For priority populations, such as Indigenous children, school-based screening programmes can increase equitable access to care. However, current traditional economic measures evaluating the effectiveness of many screening programmes in Australia do not capture the value perceived by those at the intersection of the benefits, including children and families, communities, health workers and teachers or the differences between Western-Anglo and Indigenous conceptualisations of health. This mixed-methods study aims to develop and validate a Community Reported Outcome Measure (CROM) of school health screening programmes based on concepts of value of health and healthcare and school screening programmes from the perspective of Indigenous peoples. The purpose of the tool is to provide a robustly developed and validated tool to assess the experiences of school health screening programmes from the perspective of Indigenous stakeholders including families, communities, health workers and teachers.

This mixed-methods study will be conducted in three stages in accordance with regulatory and international consensus guidance: (1) concept elicitation to construct a conceptual framework of value in school screening; (2) item generation and mapping to the conceptual framework and (3) a psychometric evaluation of the CROM. Phase 1 concept elicitation: this involves an umbrella review (phase 1.1); yarning circles with communities in New South Wales (phase 1.2); concept integration of the umbrella review and yarning circles data (phase 1.3) and an online e-Delphi study to ensure the framework of value is nationally representative (phase 1.4). Phase 2 item generation and mapping: this involves item generation (phase 2.1) and cognitive testing of the item pool (phase 2.2). Phase 3 psychometric evaluation: this involves field testing (phase 3.1) and assessing the structural validity of the CROM via Rasch analysis (phase 3.2).

This study was reviewed and approved by the Australian Institute of Aboriginal and Torres Strait Islander Studies (Ref: REC-0397) and State Education Research and Partnerships (Ref: SERAP 6500). The results of this study will be presented at relevant academic and non-scientific conferences and meetings and published in high-impact peer-reviewed journals.

Multiple well-considered but siloed initiatives and programmes exist in Australia to support ear and hearing screening and assessment for Indigenous children. However, the lack of coordination of these programmes leads to inefficiencies in resource allocation and disrupts opportunities to implement a cost-effective, efficient, and easily navigable system of care. Indigenous children experience high prevalence rates of middle ear disease, as well as earlier onset, increased severity and longer infections compared with non-Indigenous children. The aims of this study are to: (1) Understand current ear and hearing screening programmes in three New South Wales communities and evaluate their strengths and limitations, (2) Strengthen, implement and evaluate ear and hearing screening programmes and (3) Identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.

A series of desktop searches and co-design workshops will be completed to achieve aim (1) and (2) and the results will be mapped into work-as-done and work-as-imagined using the Functional Resonance Analysis Method. Strengthened screening programmes will be implemented in communities using the criteria from national and international guidance documents and the Practical, Robust, Implementation and Sustainability Model and evaluated. Finally, workshops will be conducted with key stakeholders to identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.

This project has received ethics approval from the Aboriginal Health and Medical Research Council Human Research Ethics Committee (Ref: 2350/24). Results will be disseminated to the community through the CEOs of the Aboriginal Community Controlled Health Organisations as well as published in peer-reviewed journals and presented at conferences. The findings from data collected will be used to inform the co-production of an enhanced system for ear and hearing care.