Iris Kanera

56 Chapter 3 and support can be provided that is adapted to the individual’s needs and characteristics, while still reaching large groups. To provide cancer survivors personalized information and support and stimulating self- management during life after cancer, we developed the web-based computer tailored intervention the Kanker Nazorg Wijzer (Cancer Aftercare Guide; KNW). To increase the likelihood of reaching intervention effectiveness, the Intervention Mapping (IM) protocol was used (Bartholomew, Parcel, Kok, Gottlieb, & Fernández, 2011). This is a systematic, theoretical and empirical-based approach for intervention development. In this article, the development of the KNW according to the steps of IM and the evaluation of the intervention’s effectiveness is described. METHODS/DESIGN The IM protocol consists of six steps (Bartholomew et al., 2011): (1) a needs assessment of the study population, (2) specification of performance objectives and crossing them with relevant determinants into change objectives, (3) selecting theory-informed intervention methods and practical applications to change the determinants of the health behavior, (4) producing and pretesting program materials, (5) planning program adoption and implementation, and (6) planning for evaluation. Step 1: Needs assessment In the needs assessment, the health problem and its impact on the QoL of the at-risk group is assessed (Bartholomew et al., 2011). Understanding cancer survivors’ experienced problems and information and support needs is a crucial step in designing interventions that meet survivors’ needs (Rutten, Arora, Bakos, Aziz, & Rowland, 2005). Since it was clear that an overall problem among cancer survivors is a reduced QoL (Harrington et al., 2010; Wu & Harden, 2015), the following program goal was stated: At six and 12 months after the start of the KNW program, cancer survivors will report an increased QoL. The needs assessment aimed to disclosewhich problemareas should be addressed to achieve this goal. We conducted a needs assessment consisting of a literature study, focus group interviews, and a survey. The literature provided an overview of cancer survivors’ health-related problems. Anxiety and depression (Brown, Kroenke, Theobald, Wu, & Tu, 2010), fear of recurrence (Simard et al., 2013) fatigue (Prue et al., 2006), sleep problems (Irwin, Olmstead, Ganz, & Haque, 2013), difficulties concerning return to work (Duijts et al., 2014), pain (Paice, 2011), and sexual dysfunction (Chung & Brock, 2013; Lammerink, de Bock, Pras, Reyners, & Mourits, 2012) are frequently identified problems. Furthermore, a healthy lifestyle is associated with positive health outcomes in cancer survivors, while unhealthy lifestyle behaviors may lead to the development of other chronic diseases, new primary tumors, and cancer recurrence (Aleksandrova et al., 2014; Baena & Salinas, 2014; Petersen et al., 2015;