Iris Kanera

7 159 General Discussion about the risk of excessive alcohol consumption and enhancing self-efficacy concerning adherence to alcohol recommendations is therefore important during cancer aftercare. The Kanker Nazorg Wijzer (KNW) intervention Addressing survivors of various cancer types and multiple behaviors is not common yet in stand-alone web-based programs for cancer survivors (Goode et al., 2015; Green et al., 2015; Kim & Park, 2015; Kuijpers et al., 2013; McAlpine et al., 2014; Post & Flanagan, 2016). To achieve the overall purpose of the KNW— increasing the QoL of cancer survivors—the intervention integrates seven lifestyle and psychosocial topics, and targets survivors of various cancer types (Willems et al., 2015). The self-management modules were PA, diet behavior, smoking cessation, coping with fatigue, return to work, anxiety and depression, and social relationships. Given this broad-scoped intervention design, tailoring was applied as a method to make the KNW personally relevant (de Vries & Brug, 1999; Noar et al., 2007). With regard to module use, following a modular sequence was not required in the KNW in contrast to other interventions (Goode et al., 2015). So, one or more desired modules could be selected and completed within one single session, or in several sessions, depending on participants’ preference. Further, participants could decide for themselves which part of a module was relevant to them personally. The modules are deliberately designed this way, which might have been beneficial for intervention outcomes and for preventing attrition (Brouwer et al., 2010; Schulz et al., 2012). Low use and (very) high attrition rates (discontinuing use) were observed in other web-based interventions among the general population that include several modules about one topic that needed to be followed sequentially within several weeks (Eysenbach, 2005; Kohl et al., 2013; Peels et al., 2013b). A strength in the process of intervention development was that the lifestyle modules were aimed at promoting healthy behaviors by changing behavioral determinants that were identified during the needs assessment and based on social cognitive and self- regulation theory (Baumeister et al., 1994; de Vries et al., 2003; Fishbein & Ajzen, 2010; Kok et al., 2015). It is known from prior research that social cognitive theory-based PA and/or diet change interventions can improve lifestyle behaviors in cancer survivors (Stacey et al., 2015). The systematic development of the web-based KNW intervention was guided by the Intervention Mapping protocol and based on a needs and risk assessment, a literature review, six focus group interviews and a cross-sectional survey (Kanera et al., 2016a; Willems et al., 2016). The fact that cancer survivors might have an unrealistic view about meeting lifestyle recommendations (Hawkins et al., 2015; Niu et al., 2015), as assumed for vegetable consumption in the discussion about our cross-sectional study, required development of an awareness-enhancing strategy: the “Module Referral Advice (MRA)”. The MRA was developed to make cancer survivors aware of their lifestyle behaviors and to indicate