Iris Kanera

7 155 General Discussion GENERAL DISCUSSION This thesis addressed cancer survivors’ lifestyle as a part of a research project on the impact of a systematically developed web-based, evidence- and theory-grounded cancer aftercare intervention, the Cancer Aftercare Guide (Kanker Nazorg Wijzer, KNW). The main objectives were: (1) to assess the prevalence and correlates of lifestyle behaviors 1 of cancer survivors; (2) to develop lifestyle behavior change modules for former cancer patients on physical activity (PA), dietary behavior (vegetable, fruit, fish and whole grain bread consumption), and smoking, incorporated in a broader web portal; (3) to assess the use and appreciation of the KNW intervention; and (4) to evaluate the effects of the KNW intervention on lifestyle-related outcomes after six (end of portal access) and 12 months. In this general discussion section, a summary and general discussion of the main findings is provided, methodological considerations are discussed, and suggestions for future research, proposals for improvement of the intervention, and implications for implementation of the intervention into clinical practice are presented. Finally, general conclusions are provided. SUMMARY AND DISCUSSION OF MAIN FINDINGS Part 1. Intervention development Prevalence and correlates of lifestyle behaviors The cross-sectional survey in Chapter 2 was employed to identify cancer survivors’behavioral prevalence and factors that explain engagement in these lifestyle behaviors to develop a personalized behavior change intervention. Our survey showed that a minority of cancer survivors’lifestyle behaviors was coherent with all five lifestyle recommendations. Vegetable (27.4%) and fruit (54.8%) intake were less often in accordance with the lifestyle behavior recommendations (see Box 1.1 in Chapter 1), while a majority of cancer survivors followed the recommendations concerning physical activity (PA; 87.4%), alcohol consumption (75.4%), and nonsmoking (82%; Kanera et al., 2016a). In all examined behaviors, social cognitive correlates (i.e., self-efficacy, attitude, and intention) were consistently identified as the strongest correlates, while socio-demographic, cancer-related, and other psychological factors contributed to a lower extent. Notably, the number, type, and extent of correlates that influenced the separate lifestyle behaviors varied per behavior, indicating that interventions should target the specific determinants of the five different lifestyle behaviors separately. Importantly, although the social cognitive correlates appear to be comparable to the different lifestyle behaviors, the underlying substantive content of beliefs is behavior- specific and differs; for example, self-efficacy to deal with a difficult situation for nonsmoking 1 Divers behaviors: smoking and alcohol intake, which need to be decreased, and behaviors that need to be increased as physical activity, fruit and vegetable consumption