Iris Kanera

Su 209 Summary intervention. It is investigated whether the participants allocated to the intervention followed the advice of the MRA. Moreover, the use of the modules and its predictors, the appreciation of the KNW and its predictors, and the predictors of personal relevance of the modules were identified. Almost all (98.3%) participants were referred by the MRA to at least one self-management module ( M 2.9, SD 1.5), and the majority (85.7%) visited on average 2.1 ( SD 1.6) modules. The results indicate that the MRA might be an important intervention element to guide the users to a preferred selection of modules, considering that participants were more likely to use relevant modules after a referral by the MRA. All modules were used to varying degrees, and a higher number of modules used were predicted by a higher number of risks and needs and having no partner. The overall KNW and its modules were highly appreciated, which was related to a higher perceived personal relevance. Notably, the intervention was perceived just as personally relevant by participants with different demographic and cancer-related characteristics. Chapter 5 studied possible effects of the KNW on lifestyle behaviors (i.e., respectively vegetable, fruit, whole grain bread, and fish consumption, physical activity, and smoking behavior) six months after baseline. Therefore, a randomized controlled trial was conducted. Indications were found that participating in the intervention increased moderate physical activity and vegetable intake. A meaningful increase in moderate physical activity of 151 minutes per week was observed, which was 75 minutes per week higher compared to the control group. Moreover, using the behavior-specific modules indicated possible effects for moderate physical activity, fruit, and fish consumption. However, the results did not remain significant after correction for multiple testing and should, therefore, be interpreted with caution. No significant intervention effect was found on smoking behavior due to low numbers of smokers, although smokers in the intervention condition were almost three times more likely to quit than smokers allocated to the control condition. Chapter 6 examined whether the positive changes in moderate physical activity and vegetable consumption determined after six months were maintained at 12 months. Additionally, possible moderator effects of using behavior-specific modules, gender, age, and education level were investigated. The results showed that the KNW was effective in increasing and maintaining moderate physical activity in the long term among early cancer survivors younger than 57 years with a moderate effect size. This effect was clinically relevant. The 6-month increases in vegetable consumption were not sustained in the long term. Chapter 7 gives a summary and discussion of the main findings of the studies included in this thesis and discusses the methodological considerations. It offers suggestions for future research, proposals for intervention improvement, and implications for implementation of the intervention into clinical practice. Important strengths of the presented KWN intervention studies were the large study population, the strong study design (randomized