17 These interventions improved the patients’ knowledge, decision-making during consultations and to some extent patients’ self-management, but the studies mainly focused on ESRD, often lacked a control group, and measured effectiveness directly after the intervention was provided. To our knowledge, there is no evidence yet on the effectiveness of health literacy interventions on long-term self-management of health behaviors or clinical outcomes in CKD context. Additionally, there are no interventions aiming to improve the competences of CKD HCPs to better support patients with LHL[57–61]. A better understanding of the effect of health literacy intervention strategies, targeting both patients and HCPs, is needed. In addition to lacking evidence on the effectiveness and what factors should be targeted, it is unclear what intervention strategies meet the needs and competences of patients with LHL. For example, to improve self-management of patients with LHL, some non-CKD studies suggest low intensity interventions which are easy to use and accessible[62], while others state more intensive multicomponent interventions with several elements are needed to establish behavior change. In multi-component interventions separate components, together, aim to improve the patient’s knowledge, behavior change, or the communication competences of HCPs[63,64]. It is also uncertain what type of interventions are most promising to optimize the patients’ and HCPs’ competences. In general, it is suggested to use simple language, visually attractive strategies, such as pictures and video’s, and to be careful with digital strategies, as LHL is associated with limited digital skills[65,66]. However, there is limited evidence on the effectiveness of these type of interventions on self-management or health outcomes, so further study is required. Furthermore, there are no studies in CKD context on health literacy interventions to equip HCPs to support patients with LHL better. A review of Coleman et al. gives suggestions for useful strategies to improve the competences of HCPs on this behalf, for example by didactic teaching, role-play, direct observation and feedback[67]. With these strategies, health literacy trainings should aim to optimize the competences of HCPs to review information needs and patient preferences, to respond to patients’ ideas and to enable shared decision making[68]. There is evidence from non-CKD studies, health literacy training of HCPs is effective. For example, a training improved the knowledge and
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