250 GoYK on costs and QALYs 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. In the final Chapter 7, we discuss our main findings, address methodological considerations and address the implications of the findings. First, the findings in this thesis show patients with LHL face barriers in their self-management that go beyond a limited understanding of information. These barriers relate to disease perceptions, psychological well-being, the social network and maintaining changes in health behaviors on the long-term. These findings add insights to health literacy theories, which can be enriched by adding more contextual and emotional factors. Second, our findings show that health literacy interventions focusing on both patients and professionals are promising. We provide novel insights regarding patient-professional communication, and especially the barriers professionals experience to support CKD patients with LHL. Health care for patients with LHL can be improved by focusing more on the patients’ barriers in dealing with their disease and long-term self-management, and by teaching the professionals competences in providing information, shared decision making and enabling self-management. Targeting the competences of both patients and professionals is a promising strategy to optimize care for patients with LHL. Third, our findings illustrate the benefit of a methodological approach of longitudinal research in combination with co-creation. This combined approach yielded an identification of intervention targets, and a developed and evaluated intervention, i.e. GoYK. Consulting the target groups in every step of our intervention development enriched the intervention objectives, and helped to develop an intervention that meets the context, needs and competences of CKD patients with LHL and their professionals. This is even more important in groups with vulnerabilities, such as patients with LHL, who have more difficulties to access healthcare or find and use health information.
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