227 needs of patients and HCPs, with patients from nephrology clinics considered the intervention more useful, compared to patients from general practices (Chapters 3, 4 and 5). The co-creation yielded additional intervention objectives we otherwise would not have included in our change model. These objectives related to understanding the long-term risks of CKD, mental well-being, communicating with HCPs about personal barriers, preventing relapse and maintaining health behavior changes on the long term (Chapters 3 and 4). This is important as, without co-creation, GoYK would have focused too much on improving patients’ knowledge and behavioral intentions, which is a limitation of many health literacy interventions[31,32]. Moreover, the suggestions of participants helped to align the objectives of the different components of the intervention, targeting either the patients or the HCPs. This ensured the intervention contributed to improved cooperation between patients and professionals during consultations. Our findings illustrate co-creation is helpful to make interventions better tailored to the needs of the target groups. We expect co-creation also contributed to prevent the development of top-down, paternalistic interventions, which are less effective in improving health services and changing health behaviors[33]. Moreover, our findings show co-creation is helpful to bridge differences in the needs of patients and the approach of HCPs, which is promising to make interventions, but also health care, more inclusive[34]. In addition, co-creation facilitated the tailoring of intervention content and strategies to the competences and context of people with LHL. For example, we decided to develop a fully paper-based intervention, because many patients with LHL lacked skills to use digital interventions. In the end, participants considered the intervention easy to use, useful and comprehensible (Chapters 4 and 5). These results underline that co-creation helps to develop interventions meeting the needs of the target group[33,35]. This was particularly important in our work because patients with LHL have more problems to make use of informational resources[36]. Without co-creation, we probably would have used more digital strategies, like in other health literacy interventions in people with CKD[30]. This would probably have caused lower study participation or reduced the usability of the intervention, as other studies show digital care solutions are often not accessible for people with LHL and potentially cause health
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