Iris Kanera

136 Chapter 6 are published elsewhere (Kanera et al., 2016b; Willems et al., 2015). To achieve behavior change, specific determinants and behavior change methods were applied that derived from social cognitive behavior change theories and models, such as the Reasoned Action Approach (Fishbein & Ajzen, 2010), the Self-regulation Theory (Baumeister et al., 1994), and the Integrated Model for Change (I-Change Model; de Vries et al., 2003). According to these theories, health behavior change is a dynamic process with a series of awareness, behavior initiation, routinizing, and maintenance phases. This process is influenced by pre-motivational determinants (e.g., knowledge, risk perception, awareness), motivational determinants (e.g., intention, attitude, self-efficacy, social influences), and post motivational determinants (e.g., ability to prepare and execute plans to achieve goals and to overcome potential barriers; Bolman et al., 2015; de Vries et al., 2013; Sniehotta, Schwarzer, Scholz, & Schüz, 2005b). The KNW self-management modules are PA, Diet, Smoking, Return to work, Relationships, Fatigue, and Mood. The eighth module comprises generic information on the most common residual problems (Figure 6.1). After completing the baseline assessment, the IC received feedback on their reported (lifestyle) scores by comparing them with the guidelines, including advice on what KNWmodules were most relevant for them to use. This module referral advice was designed as a traffic light (red, orange, green) and was aimed at consciousness raising, an effective behavior change method to change awareness and risk perception (Kok et al., 2015). When the PA and/or dietary guidelines were either not met or only partly met, respondents were advised to visit the corresponding module. Nevertheless, the respondents were free to use any module of their interest. Due to the module referral advice and the noncommittal design, it was expected that only a part of the IC participants would visit the lifestyle modules. The module-content was personalized by means of computer tailoring and customized to personal characteristics (gender, age, marital status, children, educational level, body mass index [BMI]), cancer-related issues (type of cancer, type and number of comorbidities), motivational behavioral determinants (attitude, self- efficacy and intention), and current lifestyle behavior. In addition, behavior change and self- regulation methods that are relevant in maintaining behavioral changes were applied, such as providing personalized feedback, goal setting, action- and coping planning, reattribution training, and self-monitoring. All these methods were used to improve self-efficacy and to overcome possible barriers, which is in line with social cognitive behavioral change theories (Baumeister et al., 1994; de Vries et al., 2013; de Vries et al., 2003; Kok et al., 2015). Within the PA module, at first, detailed questions were asked concerning possible physical limitations, co-morbid conditions, and contraindications to vigorously intensive activity, as well as perceived barriers, social support, self-efficacy, and the pros and cons of being (more) physically active. This additional information was used to optimize the tailored feedback concerning the PA action- and coping planning. Action planning includes the when, where, and how of intended action. Coping planning refers to the mental simulation