panel). People used their past experience of research to inform their decision to participate:
But I’ve always volunteered because I always think . . . I just think any sort of research, any sort of survey, it might not help me but in the future it will help other people.
PROTECTS 19, F77
I’ve been involved in research since I was 50. Initially it was memory . . . occasionally I get surveys which I fill in, how do you feel today on a scale of 1–10 and things like this. So I’ve always been interested, and I’m on the panel for Salford Royal.
PROTECTS 13, F80
This is why I was a bit dubious. I really didn’t understand what it [health coaching] would mean. But then when I thought about it, coming from a doctor’s side background, I suppose, I thought I might have had an idea that it might be about what you eat and exercise and just things in general. And then once [health coach] explained that it was for research purposes, and that you were hoping to roll it out if it was a success, that they needed people from all, that I didn’t consider myself in need really, but yeah, I’m quite happy to do it, not a problem.
PROTECTS 5, F68
Most participants enjoyed the sessions and felt they had gained something from the process, but almost universally suggested it might have been more appropriate and beneficial for people struggling with illness or who were isolated. Some participants were already active (e.g. regularly playing golf, eating healthily), so did not feel they would benefit from joining an exercise group. This is illustrated by the two examples below where participants who had friends and were not lonely felt guilty that the health coaching they received could have helped others more:
If I was on my own, you’d almost welcome that contact from someone prepared to talk and listen and give advice. My guilty feeling is maybe that time could be spent better with someone who needs it, but that someone might not always be there.
PROTECTS 4, M67
I thought if somebody was living on their own and alone it would benefit them enormously, but I’m out and about quite a lot so that side of it I didn’t think was of benefit to me . . . I just think like if I was lonely that call could be like a lifeline to you, couldn’t it?
PROTECTS 12, F80
For some, the health coaching came at difficult times and this was the reason for them dropping out of receiving the intervention (after two sessions), whereas others interviewed could not remember choosing to opt out (after three sessions):
. . . all this has been going on while my husband was very poorly and I had district nurses and doctors and Macmillan nurses, you know, and I had the family coming. I was just absolutely . . . I think that’s why [I stopped having the health coaching], yeah.
I don’t remember, actually saying, you know,‘knock me off’[health coaching] . . . Whether you think it’s worth continuing with it, or not, because of the situation, you know, with being a little bit further away from the centre of Salford, where, obviously, the connection is probably needed more than . . .
PROTECTS 20, F83
We also interviewed two people who were offered health coaching but did not return consent forms so did not receive calls. Neither remembered receiving the invite but, when asked, both provided reasons why it might not have appealed to them. The first person was very self-sufficient and thought she would probably know more than the coaches from her background in pharmacy and working in a GP surgery herself:
No, I haven’t had anything like that [invitation to health coaching]. The last thing I had was one of the big forms [questionnaires] to fill in and send back to the university . . . Well, because all these things they keep telling us, I know anyway . . . my husband was a pharmacist and I was involved in the business. And I’ve always been interested in medicine . . . I qualified as an apothecary, and I used to work from the doctor’s surgery over in Huddersfield, years and years ago. So I’ve always been interested in medical things, yeah.
PROTECTS 21, F90
The second person was extremely busy, acting as an advocate for her disabled daughter. She appeared very focused on physical illness and was unsure how a health coach could help her:
If I’m saying to this person how’s your health been? Well, I haven’t been too good, what are they actually going to do for me? Is it going to be useful for me?
PROTECTS 22, F80