Development of iADJUST: a theory-informed, patient co-designed digital psychological intervention for adjustment in chronic kidney disease

Psychological distress is common in chronic kidney disease (CKD) and associated with reduced quality of life and worse clinical outcomes, partly reflecting difficulties adjusting to illness demands. Psychological support remains inconsistently integrated within kidney care pathways, and existing interventions rarely specify or target the mechanisms underpinning adjustment to CKD. This paper describes the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD.

Intervention development was guided by the Medical Research Council framework and integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed identification of modifiable maintaining mechanisms of adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD.

iADJUST is a six-session, primarily self-guided digital psychological intervention for adults with CKD who are not on dialysis or transplanted, delivered over 12 weeks with brief therapist support. It targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic "what-if" thinking, self-critical evaluation, behavioural withdrawal, and self-regulation processes relevant to maintenance and relapse prevention. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches, delivered through video, audio, and guided tasks and activities.

iADJUST provides a theory- and evidence-informed psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms of adjustment. Its feasibility is being evaluated in a randomised waitlist-controlled feasibility trial (ISRCTN91507822).