Table 4.
Final logic model of change with the four components of our intervention, and final objectives, determinants and outcome expectations.
| Objective | Determinants | Outcome Expectations | SocM # |
|---|---|---|---|
| Improve awareness and knowledge on CKD self-management | HCPs know strategies to create CKD awareness in patients with LHL. HCPs inform CKD patients in simple language and with visual strategies. HCPs check the CKD patient’s understanding. Patients are aware of having CKD and what this diagnosis means (*). Patients understand (symptoms of) CKD and the long-term risks of CKD (*). Patients know important risk factors for developing more severe CKD (+). Patients know how self-management can stabilize kidney function (+). Patients ask for clarification and questions during consultations if needed. |
Patients are more aware of CKD. Patients understand CKD better. Patients understand self-management of CKD better. Patients understand the long-term risks of CKD better. Patients feel more urgency to prevent further kidney deterioration. Patients discuss CKD better during consultations with HCPs. |
Precontem-plation and contem-plation |
| Improve motivation and preparation of self-management |
HCPs use health or life aims in goalsetting to motivate themselves to self-manage(+). HCPs apply shared decision making to decide on aims and self-management. Patients see the rewards of self-management for CKD and quality of life (*). Patients share their personal needs regarding self-management with HCPs. Patients prepare consultations to better discuss self-management (+). Patients feel confident to follow up self-management advice at home (+). Patients involve their social network in their self-management (*). |
Patients know the exact goals of self-management of CKD. Patients contribute to decisions on self-management of CKD. Self-management goals are tailored to the patients’ needs. Patients are more confident to improve self-management. Patients are better able to adopt self-management in daily life. The social network helps to adopt self-management changes. |
Preparation |
| Improve practical competences for self-management and to maintain behaviors on the long-term | HCPs translate general self-management advice into action points. HCPs ask about and respond to self-management barriers of the patient (+). HCPs seek solutions to barriers using shared decision making. Patients have the practical competences to improve lifestyle and medication adherence. Patients share their doubts regarding advice given by HCPs (+). Patients share their barriers and relapses with HCPs (+). Patients know strategies to prevent relapse of self-management changes. Patients recognize and solve barriers that negatively influence self-management (such as negative emotions, feasibility problems, relapse) (*). Patients seek additional help if they experience self-management barriers (+). |
Patients gain practical skills for self-management of CKD. Patients are better at discussing barriers for self-management. Patients overcome barriers for maintenance of self-management. Patients maitain self-management changes in the long term. Patients deal better with emotions, infeasibility of advice and relapse. The social network supports patients in maintaining changes. |
Action and maintenance |
| Improve the competences of HCPs | HCPs have awareness and knowledge of HL and its consequences. HCPs apply strategies to identify patients with LHL. HCPs involve the social network in consultation and treatment. HCPs empower the social network to contribute to self-management. HCPs know and apply tailored strategies to support patients with LHL during different stages of behavior change. These strategies are indicated behind the objectives above (informing patients in simple language, check understanding, using health or life aims, applying shared decision making, translating advice into action points, responding to barriers etc.) (*)(~). |
HCPs have awareness and knowledge regarding health literacy. HCPs recognize patients with LHL. HCPs know effective strategies to support patients with LHL better and to involve the social network. HCPs apply the mentioned strategies effectively to support the patient during different stages of behavior change. |
HCP support |
# SoCM = Stages of Change Model. * = adapted determinant, based on step 2 of the IM protocol. + = new determinant, based on step 2 of the IM protocol. ~ = to effectuate the patient-targeted objectives, the HCP plays an important role, as is visible in the determinants. The fourth objective targeting the HCPs aims to help them to acquire the needed strategies to support patients with LHL better. HCPs = health care professionals. LHL = limited health literacy.