Background 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. Methods 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. Results 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. Conclusions 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.

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Background Childcare centres have the potential to promote health-enhancing physical activity (PA) in children. However, institutions with need for action seem to be hard to reach. During the project “QueB 2 - developing quality with and through physical activity” different strategies to empower multipliers in spreading awareness for PA were tested. Currently, the aim of the project is to involve teachers at vocational schools for early childhood education in order to sensitize prospective educators and ensure quality in planning interventions. Methods The webinar was developed in three steps: (1) Four workshops were implemented in two vocational schools by participating 80 future educators to train them in planning PA interventions. (2) The collected students’ recommendations and sample projects were categorized in eight steps of a theoretical model for project planning. (3) After finalizing the webinar, questionnaires were used to reflect on its application, utilization, and design. Results The results of the second step were summarized in a manual for planning PA interventions in childcare centres. This forms the basis of the webinar to enable teachers to disseminate PA promotion in class. The developed modules were installed at a website and provided for free in order to be used by the interested public. In step three, teachers tested the webinar and filled in the questionnaire. The majority perceived the webinar as useful, appreciated its clear structure and appealing design, and expressed an increased awareness of factors concerning PA in childcare centres. Conclusions Teachers at vocational schools perceived the webinar as useful to integrate parts of planning PA interventions in childcare settings in the curriculum. Transferring developed manuals and training modules to multipliers by providing an appealing, informative webinar seem to be a successful and sustainable way to ensure quality in planning processes. Key messages • Involving teachers at vocational schools as multipliers for PA in childcare centres by performing a webinar is a sustainable strategy to maintain quality in intervention planning. • Early childhood education students can act as ambassadors for PA.