Iris Kanera

57 The Kanker Nazorg Wijzer protocol 3 Schmid & Leitzmann, 2014). Unfortunately, a large proportion of cancer survivors do not adhere to recommendations concerning PA, dietary, and smoking behavior (Inoue-Choi et al., 2013; Rock et al., 2012). Then, we conducted six focus group interviews with 33 cancer survivors using a predefined protocol (Morgan & Krueger, 1998). The topics discussed included experienced problems during survivorship and aftercare needs. Most survivors indicated that they did not know what to expect after treatment or how to cope with their experienced problems. Commonly indicated problems included pain, fear of recurrence, fatigue, concentration problems, insomnia, sadness, insecurity, dealing with social relationships, and work related problems. Many survivors reported difficulties in adhering to PA and diet recommendations. However, PA was seen as an important contributor to recovery. Furthermore, many survivors indicated that they did not always know where they could get aftercare or that the aftercare was not easy accessible. Most survivors expressed the need for more attention from the hospital staff to their psychological, physical, and lifestyle issues. Moreover, the information provided by hospitals concerning aftercare possibilities was described as insufficient. The information on the Internet was described as cluttered and bulky. Finally, the prevalence and correlates of unmet information and support needs and healthy lifestyle behaviors were investigated in a survey conducted among 255 cancer survivors within the first year after their primary treatment (Kanera et al., 2016a; Willems et al., 2016). The results indicated that almost two-thirds of the survivors reported having unmet needs. Frequently cited unmet needs concerned emotional and social support, help to deal with fear of recurrence, management of healthcare and complications, up-to-date information, management of return to work, increasing exercise, and assistance to quit smoking. While help to eat healthier was not a frequently mentioned unmet need (Willems et al., 2016), adherence to fruit and vegetable recommendations was poor (Kanera et al., 2016a). High education, having breast cancer, participation in support programs, low QoL, high levels of anxiety, and a more negative adjustment to cancer were associated with having more unmet needs in general (Willems et al., 2016). Self-efficacy, attitude, and intention were the strongest correlates of healthy lifestyle behaviors (Kanera et al., 2016a). Step 2: Matrices of change objectives Step 2 provides the foundation of the intervention by specifying what will change as a result of the intervention (Bartholomew et al., 2011). For this purpose, performance objectives (POs) are formulated. These are statements of what the program participants need to do to perform the intended health-promoting behavior. Then, important and changeable determinants for the POs are selected. This is necessary for creating change objectives (COs). COs specify what changes in the determinants are needed to make the attainment of the POs most likely.