223 quality of consultations. Moreover, the intervention improved the use of health literacy strategies by HCPs. We found no significant effect on self-management, but in patients who showed unhealthy behaviors at baseline, self-management tended to improve. We also learned that both patients and HCPs generally used the intervention well and found its contents useful and satisfactory. Patients from nephrology clinics used the intervention more and considered the content more relevant, compared to patients from general practices. In the sixth chapter, we analyzed the cost-effectiveness of the intervention for CKD and HCPs. To reach this aim, we used a Markov model to evaluate the effects of GoYK on quality-adjusted life years and healthcare costs in the Netherlands, compared to care as usual. Using the effect of GoYK on hypertension, which is associated with CKD onset and progression, we estimated that GoYK would yield a cost saving of €28,616 and a gain of 0.37 Quality Adjusted Life Year per CKD patient across the life course. These effects were most evident in the first years. In the first 10 years, the intervention would avert 31 deaths and prevent 113 new dialysis treatments per 1000 patients who otherwise would have transitioned to end-stage renal disease. Results remained cost-effective in multiple sensitivity and scenario analyses. DISCUSSION OF THE MAIN FINDINGS The main findings in this thesis will be discussed along three main themes. These themes reflect the steps in our research. First, we discuss important targets to improve self-management of CKD patients with LHL. Second, we reflect upon developing health literacy interventions, in co-creation with the target groups. Third, we discuss the effectiveness and cost-effectiveness of health literacytailored intervention strategies targeting patients and HCPs. Targets to improve self-management of patients with LHL In our studies, we identified promising targets to improve self-management of CKD patients with LHL that should be addressed in interventions. First, we learned that the evidence for targets and interventions to optimize the health outcomes of CKD patients with LHL is weak, especially in earlier stages of CKD. Second, we
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