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The Studentship is available to UK applicants only.

Supervisors:

• Dr Matthew Graham-Brown mgb23@le.ac.uk
• Dr Courtney Lightfoot
• Dr Rupert Major 
• Dr Nilesh Sanganee

Project:

Chronic kidney disease (CKD) is a major public health emergency. 7 million people in the UK have CKD, numbers are expected to increase over the next 10 years, with a major impact on the UK health economy (1). The majority of patients with CKD are looked after in primary care, with no access to specialist secondary care renal services and public awareness of CKD and its health implications are low (2,3). Patients with CKD have an increased risk of cardiovascular disease, reduced quality of life, functional impairment and high symptom burden (4). 

In the UK, identification, risk stratification, coding and optimisation of therapy for CKD do not meet standards outlined by NICE (5). To improve outcomes for patients, and reduce the number of patients suffering from the complications associated with CKD requires the implementation of guideline-directed care. One NICE guideline of interest to our group is the information and education for people with CKD. Our group has co-developed and tested ‘My Kidneys & Me’, a digital health platform that provides information and support to those living with CKD to help them better self-manage their condition. The ability to effectively self-manage aspects of health was highlighted as a key priority for patients living with chronic health conditions in the NHS Long Term Plan (6) and this is reflected in NICE guidelines for CKD (7). 

My Kidneys & Me has been shown to improve ‘patient activation’ (knowledge, skills and confidence to manage own health and healthcare), kidney-related health knowledge and health-related behaviours (8,9,10). The platform is ready for implementation in both primary and secondary care settings. This PhD project will look specifically at the delivery of My Kidneys & Me, alongside CKD education for professionals to improve knowledge and confidence in managing CKD-related health, in turn to improve CKD-related and CV outcomes in people with CKD.

This project will take a mixed-methods approach and the student will receive appropriate training and support from supervisors and experienced members of the Kidney Lifestyle Team.

Work package 1
The student will be supported to conduct implementation projects in primary care sites. This work will involve recruiting individuals involved in signposting, using, and discussing My Kidneys & Me to people living with CKD, to be interviewed to explore their experiences of using My Kidneys & Me. Individuals will be recruited to the LINK-UP study (a platform qualitative study for patients with kidney disease, family/caregivers of patients with kidney disease, clinicians or stakeholders involved in the care of patients with kidney disease – ethical approval obtained). In addition, LUCID virtual CKD clinical meetings (11) will be recorded/ the student will be able to attend LUCID clinics (11) and document information relating to the management and education of people living with CKD, alongside the delivery of education for healthcare and administration professionals working in primary care (amended required to LINK-UP). An ethnographic approach to data collection will be employed, using a range of qualitative methodologies (focus groups, one-to-one interviews, observation) (12), and data collection and analysis undertaken will align with an appropriate framework (13). Data will be recorded, transcribed and analysed with an appropriate technique (e.g. thematic, content, narrative, framework analyses) to understand the barriers and facilitators to the delivery of CKD education, and embedding My Kidneys & Me into routine clinical care and practice. Findings will establish which implementation strategies and processes are successful, or unsuccessful, and in what settings.

Work package 2
Working with the LUCID clinicians, from both primary (GPs) and secondary (Nephrologists) care, the student will help to co-develop appropriate content and relevant revisions to the healthcare professional education resource that supports My Kidneys & Me. The student will complete a mixed-methods feasibility evaluation to identify any barriers and facilitators to engaging with the resource. Data will be analysed for uptake and engagement to explore which parts of the resource are used most/least. Normalisation process theory (NPT) will be used as a framework for evaluating the intervention (14). Think-aloud and semi-structured interviews, with the same group of individuals from work package 1, will be conducted to define the extent to which the healthcare professional educational resource addresses the needs of individuals working in and delivering care to people living with CKD in primary care. 


References
1) Kidney disease: A UK public health emergency the health economics of kidney disease to 2023. Kidney Research UK. 2023. https://www.kidneyresearchuk.org/wp-content/uploads/2023/06/Economics-of-Kidney-Disease-full-report_accessible.pdf 
2) Greer RC, Crews DC, Boulware LE. Challenges perceived by primary care providers to educating patients about chronic kidney disease. Journal of Renal Care. 2012;38(4):174-81.
3) Tuot DS, Wong KK, Velasquez A, Crews DC, Zonderman AB, Evans MK, et al. CKD Awareness in the General Population: Performance of CKD-Specific Questions. Kidney Medicine. 2019;1(2):43-50.
4) Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022;12(1):7-11.
5) Healthcare Quality Improvement Partnership. Variability in testing exposing high risk patients to chronic kidney disease, national clinical audit finds. 2017. https://www.hqip.org.uk/variability-in-testing-exposing-high-risk-patients-to-chronic-kidney-disease-national-clinical-audit-finds/.
6) NHS England. The NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf 
7) National Institute for Health and Care Excellence (NICE). Chronic kidney disease: assessment and management. 2021. https://www.nice.org.uk/guidance/ng203/resources/chronic-kidney-disease-assessment-and-management-pdf-66143713055173 
8) Lightfoot CJ, Wilkinson TJ, Hadjiconstantinou M, Graham-Brown M, Barratt J, Brough C, et al. The Codevelopment of "My Kidneys and Me": A Digital Self-management Program for People With Chronic Kidney Disease. Journal of Medical Internet Research. 2022;24(11):e39657.
9) Lightfoot CJ, Wilkinson TJ, Vadaszy N, Graham-Brown MPM, Davies MJ, Yates T, et al. Improving self-management behaviour through a digital lifestyle intervention: An internal pilot study. Journal of Renal Care. 2024; 50(3):283-296.
10) Lightfoot CJ, Wilkinson TJ, Sohansoha GK, Gillies CL, Vadaszy N, Ford EC, Davies MJ, Yates T, Smith AC, Graham-Brown MPM, on behalf of SMILE-K collaborators. Effect of a novel digital health education intervention - My Kidneys and Me - on patient activation and self-management in patients with chronic kidney disease: a multicentre parallel-group randomised control trial. npj Digital Medicine. 2024; 12(11):e064916.
11) Major RW, Lakhani N, Ahmed Y, Atkin J, Baines R, Balment R, et al. Integrated primary and secondary care optimizes the management of people with CKD—the LUCID project, Clinical Kidney Journal. 2025; 18(4): sfaf049. 
12) Hamilton AB, Finley EP. Qualitative methods in implementation research: An introduction. Psychiatry Research. 2019; 280: 112516.
13) Day S, Laver K, Jeon YH, Radford K, Low LF. Frameworks for cultural adaptation of psychosocial interventions: A systematic review with narrative synthesis. Dementia. 2023; 22(8):1921-1949
14) Murray E, S Treweek, C Pope, et al. Normalisation process theory: A framework for developing, evaluating and implementing complex interventions. BMC Med. BioMed Central; 2010; 8(63): 1–11.