Marco Boonstra

122 and medication to be complex. Finally, patients report problems in maintaining better self-management in the long term[16]. The long-term effect of existing HL interventions, targeting self-management behaviors of CKD patients with LHL, often with digital strategies, is unknown[17]. These interventions do not aim to increase competences of HCPs and target groups often were not consulted during development[18-25]. However, multi-component and co-created interventions, aiming to establish more productive interactions between patients with LHL and HCPs [26], are more likely to be accepted or effective[27-30]. Multi-component interventions have several elements which all contribute to establish change[31]. In such interventions, for example, separate components aim to improve the patient’s knowledge, health behaviors, or the communication competences of HCPs. In our study, co-creation is approached from two perspectives. Firstly, we aim to co-create aligned intervention components targeting both patients and HCPs to facilitate patient-centered communication, which is central in definitions regarding co-creation of care[31]. Secondly, we apply several co-creation methods during the defining, production and evaluation of the intervention (i.e., interviews and usability tests). Co-creation is defined as a participatory approach in cooperation between researchers and target groups, to ensure interventions meet their needs, preferences and abilities with an understanding of the specific context and setting[27]. To our knowledge, no co-created and multi-component HL interventions targeting both CKD patients with LHL and HCPs exist. It is unclear how the objectives, strategies and content of such an intervention can be aligned to the needs of LHL patients with CKD and HCPs. To overcome this problem, we combined the principles of the Intervention Mapping (IM) protocol and co-creation to develop an intervention step by step, targeting the self-management and communication competences of CKD patients with LHL and the competence of HCPs in supporting these patients. Firstly, we aimed to determine the objectives and strategies for the intervention. Secondly, we aimed to design and produce the intervention and evaluate if it was usable, comprehensible, and met the needs of the target groups.

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