18 competences of HCPs to communicate better with patients with LHL[69]. In addition, HCPs were better able to check the patients’ understanding by asking them to repeat the main messages in their own words[69], also referred to as teach-back[67]. DEVELOPING HEALTH LITERACY INTERVENTIONS FOR CKD HEALTH SETTINGS Despite the substantial evidence on the role of health literacy in developing CKD and its negative associations with CKD health outcomes[3,45], interventions remain scarce. Several international organizations state it is necessary to develop interventions targeting CKD, and, more specific, patients with LHL, to abate the global rise of CKD. The World Health Organization (WHO) signals an increase in CKD, diabetes and cardiovascular diseases. Often these diseases come together, complicating the treatment and self-management by the patients, especially for those with LHL, which needs attention in care and research[70]. With an expected shortage in the health workforce and growing digitalization, policy from the European Union as well as interventions are needed to improve health literacy, and to guarantee sustainable health systems in the future[71]. The framework delivered by the project ‘Intervention Research On Health Literacy among Ageing population’ (IROHLA) offers guidance to develop health literacy interventions with the aim to optimize self-management, communication between patients and HCPs and health outcomes[26,72]. This framework, shown in Figure 1.2, is based upon scientific literature, expert consultations and meetings within the project[28]. We use this framework in the intervention development in this thesis. Central are the individual, or patient, the healthcare professional, and the communication between them. Communication, influenced by both the context of the patient and the health system, is key to optimize the patients’ health literacy, and thereby intermediate results, such as self-management or care use. The improved intermediate results lead to improved health outcomes, which foster healthy ageing. Although the IROHLA framework provides information on relevant target groups for interventions, we did not exactly know what factors or barriers our health literacy intervention in CKD setting needed to target and what strategies were
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