Iris Kanera

160 Chapter 7 whether they negatively deviate from lifestyle recommendations, followed by a referral to the relevant module(s). This MRA might have led to a feeling of discomfort (in case of red or orange “traffic light”), which might have increased the likelihood of module use (Kanera et al., 2016c). More details are discussed later in this chapter (Part 2). Moreover, instruction videos and videos of fellow cancer survivors and health professionals are integrated into the modules and news items. These videos substituted an element of personal contact by expressing empathy and creating feelings of relatedness that may increase participants’ intrinsic motivation and intervention involvement (Walthouwer et al., 2015c). Finally, mail messages were used to alert participants to the modules (variable frequency) and news items (six weekly) were provided including videos of professionals who discussed relevant cancer aftercare issues. Part 2. Intervention process evaluation Findings on intervention use among those participants who had access to the web-based KNW for six months showed that participants used most of the recommended modules (Chapter 4). The MRA recommendations (M = 2.9 modules) corresponded closely to module use ( M = 2.1 modules; Kanera et al., 2016c). Importantly, the likelihood of using modules was higher when the MRA referred to the modules. Module users were those with the highest numbers of risks and needs, implying that the MRA was able to effectively direct participants to relevant content, in particular those with a greater range of needs. This is in line with the intended inner workings of the intervention. Additionally, survivors with higher reported needs are in general more inclined to use a larger part of an intervention (Berry et al., 2015; Borosund et al., 2013). Vice versa, module use not based on referral or perceived need was very uncommon among the KNW participants. Lower module use despite referral might have several reasons, for instance that the portal slips one’s mind. This issue needs further exploration. We may conclude that our KNW users have retrieved their most relevant information from the tailored intervention. The KNW allowed self-selection regarding the modules and other intervention elements to increase perceived personal relevance, which was associated with a higher appreciation. Module use varied from 58% to 10% of participants. Notably, the highest use concerns the module Diet, which fits with the lowest initial adherence rate to diet recommendations among the respondents (Kanera et al., 2016a). High Diet module use is striking, since no need for such advice was mentioned during the needs assessment (Willems et. al., 2016). This, again, suggests that the MRA made respondents aware of their risks successfully, which emphasizes the relevance of the strategy of creating awareness and cue to action in the context of behavior initiation and change (Bolman et al., 2015; de Vries et al., 2013; Peels, 2014). Cancer survivors with a “red” MRA were less likely to use module Diet compared to those receiving an “orange” MRA (Kanera et al., 2016c). The red MRA might have been too