Iris Kanera

208 Summary Chapter 1 provides the background and rationale of the current thesis and highlights the importance of promoting the adoption and maintenance of healthy lifestyle behaviors among cancer survivors. Relevant determinants of lifestyle behaviors and behavior change methods are considered, and the theoretical psychosocial framework used for the studies conducted is explained. In addition, the pros and cons of applying web-based interventions targeting cancer survivors are described, and an overview of previously conducted studies evaluating web-based lifestyle interventions for cancer survivors is provided. Chapter 2 assesses the behavioral risks of the target population related to smoking, physical activity, alcohol, and fruit and vegetable consumption. Therefore, a cross-sectional study was conducted. Relevant correlates of these different lifestyle behaviors among early cancer survivors were identified. Results showed that only a small group of cancer survivors (11%) adhered to the recommendations for all five lifestyle behaviors, and that both adherence to the recommendations for vegetable (27.4%) and fruit (54.8%) consumption was particularly low. The majority of cancer survivors followed the recommendations on physical activity (87.4%), refrained from smoking (82%), and followed the alcohol recommendations (75.4%). Each separate lifestyle behavior was influenced by different patterns of correlates, however, self-efficacy, attitude, and intention contributed to the highest extent. The insights gained from this study were valuable for the development of the intervention. Chapter 3 describes the systematic development of the web-based computer tailored cancer aftercare intervention by using the Intervention Mapping protocol. The intervention aims to reduce cancer survivors’ experienced problems in seven areas, based on the needs assessment: (1) cancer-related fatigue, (2) difficulties concerning return to work, (3) anxiety and depression, (4) relationships and intimacy issues, (5) a lack of physical activity, (6) a lack of healthy food consumption, and (7) difficulties in preparing or maintaining smoking cessation. To address these problem areas, seven self-management training modules were developed. They were based on principles of problem-solving therapy, cognitive behavioral therapy, social-cognitive, and self-regulation theories. It is expected that reducing the problems that are experienced through behavioral change will ultimately result in a higher quality of life. Since the intervention comprises a broad range of topics and targets a varied group, the content is personalized by means of computer tailoring. A personalized Module Referral Advice (MRA), based on identified risks and needs, offers guidance on which modules are most essential to use. Also, the information and advice provided within the modules is tailored to demographic, cancer-related, psychological, and motivational factors, and to the current risk behaviors and needs. Moreover, interactive features, video material, animations, and hyperlinks are included in order to substitute an element of personal contact and to support the recall of the provided information. This chapter also includes a detailed description of the study design for evaluation of this cancer aftercare intervention. Chapter 4 describes the process evaluation of the use and appreciation of the KNW