Table 2 Challenges faced during the study and solutions

Lack of spirometric data by which to identify eligible patients

Worked in conjunction with the spirometry community program

Trained research assistants to perform post-bronchodilator spirometry

Looked for other markers of COPD to help with identification of potentially eligible patients (ex. medications, exacerbation history)

Multiple modes of recruitment including in-person during a scheduled visit, phone calls, letters, flyers in clinic

Limited patient access due to poor health and transportation barriers

Flexibility in scheduling, accepting no shows and rescheduling, meeting patients closer to home, meeting with patients during their medical visits, home visits

Space constraints at clinic

Scheduling around times where space is available, using more than one visit if space not available for sufficient time, meeting patients outside of the clinic setting

Diverted attention

Prioritization of recruitment

Loss to follow up (by phone)

Other forms of communications used (letters, emergency contacts)

Poor patient health

Home visits