Iris Kanera

170 Chapter 7 healthy lifestyle on, for example, residual symptoms or side effects of hormone therapy (Lammerink, de Bock, Schroder, & Mourits, 2012). Overall, the KNW contains a high amount of written text that might be exhausting for cancer survivors who often report suffering from concentration problems. When developing a future KNW version, the amount of written information should be evaluated critically and could possibly be replaced by attractive and empathic videos. In addition, digital technologies continue to evolve and become more popular, especially those technologies utilizing smartphones. Incorporating mobile health (mHealth) technologies show promise in supporting people to attain health care goals and maintain healthy behaviors (Castano, Stockwell, & Malbon, 2013). Acceptance of using mobile technology and beneficial effects on lifestyle were indicated among individuals aged over 50, among individuals with a chronic illness, and among the general population (Doumit et al., 2016; Mercer et al., 2016; Wang et al., 2015). In the Netherlands, smartphone use increased considerably from 56.5% in 2012 to 84.6% in 2016 in the total population, and from 9.8% in 2016 to 50.9% among the elderly aged 65 years or older (Statistics Netherlands, 2016). These developments offer opportunities to improve the KNW by adding mobile technology (e.g., apps including wearables) that may increase intervention use and may support behavior change and behavior maintenance. IMPLICATIONS FOR IMPLEMENTATION OF THE INTERVENTION INTO CLINICAL PRACTICE As explored in the current thesis, various arguments advocate for implementing the KNW within Dutch cancer aftercare. The evidence- and theory-grounded, personalized, and highly appreciated online intervention fits with the risks and needs of early cancer survivors and provides easily accessible, highly structured, and comprehensive support for a large number of cancer survivors, which is lacking in current cancer aftercare in the Netherlands. Moreover, short-term benefits can be expected concerning moderate PA, diet quality (Kanera et al., 2016b), fatigue, mood, and QoL domains (Willems et al., 2017a), while long- term benefits in moderate PA are shown (Kanera et al., 2017). According to this thesis, it may be expected that particularly female, middle-aged survivors of breast cancer with all levels of education, relatively mild physical and psychosocial complaints, and a relatively good cancer prognosis might benefit most when attention would be drawn to the KNW during medical control visits. Since a growing number of cancer survivors use the Internet as a source of information, the KNW should be easy to find on the Internet, and the KNW should be presented as (part of ) a trusted source. Other trusted web sources could refer to the KNW, such as www.kanker.nl , www.nfk.nl , www.kwf.nl, www.iknl.nl , hospital websites, and websites of specialized paramedics. In this way, survivors can use online cancer aftercare