39 Figure 2.2 Overview of the characteristics of the included 48 studies: study population (CKD-stage, region, number of participants) and measured domains of HL, specified by study type. The total numbers per category sometimes exceed 48 as some studies were counted multiple times because they addressed multiple CKD-stages or multiple HL domains. CKD = chronic kidney disease, HL = health literacy. STRENGTH OF EVIDENCE FOR MEDIATING FACTORS Table 2.1 summarizes the results on associations between LHL, patient- and system-level factors and health outcomes. In general, evidence was weak. 27 studies provided evidence for an association of LHL with potential mediating factors. Evidence was only strong for an association with smoking[7,33,34] and having a suboptimal transplantation process[35–39]. No studies explicitly assessed mediation. However, four studies provided weak evidence for a potential mediating role of factors related to self-care management[34,40,41] and utilization of care[42], finding independent associations with both LHL and health outcomes. 11 studies found no associations of LHL with the factors of their interest. Details are in the following paragraphs.
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