Effectiveness of a health literacy intervention targeting kidney patients and professionals

Abstract Background Chronic kidney disease (CKD) patients with limited health literacy (LHL) experience a faster kidney decline. To counteract this, we developed Grip on your Kidneys (GoyK). This intervention targets patients’ communication and self-management. It trains health care professionals (HCPs) competences to support patients with LHL. This study aims to test the effectiveness of GoyK on patients’ health and self-management, HCPs’ communication competences, and the quality of consultations. Methods A clustered and non-blinded quasi-experimental study was conducted, including 161 patients with mild to severe CKD and 48 HCPs from Dutch general practices and nephrology clinics. Patients (n = 77) and HCPs (n = 30) in the intervention group received GoyK. In the control group, patients (n = 76) had routine visits with HCPs (n = 19). Between March 2021 and June 2022, data were collected with questionnaires and from patient records at baseline (T0), 4 months (T1) and 9 months (T2). Primary outcomes were patients’ self-management and HCPs’ use of health literacy communication strategies. Preliminary results At T1, the intervention improved the days per week patients exercised (B = 1.00, 95% confidence interval, CI = 0.35-1.65, P = 0.003), and Likert-scale reported (1-4) fluid intake (B = 0.37, CI = 0.10-0.63, p = 0.006). The intervention had a positive effect on several outcomes related to how patients perceived the consultation quality, and improved the reported use of communication strategies by HCPs at T1 (B = 0.68, CI = 0.35-1.01, p = <0.001). We found no effects on other patient outcomes, like activation for self-management or salt intake. Conclusions Our health literacy intervention, targeting CKD patients with LHL and HCPs, improved lifestyle behaviors of patients and the quality of consultations. A further strengthening of other self-management behaviors and on HCPs’ competences is needed, also to reach sustainable effects in the care for patients with LHL. Key messages • A health literacy intervention, targeting patients and professionals simultaneously, improved the patients’ self-management and care consultations. • Training of HCPs improved their competences to support patients with LHL, and care organizations and studies need to implement education on this topic.


Background:
Chronic kidney disease (CKD) patients with limited health literacy (LHL) experience a faster kidney decline. To counteract this, we developed Grip on your Kidneys (GoyK). This intervention targets patients' communication and self-management. It trains health care professionals (HCPs) competences to support patients with LHL. This study aims to test the effectiveness of GoyK on patients' health and self-management, HCPs' communication competences, and the quality of consultations.

Methods:
A clustered and non-blinded quasi-experimental study was conducted, including 161 patients with mild to severe CKD and 48 HCPs from Dutch general practices and nephrology clinics. Patients (n = 77) and HCPs (n = 30) in the intervention group received GoyK. In the control group, patients (n = 76) had routine visits with HCPs (n = 19). Between March 2021 and June 2022, data were collected with questionnaires and from patient records at baseline (T0), 4 months (T1) and 9 months (T2). Primary outcomes were patients' self-management and HCPs' use of health literacy communication strategies. Preliminary results: At T1, the intervention improved the days per week patients exercised (B = 1.00, 95% confidence interval, CI = 0.35-1.65, P = 0.003), and Likert-scale reported (1-4) fluid intake (B = 0.37, CI = 0.10-0.63, p = 0.006). The intervention had a positive effect on several outcomes related to how patients perceived the consultation quality, and improved the reported use of communication strategies by HCPs at T1 (B = 0.68, CI = 0.35-1.01, p = <0.001). We found no effects on other patient outcomes, like activation for self-management or salt intake.

Conclusions:
Our health literacy intervention, targeting CKD patients with LHL and HCPs, improved lifestyle behaviors of patients and the quality of consultations. A further strengthening of other self-management behaviors and on HCPs' competences is needed, also to reach sustainable effects in the care for patients with LHL.

Key messages:
A health literacy intervention, targeting patients and professionals simultaneously, improved the patients' selfmanagement and care consultations.
Training of HCPs improved their competences to support patients with LHL, and care organizations and studies need to implement education on this topic.

Background:
Balancing electronic nicotine delivery systems (ENDS) health communication between limiting the harm for new users while offering current smokers the benefits of reduced-risk products is challenging. This umbrella review aims to summarize the evidence about ENDS risk and safety health profile to inform ENDS health communication strategies.

Methods:
Six databases were searched for systematic reviews presenting evidence on ENDS health effects. Ninety reviews divided into 5 categories were included: toxicity = 20, health effects = 40, smoking cessation = 24, transition to combustible cigarettes (CCs) = 13, and industry claims = 4. Findings were summarized narratively. Meta-analyses were conducted when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limitedsuggestive, and limited-not-conclusive.

Results:
We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of asthma; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CCs initiation; and exposure to ENDS marketing increases its use/intention-touse. Evidence was moderate for ENDS association with mental health and substance use, and limited-not-conclusive for its association with cardiovascular, cancer, ear, ocular, and oral diseases, and pregnancy outcomes.

Conclusions:
Currently, ENDS communication can focus on high-level evidence related to ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning), and anti-ENDS industry sentiment. Further research is needed to assess the full spectrum of ENDS health profiles.

Key messages:
Further research is needed to establish the risk and safety health profile of ENDS with consideration of the wide variety of ENDS, their frequency of use, and different segments of the population. More prospective cohort studies that take place over longer time periods and with larger sample sizes are necessary to gauge accurately the short-and long-term health-related risks of ENDS.