Marco Boonstra

126 frequently used intervention methods, such as individual and group counselling, or digital, written and visual communication. During this feedback session, we also showed patients real examples of strategies, and asked for feedback and preferences. These strategies are normally used by several nephrology clinics, the Dutch Kidney Foundation and the Dutch Kidney Patient Association. Step 4: Program production In the fourth step, we produced a first draft of the patient intervention. During the production, we linked the final objectives and determinants from step 2 with the strategies from step 3 and developed the content of each component of the intervention. Below we provide a description of this program production. First, a draft version of the intervention was fully designed by the research team in cooperation with a professional graphic designer. Second, the advisory board provided feedback on the draft version in a 2-hour workshop, and in an additional round of written comments. Third, we improved the draft intervention and prepared it for the evaluation below. Step 5: Evaluation The fifth, final step consisted of pilot-tests to evaluate the intervention’s adoption and barriers for future implementation. This was done by determining its usability, usefulness, comprehensibility, and fit to needs. First, CKD patients with LHL (n=4) used the intervention independently or with the help of a significant other. Second, in an interview and evaluation questionnaire, we asked their opinion on the intervention. The recordings of the interviews were analyzed afterwards. Third, independent raters, a researcher from our department and two students in nursing, filled in checklists of the Health Literacy Assessment Tool for Identifying Facilitating Factors and Barriers to Information, Care, and Services[36] to check writing style, organization and design of the patient intervention.

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