136 Step 5: Evaluation of the intervention Patients, in general, found the intervention easy to use, useful and comprehensible. They reported it helped to improve their understanding, but also to contribute to consultations with HCPs. Details are in table 4.3. Additionally, the interviews informed improvements. First, patients suggested delivering the intervention in smaller steps to prevent that they needed to do too much at once. Second, if GPs did not discuss CKD during consultations, patients did not see why they needed the intervention. Third, sometimes HCPs did not respond adequately to the filled in card. We ensured the workshop taught HCPs about the patient intervention better, so that they understood their role. Patient with moderate CKD, female, 47 years: ‘I learned a lot from this program. I learned about the functioning of the kidneys, and I think it is good to know what information I should share with the doctor’. Patient with moderate CKD, male, 77 years: ‘The general practitioner never extensively discussed my kidney problems. So when I used the intervention, I was wondering to what extent it was for me’. The checklists of the Health Literacy Assessment Tool [39] gave a combined rating above 70% for all strategies of the patient intervention. This indicated writing style, organization and design of the intervention, in general, met the needs of patients with LHL. The content of the brochure and website was identical, but the website was rated lower. The reason was the website lacked features, such as a search function, because it was structured as an e-learning that patients use step-by-step. The topic-based brochures contained more text, giving a lower score on writing and organization of information. Details are in supplementary file 5.
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