238 focusing on patients with a risk profile for developing CKD, such as those with diabetes or cardiovascular diseases, and on patients with an early-stage CKD diagnosis, such as those in primary care settings. Second, our findings show that health literacy interventions are able to improve clinical outcomes, such as hypertension. An important remaining question is to what extent our intervention can optimize self-management of health behaviors and eGFR. To answer this, more extensive intervention studies with bigger samples and a longer follow-up are needed. Therefore, we suggest a broader implementation of our intervention in CKD care settings, which requires additional research on the effectiveness of GoYK. In addition, we invite researchers to develop and test new interventions simultaneously targeting patients and HCPs. Our methodology can provide a blueprint to develop these interventions. Third, to our knowledge, research on the cost-effectiveness of health literacy interventions is rare. We suggest that researchers conducting educational or behavioral intervention studies should more often include cost-effectiveness analyses. This is important to determine to what extent these interventions, for example targeting health literacy or health behaviors, are able to mitigate the economic burden related to rising healthcare costs. In addition, such insights can be important to establish a business case to convince health insurance companies to invest in the most promising interventions as routine care. Fourth, we learned co-creation is helpful to tailor interventions to the specific needs and competences of both CKD patients with LHL and HCPs. We recommend that other researchers should always include the target groups in different phases of their research, as this is helpful to determine the objectives, strategies and content of an intervention, especially for hard-to-reach groups, such as those with LHL or lower socio-economic status. In addition, we noticed it was challenging to guarantee acceptability in the different general practices in our quasi-experimental study. More research is needed on the barriers and facilitators of implementation in this care setting.
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