Marco Boonstra

159 INTRODUCTION Approximately 25% of chronic kidney disease (CKD) patients have limited health literacy (LHL)[1], a risk factor for CKD onset and progression[2]. Health literacy is the capacity to obtain, process, and understand basic health information and services, needed to make appropriate health decisions[3]. CKD patients with LHL often have problems in self-management[4]. Health literacy problems also lead to suboptimal communication between patients and health care professionals[5]. Intervening on these factors is central in this study. Better self-management is associated with better health in CKD patients[6]. Self-management is the ability to manage symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition[7]. For CKD patients, integrating health behaviours, such as eating less salt, is central in their self-management. An important precondition for self-management is patient activation, defined as having the knowledge, skills, and confidence to manage health[8]. Regularly, professionals fail to activate the patients and to adequately support self-management[9]. They overestimate patients, use difficult language, or do not meet the specific needs of patients with LHL[10]. Patients with LHL struggle to participate in consultations and often have lower understanding of treatment recommendations[11]. The above illustrates the need to optimize selfmanagement and communication between patients and professionals. Health literacy interventions have been effective in improving the competences of patients[12] and professionals[13], but are uncommon in CKD care. Most interventions target patients with severe CKD or kidney failure, and are not fit to prevent kidney decline in earlier CKD stages. Evidence for their effectiveness is weak and interventions targeting professionals in CKD settings do not exist[14]. To overcome, we developed and pilot-tested Grip on Your Kidneys (GoYK)[15]. GoYK aligns with theory from the European project entitled Intervention Research on Health Literacy among the Ageing Population (IROHLA)[16]. The intervention aims to activate patients by improving their knowledge on CKD and self-management, to motivate patients to integrate healthy behaviours into their

RkJQdWJsaXNoZXIy MTk4NDMw