Lay summary
When referrals are accepted by outpatient specialist health services, patients are often posted a letter offering an appointment some months away. In the meantime many are distressed, not sure when they should seek more help, which information to trust or what to do in the meantime. Simple digital tools would help, but have limited uptake. This Māori-led project aims to co-develop and evaluate the effectiveness of a Smart Start (digital) letter to improve patient experiences and outcomes. The Smart Start letter will be designed with clinicians in diabetes and bariatric services, and Māori and tauiwi patient representatives, using behaviour-change and engagement theories. The letter will be sent to all waitlisted patients in each collaborating service for a period of 6-12 months. Theory-driven realist evaluation methods using qualitative and quantitative data will be used to measure the effectiveness of the intervention for improving both patient and clinical service outcomes.