Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009–19. We assessed the quality of the studies and conducted a best-evidence synthesis. We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient–provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.

Limited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management. We performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals. Four themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers. We suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs. HCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.

Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.

Background: Chronic kidney disease (CKD) patients with limited health literacy are at risk for faster disease progression. To counteract this problem, we developed ‘Grip on your Kidneys’ (GoYK), an intervention targeting patients and health care professionals. We assessed the effect on self-management, patient activation, clinical parameters, consultation quality, and the professionals’ use of health literacy strategies. We further evaluated the process. Methods: A quasi-experimental study included 147 patients with CKD and 48 professionals from Dutch general practices and nephrology clinics. Patients and professionals in the intervention group (IG) received GoYK. Control patients received care-as-usual from the participating professionals. Data were collected with questionnaires and from patient records at baseline ( T 0), 4 months ( T 1) and 9 months ( T 2). Results: No effects on self-management and patient activation were found. Conversely, at T 2, the proportion of patients with hypertension decreased in the intervention group (odds ratio = 0.45, 95% confidence interval (95%CI) [0.20, 0.99]). In the intervention group, more lifestyle topics were discussed, at T 1 (difference = 0.80, 95%CI [0.28, 1.31]) and T 2 (difference = 0.69, 95%CI [0.14, 1.25]). Furthermore, several outcomes related to consultation quality improved. Professionals in the intervention group improved the use of health literacy strategies more, at T1 (difference = 0.64, 95%CI [0.33, 0.95]) and T 2 (difference = 0.56, 95%CI [0.19, 0.93]). In general, patients and professionals considered GoYK to be useful. Conclusions: GoYK is promising, and offers a blueprint to optimize care for patients with limited health literacy. Researchers should develop and test interventions like GoYK, focusing on patients at risk for CKD, and with very low health literacy. Graphical

Background: Chronic kidney disease (CKD) is a progressive disease with high societal costs. CKD progression is influenced by patients’ health literacy, i.e., the patients’ ability to deal with information related to their own health. Objective: To assess the cost-effectiveness of Grip on Your Kidneys (GoYK), a multi-component health literacy intervention for CKD patients and their healthcare professionals. Design and Main Measures: We performed a cost-utility analysis of the GoYK intervention, measuring health outcomes in terms of quality-adjusted life years (QALYs) and costs in euros, and extrapolated the results to a lifetime horizon using a Markov model. Subjects: The GoYK study was a quasi-experimental study involving 147 patients with CKD and 48 healthcare professionals from Dutch general practices and nephrology clinics, followed over nine months. Key Results: We found that the GoYK intervention would yield a cost-saving of €28,616 and a gain of 0.37 QALYs per CKD patient across the life course. Moreover, GoYK would avert 31 deaths and 113 new dialyses per 1,000 patients in the first 10 years. These results mainly stemmed from the intervention effect on the transition to end-stage renal disease, where reductions of as little as 1% would already mean GoYK is cost-saving. The intervention remained cost-effective in multiple sensitivity and scenario analyses. Conclusions: GoYK might be a solution to slow CKD progression and, thereby, reduce CKD costs. Given these promising findings and the novelty of our study, further research should confirm our findings before broad implementation.

PurposeThis study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics.Methods1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores.Cronbach αandSpearman rho’sindicated measurement properties were good to acceptable for the SILQ-NL37.ResultsThirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher.ConclusionsAccording to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.