10 Many people have limited health literacy (LHL)[1], which is associated with worse health outcomes[2,3], barriers in patient-professional communication[4,5], and worse self-management of lifestyle[6–10] and medication[11,12]. Patients with LHL are less able to access, understand, appraise and communicate information to engage with the demands of different health contexts to promote and maintain good health across the life course[13]. With effective communication, healthcare professionals (HCPs) can mitigate these effects of LHL. However, they have problems to identify patients with LHL and lack competences to communicate with them effectively[5,14]. Despite this evidence, health literacy is often not appropriately addressed in clinical care. Targeting patients with LHL and their HCPs with interventions is a proposed strategy to mitigate the global impact of chronic kidney disease (CKD)[15]. CKD occurs frequently and during the last decades, its global prevalence has risen continuously. It is now estimated that 10 to 15% of all adults have CKD[16–18]. The patients’ health and quality of life are highly affected when the kidneys deteriorate. Especially when patients need dialysis or a transplantation, the treatment and disease are a severe burden[19]. To prevent kidney deterioration, self-management of lifestyle and medication is key, but patients, especially those with LHL, consider it complicated or burdensome[20]. Additionally, HCPs encounter challenges to inform patients about CKD and to support their selfmanagement effectively[21]. Tailored interventions, targeting both the barriers of CKD patients with LHL, and the HCPs, are absent. “I had no idea CKD could be very severe, so to say. Until, later, the nephrologist said I was very close to needing dialysis. I thought: ‘Wait a minute, maybe it is bad after all! But then it was already too late, so it didn’t matter anymore”, male with severe kidney disease, 63 years “I am thinking, but during my whole career, I never said to a patient you have kidney disease, despite the fact that there are dozens of people with reduced kidney function. I just stick to telling ‘there are some proteins in your urine”, general practitioner, 61 years
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