Iris Kanera

1 19 INTRODUCTION focuses mainly on lifestyle-related topics, and another Ph.D. thesis by Willems (2017), addresses mainly psychosocial issues, like fatigue, anxiety, and depression. The rationale behind the web-based program was to help cancer survivors to 1) become aware of health risk behaviors, 2) to get motivated to change and to be able to control behaviors, 3) to initiate health enhancing behaviors and maintain the improved behaviors. The idea was to offer web-based, fully automated, easily accessible, and personalized self-management support program for a large group of cancer survivors that combines psychosocial and lifestyle issues. Such a comprehensive eHealth intervention could be integrated into an individual survivorship care plan, and could be used as one of the first steps in stepped care (guided self-help), while saving oncology care providers’ time and health care costs. At the time when the project began (2012), existing public websites mainly provided general information on cancer diagnosis and treatment, but there was limited published research that evaluated web-based interventions targeting cancer survivors (Ream, Blows, Scanlon, & Richardson, 2009). Therefore, a comprehensive needs assessment was required to determine the most prevalent cancer-related problems and behavioral risks, the (unmet) information- and support needs, and moreover, to identify preferences for delivery details and lay-out of the web-based intervention. Qualitative as well as quantitative research methods were planned (systematic literature review, focus group interviews among the target group, testing findings on a large scale by conducting a survey study). Subsequently, the web-based intervention, the Kanker NazorgWijzer (KNW) had to be developed, and pre- tested before its implementation and broad scale evaluation among the target group. The target group consisted of adult cancer survivors (any type of cancer) in the first year after successfully completing primary cancer treatment. For the evaluation of the intervention, a two-armed randomized controlled trial (intervention group and waiting list control group) was planned. Online follow-up measurements were planned at three, six, and 12 months after the baseline assessment. It was considered useful to study how cancer survivors would use and appreciate a stand-alone online cancer aftercare intervention that addresses a broad range of topics. Furthermore, it was planned to assess short- and long-term effects of the KNW on lifestyle-related outcomes and on psychosocial outcomes. The objectives of the present thesis were: (1) to assess the prevalence and correlates of lifestyle behaviors of cancer survivors; (2) to develop lifestyle behavior change modules for former cancer patients on PA, dietary behavior (vegetable, fruit, fish and whole grain bread consumption), and smoking, incorporated in the broader web portal; (3) to assess the use and appreciation of the KNW intervention; (4) to evaluate the effects of the KNW intervention on lifestyle-related outcomes after 6 (end of portal access) and 12 months.