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Nurses provided standard written prompts or information at weeks 16 and 24.
The eight nurses attended two days of training and practiced telephone coaching sessions with the research team.
The usual care group received a standard information leaflet about self management of COPD.25 The 13 page leaflet gave a definition of COPD, a detailed description of associated symptoms, how the illness can be managed with the use of inhalers, how to treat exacerbations, and details of other resources (eg, British Lung Foundation and NHS Smokefree).
The intervention consisted of telephone health coaching delivered by a nurse with supporting written documents, a pedometer, and a self monitoring diary.
This prevention model has only recently been adopted in COPD, with calls for interventions to reduce risk in people with early disease.3The growing number of people at risk of developing long term conditions and the prevalence of early disease, means an accessible and low resource approach needs to be taken to support self management.Social Cognitive Theory underpinned the intervention,26 and included education, monitoring, and assessment of progress, and taught skills with the aim of increasing self efficacy.2728 We incorporated best evidence for the promotion of physical activity (tailored, ongoing support, duration six months, use of pedometer).29303132 The intervention components are detailed in web appendix 1.The first telephone coaching session at one week after randomisation aimed to last 35-60 minutes (determined by the number of issues requiring discussion, such as current smoking), followed by a 15-20 minute telephone session at weeks 3, 7, and 11 with written supportive materials tailored to the patient after each telephone call (eg, summary of goals agreed, physical activity diary, contact details for local services, information leaflet showing correct inhaler use technique).Nurses followed a proforma to guide the consultation in accordance with the telephone consultation protocol.The nurses briefly summarised the content of the call and any actions agreed after each telephone call.
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The allocation was made using a web-based programme hosted by the Primary Care Clinical Research and Trials Unit, University of Birmingham.