Table 1 Study objectives and outcome measures

Implementation

Objective 1: Enhance health provider knowledge, skills and confidence

BE WELL Health Provider Impact Questionnaire

To evaluate the effects of the BE WELL workshop on health care provider knowledge, confidence and skills

The questionnaire will include a Likert scale to assess self-reported knowledge of COPD, and skills in assessing people with COPD (including spirometry and 6MWT), and confidence in exercise prescription (EP/PTs only) and providing an exercise program and education for Indigenous people with COPD

AHWs and EPs/PTs who attend the BE WELL workshop

Before and immediately after the BE WELL workshop, and at 3, 6 and 12 months post-workshop

Online education survey

To evaluate the AHW and EP/PT experience of the online education sessions for developing ‘yarning’ educational resources for BE WELL participants undertaking the PR program

A 15-question survey using a 5-point Likert scale evaluating the mode of delivery, structure of the sessions, and engagement

AHWs and EPs/PTs who attend the BE WELL online education sessions

After completion of the online education sessions at each participating ACCHS

Online education semi-structured interviews

To explore the AHW and EP/PT experiences of the online education sessions to completement the responses from the online education survey

To guide discussion, 13 interview questions covering context, co-design, engagement, knowledge and understanding, cultural integration and impact will be used.

The interviews will be conducted by a member of the research team experienced in qualitative interviews and who is not involved in the delivery of the online education sessions

AHWs and EPs/PTs who attend the BE WELL online education sessions

After completion of the online education sessions at each participating ACCHS

Objective 2: Identify factors that influence successful implementation

Focus groups

To explore the local structural, system level and other contextual factors that could influence successful implementation within each ACCHS

To guide discussion there will be questions relating to the elements of the RE-AIM framework i.e. Reach, Effectiveness, Adoption, Implementation, Maintenance

ACCHS staff involved in BE WELL project

At project inception and at 12-months after the BE WELL workshop

Survey

To gain feedback from patients about the BE WELL PR program

Survey using 5-point Likert scale to evaluate patients’ knowledge of lung disease, confidence in self-management, program satisfaction and suggestions for improvement

Indigenous patients enrolled in the BE WELL PR program

At the completion of each patient’s PR program

Focus groups

To gain a more in-depth understanding of the patient experience of the BE WELL PR program

To guide discussion there will be questions relating to patients’ experiences of the BE WELL PR program and patients’ perceived changes in knowledge of lung disease, confidence in self-management, and their degree of satisfaction with the program.

Advice will be sought from each ACCHS to determine the most culturally appropriate method of engaging with patients

Indigenous patients enrolled in the BE WELL PR program

After completion of PR by a group of participants

Objective 3: Uptake of new services for COPD management

BE WELL Service Delivery Inventory

To evaluate the extent of respiratory services at each ACCHS and the impact of the BE WELL program on the services provided

The inventory will cover the following services: spirometry for assessment of COPD, assessment of smoking status, provision of evidence-based smoking cessation advice and/or treatment, provision of pulmonary rehabilitation programs that include exercise training and patient education

Executive staff of each ACCHS

At initial consultation and at project completion

Intervention

Objective 4: Impact of BE WELL PR program on patient outcomes and health care costs

6MWT (23)

To evaluate functional exercise capacity

Measures distance walked in 6 min on a flat, indoor track. Two tests will be performed at baseline and one test at program completion. Oxygen saturation and pulse rate will be recorded continuously using a pulse oximeter (MIR Spirodoc Spirometer, Rome, Italy)

Indigenous patients attending the BE WELL PR program

Before and after participation in the 8-week BE WELL PR program

SGRQ (24)

To evaluate HRQoL

A 50-item questionnaire with domains of impact, symptoms and activity impairment associated with COPD

EQ5D-5L (25)

To evaluate HRQoL

A generic quality of life questionnaire consisting of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) which will be used in cost-effectiveness analysis

CAT (26)

To evaluate the impact that COPD on wellbeing and daily life

An 8-item questionnaire evaluating symptoms, activity limitations, sleep, confidence

Hospitalisations

To evaluate the impact of the BE WELL PR program on hospitalisations

Hospital separation data will be collected from the NSW Centre for Health Record Linkage (CHeReL).

Administrative hospital records including information on the Diagnostic Related Group (DRG) classification and International Classification of Disease (ICD-10) codes for hospital separations will be used to estimate a cost using local cost weights

Indigenous patients who participated in the BE WELL PR program

In the periods 12 months preceding and following participation in the BE WELL PR program

Other healthcare costs (GP visits, medications)

To evaluate the impact of the BE WELL PR program on other healthcare costs

Costs of medical services and medications will be recorded from patients who consent to access of their administrative health care use data through the Medical and Pharmaceutical Benefits Schedules (PBS) from Medicare Australia. Additional primary health care and medication use data will be abstracted from primary health care histories particularly in sites where the PBS have limited implementation, e.g. very remote Australian health care services

Costs of BE WELL pulmonary rehabilitation program

To determine the costs of provision of the BE WELL PR program for comparison with any costs savings

Costs of program delivery will include staff time, facility costs, training resources

Executive staff of the ACCHS

During the BE WELL project