Marco Boonstra

124 COVID-19 anxiety (n=2), severe illness (n=1), and losing interest (n=1). STUDY PROCEDURE The study procedure consisted of a number of steps (Figure 4.1), described hereafter. Although, the steps to develop the patient and HCP intervention were conducted simultaneously to align their components, we first describe the procedure for developing the patient intervention and then for developing the HCP intervention. Step 1: Problem analysis For both interventions, step 1, the problem analysis, came from the identified barriers for self-management and the proposed solutions in a previous longitudinal, qualitative study, as described in the introduction (see supplementary file 1)[16]. This provided the starting point of our intervention development. Step 2: Logic Model of Change Derived from step 1, the research team formulated preliminary objectives and determinants to intervene on self-management of patients with LHL. Next, an advisory board, consisting of two CKD patients, a medical doctor, a nurse and two researchers provided feedback in a 2-hour meeting on these objectives and determinants. With the mixed-methods below, we further checked and improved the objectives and determinants to be addressed, and outcomes to be aimed at, to include in a final logic model of change (see paragraph 2.2.3.). First, we interviewed CKD patients with LHL (n=19) about 1.5 hours, directly after a consultation with their HCP. We asked open-ended questions on their experiences with self-management and during the consultation to identify new objectives and determinants. Second, we asked them to respond to quotations that reflected the preliminary objectives and determinants. After each meeting, we filled in a standardized form to note important experiences, based on rehearsal of the audio-recordings of the interview. Examples of the used quotations and the form is in supplementary files 2 and 3.

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