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Article History

Received: 3 March 2026

Accepted: 25 May 2026

First Online: 11 June 2026

Declarations

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: All study procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. The study was approved by Health and Social Care Research Ethics Committee A (reference 24/NI/0037). Written, verbal, or online informed consent was obtained from all participants for participation in interviews or focus groups, for audio-recording, and for the use of anonymised quotations in research outputs and publications. Patient participants were additionally invited to provide optional consent for access to relevant medical records relating to kidney health status. All participants were additionally invited to provide optional consent for future contact regarding ethically approved studies and for receipt of a lay summary of the study findings. Ongoing verbal consent was reconfirmed at the start of each interview and focus group. Interviews and focus groups were audio-recorded, transcribed verbatim, and anonymised prior to analysis, with field notes also anonymised prior to analysis. Audio and text files were stored securely in password-protected folders in accordance with UK data protection regulations.

: Not applicable. No identifiable individual data are presented in this article.

: MRD is an Advanced Research Fellow and qualitative health researcher specialising in health services research and equity-focused implementation science; she is also an accredited community-based counsellor. BK is a Postdoctoral Researcher with a background in health psychology and expertise in qualitative health research. SS and PC are clinical academic nephrologists with a focus on population kidney health and deprivation-related inequalities. TB and BJ are academic general practitioners with expertise in multimorbidity and primary care service organisation. SB is a clinical epidemiologist specialising in chronic disease outcomes. MMa is a Professor of Medical Sociology with expertise in structural determinants of health and health inequalities. NSR and EC are academic researchers contributing to chronic disease and health services research. AH, MG, MMe and FN are Patient and Public Involvement contributors.

: TB is also funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (Grant NIHR204295). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health and Care Research, or the Department of Health and Social Care.SB has received consulting fees from AstraZeneca, GSK, Stada UK, and Novo Nordisk, and research support from AstraZeneca. These relationships are outside the scope of the present study.The remaining authors declare that they have no competing interests.