232 the identification of intervention targets and strategies, and the development and evaluation of GoYK. The systematic review helped to identify research gaps, and to provide evidence on promising targets for interventions. The qualitative methods filled these research gaps by uncovering barriers in selfmanagement and communication of both patients with LHL and of HCPs. The co-creation study integrated qualitative and quantitative methods, resulting in the development of GoYK, based upon the earlier results. After that, we used quantitative methods to assess the effectiveness of the developed intervention. We concluded with a cost-effectiveness analysis to learn if the intervention was cost saving. A limitation is the sequential use of our quantitative methods and qualitative methods. These could have been combined for a more comprehensive understanding. For example, conducting in-depth interviews in addition to the quasi-experimental study could have yielded experiences of participants with the intervention, which can offer explanations for its (in)effectiveness. The next section describes the strengths and limitations of the samples used for the various methods we used. Thereafter, we consider the quality of the information and to what extent our research meets the causality criteria. Quality of the samples For the qualitative and quantitative studies (Chapter 3, 4 and 5), we recruited participants from seven Dutch general practices and seven hospitals. Regarding the quality of those samples, we see strengths and limitations. Strengths include the representativeness of the sample and our successful recruitment of hardto-reach patients with LHL. Our sample’s background characteristics are largely representative of the population with CKD in the Netherlands. Similarly, the HCPs who participated in our study are representative of HCPs working within the Dutch CKD care settings. Our recruitment strategy, which combined efforts of the HCPs to recruit patients with the measurement of health literacy level with a screener(45), enabled us to identify and recruit patients with LHL, who are generally underrepresented in research(44). However, limitations regarding the quality of our samples should also be considered. A first limitation relates to the sample size of the quantitative study, which was lower than intended. An a priori sample calculation advised a sample
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