143 DISCUSSION Following the principles of the IM protocol, we produced a four-component intervention, Grip on your Kidneys. Three components contain objectives targeting CKD patients with LHL to improve their CKD knowledge, and competences to prepare, act upon and maintain self-management. One component has the objective to optimize the competences of HCPs to support these patients. From patients, we learned additional determinants within these objectives, especially to improve their communication competences and maintaining of lifestyle behavior changes. Patients preferred visual strategies, and strategies to improve their contribution to consultations, while HCPs valued training on LHL. Evaluation showed our intervention is comprehensible and useful for patients with LHL and their HCPs. The four components of Grip on your Kidneys encompass a comprehensive set of objectives and determinants focusing on both CKD patients with LHL and HCPs. Based on interviews, we added eight determinants targeting their communication competences to discuss self-management needs and barriers and the patient’s competences to maintain lifestyle changes on the long-term. We think these are important to overcome a weakness of HL interventions, that they often focus only on the patients, and specifically their knowledge[30,44]. There is evidence our final objectives and determinants are relevant. For example, HL theory states it is important to focus on both the patient and HCP to improve self-management and health outcomes[45,46]. Additionally, the importance of teaching the HCPs competences to support patients with LHL is acknowledged[6,14,47]. Although, other studies give results challenging our intervention. For GPs, there is evidence low intensity interventions have a more positive effect on health behaviors[48], indicating our intervention objectives might be too extensive. HCPs consider learning competences related to enabling self-management, the most important objective of our training, less relevant, compared to providing simple information[49]. In step 3 of our study, we found patients with LHL preferred visual strategies and supporting tools to discuss their needs and barriers with HCPs. Written and digital strategies, and group meetings were not preferred often. Other studies confirm people with LHL prefer visual strategies, and have problems to use digital[50,51], written and oral information, also in CKD care[45,52–55]. Our results
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