Iris Kanera

172 Chapter 7 This thesis showed that participants of the KNW achieved increases in moderate PA and diet quality six months after getting access. The KNW succeeded in achieving clinically relevant increases of moderate PA after 12 months among survivors younger than 57 years of age with approximately the same effect sizes compared to interventions that included in-person support. Initially higher increases in vegetable consumption were not sustained in long term. No significant higher likelihood of smoking cessation could be proven among KNW participants, though the study provided clear indications in the positive direction. Moreover, positive changes were found in psychosocial outcomes, such as depression and fatigue, which are addressed elsewhere (Willems et al., 2017a; Willems et al., 2017b). Computer tailoring and the MRA awareness and advice tool seemed to be important key elements in the fully automated and broad-scoped KNW intervention intended to provide personal relevant support. Relevant modules were used, and the intervention was highly appreciated and perceived as personally relevant. The internal validity of the effect study was high, given the strong research design, large sample size, low dropout rates, and the advanced statistical methods used. Since middle-aged, female survivors of breast cancer with a good prognosis and relatively low levels of physical and psychosocial complaints were overrepresented in the study sample, generalization of these results to the overall cancer survivor population requires caution. Our findings offer important new information to the research field and to clinical practice. Overall, it reveals that the fully automated KNW is accessible to a large cancer survivor audience and provides personalized, highly appreciated, and structured self-management support for a broad range of problem areas that cancer survivors face after completing primary cancer treatment. Furthermore, the KNW can be integrated into current cancer aftercare, possibly as web-based guided self-help, as it is well accepted by early cancer survivors, fits with the demands of current cancer aftercare guidelines, and requires very little time from health care providers.