The Chronic Conditions Course for Young Adults (CCC-YA): An evaluation of an adapted online psychological program for young adults with chronic physical health conditions

The intervention, the Chronic Conditions Course for Young Adults, is an internet-delivered self-management program. It is adapted from the Chronic Conditions Course for young adults aged 18-29 with chronic physical health conditions. The program is based on cognitive behaviour therapy (CBT) principles and teaches evidence-based skills for managing the impacts of chronic health conditions on daily functioning and emotional wellbeing. Adaptations from the original program include developmentally tailored language, case stories and examples, modifications to content delivery and format, and the inclusion of additional material targeting key domains relevant to young adulthood (e.g., study, work, relationships, identity, and independence). The course runs for 8 weeks and consists of: (a) 5 online lessons with exercises for learning the information and skills. The duration of each lesson is approximately 20 to 30 minutes. Lessons can be viewed in the online platform, or downloaded as PDF files. Lessons are accompanied by lesson worksheets which can be downloaded and/or printed as PDF files. Participants are encouraged to engage with the home-based exercises at a frequency and duration that is helpful for them, though a suggested time commitment of at least 30 minutes each week is encouraged. The first lesson (week 1) provides an introduction and overview of the course, including psychoeducation about chronic health conditions and emotional wellbeing, tailored to the experiences and developmental context of young adults. Participants are encouraged to identify their symptoms (e.g., thinking styles, physical symptoms, unhelpful habits) as a home-based exercise. Lesson 2 (week 2) introduces cognitive challenging skills, and participants are encouraged to practise thought challenging in the following two weeks. Lesson 3 (week 4) covers behavioural activation and relaxation strategies to manage mood and anxiety symptoms, and participants are provided with resources to undertake activity scheduling as a home-based task. Lesson 4 (week 5) introduces activity pacing to manage symptoms such as pain and fatigue, and graded exposure to manage anxiety and avoidance. Following lesson 4, participants are encouraged to attempt activity pacing and/or graded exposure tasks as a home-based exercise. Lesson 5 (week 7) includes information and strategies relating to relapse prevention, and participants are given materials to help with goal-setting for the future and a relapse prevention plan. (b) Automatic emails that help guide people through the course, sent once or twice per week. Examples of these e-mails include: reminders when new lessons are available, congratulatory messages once a lesson has been completed, brief messages that reinforce the core concepts of the lessons, and e-mails inviting contact and encouraging engagement if a participant has not logged in for a while. (c) Additional Resources developed specifically for this study. These resources provide information about different problems people often struggle with, including managing sleep, working with health professionals, etc. (d) Case stories and examples based on previous participants, tailored to reflect the experiences of young adults with chronic health conditions. These are briefly incorporated into each lesson and available as optional materials that participants can access at their own discretion. Participants will have the option of support from a psychologist as they work through the course, via telephone or secure personal messaging. All psychologists will be nationally registered and employed by Macquarie University. All psychologists will be provided with training and supervision from a senior psychologist to ensure competence and safety in their practice. Adherence with the intervention is monitored via the study's secure web platform, which records the number of participant log-ins, lesson completions, time spent completing each lesson, and number of downloads of additional resources.