Marco Boonstra

41 HL screeners, patients did not perceive utilization of care as a major challenge [61,62,68]. Patient-provider interaction Eight studies gave weak evidence on factors related to patient-provider interaction. CKD patients did not perceive engaging with providers as their greatest HL problem[41,61,62]. However, in adolescents above 18 years, one study showed that LHL was associated with several behaviors related to communication [49]. Another study showed an association of these behaviors with perceived general health[69]. Health care professional visits[37] and simple word choice[56] positively influenced CKD awareness and knowledge. LHL was not associated with provider satisfaction[41]. Other system factors Five studies provided weak evidence on associations of LHL with the social context. For an association of LHL with reduced social support evidence was weak[36,45,70]. The social context was a strong and independent factor influencing self-management behaviors[70] and medication trade-offs[40]. There was no evidence regarding other Paasche-Orlow derived mechanisms, such as the HL competences of professionals. Suggestions for intervention targets Table 2.2 provides an overview of the four qualitative studies, which offer suggestions for intervention targets within different Paasche-Orlow derived mechanisms. Patients indicated that a lack of knowledge[71–73] and symptoms[73], perceived disease seriousness[73] and struggles to find information[71] influence self-care management in earlier CKD stages. A lack of knowledge[71,72,74] and time[73,74], perceived hierarchy[74], difficult language[71,72] and insufficient information[71,73,74] were barriers for effective patient-provider interaction and treatment decision-making. To improve that situation, patients suggested easier language[71–73], peer support[72] and a role of the social support [71,72].

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