Individuals with moderate-to-severe chronic obstructive pulmonary disease (COPD) are at high risk for rapid
functional decline and hospitalization. Pulmonary rehabilitation is one of the few interventions that has been
shown to effectively modify the course of COPD and improve health outcomes; however, challenges in
implementation and access to this high resource intervention in real-life settings have led to low-availability and
engagement due to both healthcare system-level and patient-level barriers. To address barriers specific to low-
resourced healthcare settings, we developed COPD Wellness with patient and clinical stakeholders. This 10-
week community-based program retains key elements of pulmonary rehabilitation (exercise training, self-
management, and peer social support), but is designed to be portable and feasible to deliver in diverse settings.
While COPD Wellness addresses many system-level barriers, it does not directly address patient-level barriers.
Lower levels of adherence are common across low-income, low health literacy communities, reflecting the
burden of competing socio-environmental stressors that interfere with the ability to carry out rehabilitation
activities and independently contribute to poor outcomes in COPD. We adapted the evidence-based resource
support program, Health Advocates (HA), for the unmet social needs of older patients with COPD as a strategy
to improve acceptance, adherence, and impact of pulmonary rehabilitation programs (Plus+).
The proposed study will directly test the benefit of the COPD Wellness and Plus+ Program relative to usual care
and estimate the added benefit of the HA in COPD Wellness Plus+ to COPD Wellness alone in a three-arm,
randomized waitlist-controlled trial conducted in three geographically isolated urban primary care sites that
provide care for some of the most socially vulnerable patient populations with COPD. In this Type 1 effectiveness-
implementation hybrid design, we aim to 1) determine the effectiveness of COPD Wellness and Plus+ to improve
functional and symptom outcomes; and, using a mixed-methods approach 2) to evaluate the implementation of
COPD Wellness and Plus+ across study sites applying the RE-AIM and CFIR frameworks to identify additional
barriers and enablers of intervention implementation and patient acceptance and adherence. COPD Wellness
Plus+ was designed to specifically address barriers to rehabilitation and function within low-resourced healthcare
settings. If effective, the COPD Wellness Plus+ program can offer a feasible pathway for broader implementation
of low intensity pulmonary rehabilitation regionally and nationally in the U.S.