237 of patients with LHL, as they may lack the required competences. Hence, digitalization may not be the solution that many believe it to be. We suggest specific, tailored care solutions for patients with LHL, and additional support to use digital resources like Electronic Patient Records. Our finding on the difficulties that patients encounter when they make use of informational resources also holds value when we focus on the broader health systems in the Netherlands. Patients often need to complete complex procedures to access and receive care. For example, they need to obtain information from health insurance companies in online client portals or fill in complicated forms to arrange care. This may increase health inequalities, as people with higher literacy are able to get the health care they need, whereas people with lower literacy are not. We suggest policy makers, such as the government and health insurance companies, should reduce this administrative burden and ensure care systems are accessible for everyone. Lastly, our work shows HCPs lack competences to recognize and communicate with patients with LHL. HCPs are not sufficiently successful to support this group of patients, which can be improved with health literacy training. This has two important implications. First, more attention can be given to health literacy and strategies to support people with LHL in medical, nursing and social work curriculum. Second, health care organizations can provide trainings in their workplace to help their staff better recognizing and supporting patients with LHL. Our training offers important strategies for HCPs to develop competences in shared-decision making and in supporting long-term self-management. This training can also be adapted to the context of other patient populations. Implications for research Our findings also have several implications for research. First, we found that most health literacy research is conducted in CKD settings focusing on dialysis and transplant patients, who have end-stage renal disease. Preventive interventions in early stages of CKD are needed to slow down the global rise in the occurrence of kidney disease, and to mitigate the negative effects of LHL. To this purpose, researchers should put more effort in developing and testing interventions
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