138 RESULTS FOR THE HCP INTERVENTION Step 2: Logic Model of Change For the HCP intervention, we formulated one objective, aiming to improve the competences of HCPs to apply strategies to communicate better with patients with LHL. This is important as, according to the experiences of patients, effective communication is key to improve self-management. Within this objective, we formulated three determinants: 1. HCPs have awareness and knowledge on health literacy and its consequences. 2. HCPs know and apply strategies to identify patients with LHL. 3. HCPs know and apply tailored strategies to improve awareness, knowledge and self-management, as indicated behind the objectives in table 4.2. Comparison of our preliminary determinants with those of the training of Kaper et al.[37,38] revealed there was overlap. For example, we embraced the determinants to make HCPs aware and knowledgeable on the prevalence, risks and impact of LHL, be able to identify patients with LHL, and to improve their patient-centered communication strategies. For example, we considered it important HCPs are able to recognize patients with LHL, provide simple information, involve patients in shared decision making and enable their selfmanagement. However, as CKD is a chronic disease, we decided to put more emphasis on strategies to enable maintaining long-term self-management, by discussing barriers, emotions, concern and needs of the patients. We dropped determinants related to the assessment and writing of comprehensible information because we aimed for comprehensible information within the patient intervention. The final objectives, determinants and expected improved outcomes for both the patient and HCP intervention are in the logic model of change in table 4.4.
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