Abstract

Background: Chronic kidney disease (CKD) is one of the chronic diseases that seriously jeopardize human health and is characterized by complexity, progress, and irreversibility. In recent years, the morbidity and mortality rates of CKD have been increasing year by year. Health literacy can enhance CKD patients' access to, understanding of, and application of health information and is a prerequisite for improving patients' health behaviors and delaying disease progression, and thus has received increasing attention.

Objective: The aim is to construct an intervention program for health literacy in patients with chronic kidney disease using the 2021 version of the Complex Intervention Development and Evaluation Framework as a guide to provide a scientific basis for conducting future intervention studies.

Methods: First, based on the social-ecological system theory, a cross-sectional study was used to analyze the current situation of health literacy in CKD patients and the factors influencing it. Through qualitative interviews, we further explored the factors promoting and hindering the health literacy of CKD patients and uncovered their intervention needs. Then, an evidence-based approach was used to summarize the evidence of existing intervention strategies, and a preliminary draft of a health literacy intervention program for CKD patients was constructed based on the health literacy model. Based on this, the Delphi method was adopted to revise and improve the intervention program, and the final draft of the health literacy intervention program for CKD patients was formed.

Results: The results of the quantitative study showed that health literacy among CKD patients is not optimistic. The number of comorbidities was a barrier, while education level, per capita monthly household income, family support, and optimism were facilitators of health literacy in CKD patients. Moreover, qualitative studies have shown that facilitators of health literacy in CKD patients include positive coping, social support, and technology-enabled health; barriers include negative coping, lack of disease awareness, and online information pollution; and intervention needs include intervention content needs, intervention form needs, and intervention individualization needs. The best evidence summary summarizes 20 pieces of evidence in 4 areas (intervention goals, assessment tools, intervention strategies, and evaluation of intervention effects). Based on these results, an initial intervention program was constructed, followed by two rounds of Delphi expert correspondence to refine the intervention program. Conclusion: Health literacy intervention program for CKD patients, including 4 modules, 12 intervention topics, and 43 intervention contents, which is constructed in a scientific and rigorous manner and can provide a basis for improving the health literacy level of CKD patients.