Abstract Body: Introduction:
Lifestyle interventions are a promising approach to promote health behavior change, yet integrated interventions for multimorbid conditions, such as cardio-kidney-metabolic syndrome, are lacking. Moreover, patient recruitment, engagement and retention are major barriers to impacting behavior change, especially for people living with socioeconomic disadvantages. To overcome these challenges, we aimed to co-design with community, health system and patient partners ‘The Health Integrated Nutrition and Kidney Wellness (THINK-Well)’ intervention for people with cardio-kidney-metabolic syndrome and to describe our human-centered design approach to intervention development.

Methods:
Using human-centered design methods, we conducted three one-hour virtual meetings with a panel of seven partners representing patients with kidney disease, registered dietitians, grocers, nephrologists, healthcare payers, lifestyle coaches, and a national kidney organization. Meetings used a virtual collaboration board to share observed barriers to recruitment, engagement and retention, propose solutions, and create an intervention blueprint.

Results:
Based on panelists feedback, the top challenges were poor visibility of recruitment communications and the need for curriculum individualization and incentives to promote engagement and retention. The first meeting generated thirty ideas, which were prioritized by importance and implementation difficulty during the second meeting. The blueprint for THINK-Well intervention was designed to align with the Capability, Opportunity, Motivation-Behavior theory in the third meeting. The intervention included recruitment newsletters and reminder text messages to increase awareness of resources; a mix of biweekly virtual and in-person group meetings to promote socialization and remove travel constraints; retention items such as food boxes and biometric devices to enable and educate about nutrient-rich eating and health monitoring; and goal setting to motivate through individualized counseling.

Conclusions:
We co-designed THINK-Well intervention in partnership with patients, multi-level health system representatives and community advocates. The human-centered design approach generated practical solutions to recruitment, engagement and retention using the experiential knowledge of panelists. Future steps will test feasibility and implementation of THINK-Well Intervention.