Iris Kanera

110 Chapter 5 Box 5.1 Lifestyle recommendations for cancer survivors used in the KNW intervention Physical Activity recommendation At least 150 minutes a week moderately intense activities, spread over at least 5 days a week (e.g., 30 minutes a day) Healthy diet recommendation At least 200 g vegetables every day At least 200 g (2 pieces) of fruits every day Whole grain bread 1 : 6-7 slices (men); 5-6 slices (women) every day Fish two times per week Limitation of alcohol to one consumption (women) / two consumptions (men) a day Less than 500 g a week of red and processed meat Less than 6 g a day of salt Limitation of processed energy-dense foods Note: Adapted from “Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.” by WCRF / AICR (2009) and “American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity”by Kushi et al. (2012; not all recommendations are displayed) 1 for persons aged 18-70 years. We developed and evaluated a web-based, computer tailored intervention for cancer survivors, named Kanker Nazorg Wijzer (Cancer Aftercare Guide, KNW) which aims to complement existing face-to-face aftercare. The detailed research protocol has been described earlier by Willems et al. (2015). The comprehensive content of the KNW covers a combination of multiple lifestyle issues and psychosocial elements, provided through eight specific modules. The lifestyle components of this program, operationalized through the modules Physical Activity, Diet, and Smoking are based on assumptions of the Integrated Model for Change (I-Change Model; de Vries et al., 2003) in which ideas of social-cognitive theories are integrated (Ajzen, 2011; Fishbein & Ajzen, 2010). Furthermore, change methods derived from of the Self-regulation Theory (Baumeister et al., 1994) were applied. Previous research has demonstrated that interventions targeting cancer survivors’ behavior change, such as PA and dieting are effective when these incorporate social-cognitive theories (Green et al., 2014; Stacey, James, Chapman, Courneya, & Lubans, 2015). The theoretical models explain behavior change as a dynamic process with a series of awareness, initiation, and maintenance phases that are influenced by pre-motivational (awareness and knowledge), motivational (intention, attitude, self-efficacy), and post-motivational determinants (goal setting, action- and coping planning; Bolman et al., 2015; de Vries et al., 2013; Peels, 2014). The theories assume that a continuous process of self-regulation is facilitated through the application of behavior change strategies such as goal setting, action- and coping planning, monitoring, evaluating plans, and refining goals when necessary (Bartholomew et al., 2011; Lechner, Mesters, & Bolman, 2010). In addition, the contribution of the determinants to change can differ from one behavior to another and from one person to another (Fishbein &