Iris Kanera

5 113 Lifestyle-related effects of the Kanker Nazorg Wijzer grounded, web-based intervention aiming to enhance QoL among early cancer survivors by promoting positive lifestyle changes (i.e., sufficient PA, healthy diet, and smoking cessation) and by providing psychosocial support in the area of fatigue, anxiety and depression, relational problems, and return to work. Each separate topic is integrated in one of the eight KNW modules. After completing the baseline assessment, participants (IC) received personalized recommendations on which modules could be most meaningful for them. The recommendations were based on the responses to the baseline assessment (for detailed information see Willems et al., 2015). Nevertheless, the program allows the user to make a free selection of all modules based on personal needs and interest. Technically, the KNW is a fully automated expert system containing an extensive pre- programmed message library that operates without human involvement. By means of computer tailoring, individual answers to the baseline assessment are automatically evaluated, and the corresponding messages and intervention fragments from the pre- programmed library are selected and combined, using if-then algorithms. Consequently, personalized information is generated (de Vries & Brug, 1999). The information within the KNW is tailored to personal characteristics (gender, age, marital status, children, educational level), cancer-related issues (type of cancer, type and number of comorbidities), motivational determinants (attitude, self-efficacy, social support, and intention), and current behavior (e.g., lifestyle). Concerning the content of the KNW, seven out of the eight modules are self-management modules and configured to target the specific needs associated with the relevant topic. The eighth module provides general information about the most common residual problems. The main target of the module PA was to increase PA, during, for example commutes, daily living activities, leisure time, and sports. In the module Diet, the emphasis is placed on increasing healthy eating behaviors through fruit, vegetable, whole grains, and fish consumption. The participants were encouraged to set one or two goals concerning these food groups. Promoting the consumption of healthy food might be a more positive way to achieve changes in diet than by focusing on omission of unhealthy food. More healthy food choices could lead to fewer unhealthy choices. High-fiber diets are, for example, commonly low in fat (Davies et al., 2011). However, all dietary recommendations, including the limitation of red meat, fat, sugar, salt, and alcohol consumption, were presented within the module Diet (Box 5.1). The goal of module Smoking was to support smokers in refraining from smoking. In addition, support was also provided to former smokers to prevent relapse. Throughout the KNW, principles of ProblemSolvingTherapy havebeen applied toencourage self-management (D’Zurilla & Nezu, 2007). Within the lifestyle modules, motivational determinants were addressed based on social-cognitive theories, e.g., the I-Change Model, and self-regulation strategies were applied (Baumeister et al., 1994; de Vries et al., 2003;