22 AIMS OF THIS THESIS Against this background, this thesis aims to develop and evaluate a multicomponent intervention to strengthen self-management of CKD patients with LHL and to strengthen communication between these patients and their HCPs in both general practices and hospitals. To reach our main aim, we used a stepwise approach with multiple studies. Each study had a specific aim: 1. To summarize the evidence on patient- and system-level factors potentially mediating the relation between LHL and health outcomes, and on the effectiveness of health literacy interventions customized to CKD patients LHL (Chapter 2). 2. To explore experiences with and barriers for self-management, from the perspectives of both CKD patients with LHL and HCPs (Chapter 3). 3. To determine the objectives and strategies for a multi-component intervention targeting CKD patients with LHL and health care professionals. Moreover, to design, produce and evaluate the intervention to meet the needs of the target groups (Chapter 4). 4. To assess the effect of the intervention on self-management of health behaviors, patient activation, clinical parameters, quality of consultations, and the health care professionals’ use of health literacy strategies. Moreover, to evaluate the use and usefulness of, and satisfaction with the intervention (Chapter 5). 5. To analyze the cost-effectiveness of the intervention by evaluating the effects of the intervention on quality-adjusted life years and healthcare costs in the Netherlands compared to care as usual (Chapter 6).
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