Iris Kanera

58 Chapter 3 To specify POs, it needs to be clear what the program outcome should be (i.e., what the program aims to achieve). Based on the needs assessment, the focus of the program was set to significantly reduce experienced problems in seven areas, namely (1) cancer related fatigue, (2) difficulties concerning return to work, (3) anxiety and depression, (4) social relationship and intimacy issues, (5) a lack of PA, (6) a lack of healthy food intake, and (7) difficulties in preparing or maintaining smoking cessation. By effectively managing these problems, improved outcomes in these problem areas are expected, ultimately resulting in a better QoL. Several POs were formulated for each problem area. An example of a PO for the program outcome “Reduce cancer-related fatigue” is “Say ‘no’ to a request when it is too much to handle” (see Table 3.1). Then, the most important and changeable behavioral determinants of the POs were selected from theory and literature. The most relevant determinants differed for each problem area. For example, relevant determinants for reducing cancer- related fatigue included knowledge, awareness, attitude, skills, self-efficacy, perceived behavior of others, and outcome expectations. Relevant determinants of engagement in sufficient PA included attitude, self-efficacy, social support, and perceived barriers. Next, COs were stated. Examples of COs for the PO “Say ‘no’ to a request when it is too much to handle” were “Describe steps to undertake to effectively say ‘no’ to others” ( knowledge ) and “See fellow survivors acknowledging the importance of saying ‘no’ to others” ( perceived behavior of others ) (see Table 3.2). Table 3.1 Performance objectives for the program outcome “Reduce cancer-related fatigue” PO 1 Manage daily tasks efficiently PO 1.1 Alternate mental and physical activities PO 1.2 Take small moments of rest divided over the day PO 1.3 Take adequate measures so not to exceed personal limits PO 1.4 Say “no”to a request when it is too much to handle PO 1.5 Make a structured plan of daily activities PO 2 Turn non-helpful thoughts about fatigue into helpful thoughts PO 2.1 Recognize common non-helpful thoughts about fatigue PO 2.2 Identify personal non-helpful thoughts PO 2.3 Generate helpful thoughts PO 2.4 Replace non-helpful thoughts with helpful thoughts PO 2.5 Implement personal strategies to cope with rumination PO 2.6 Use relaxation or mindfulness techniques PO 3 Take sleep hygiene measures PO 3.1 Identify the type of sleeping problem one is experiencing PO 3.2 Go to bed and get out of bed at set times every day of the week PO 3.3 Take care of optimal sleeping conditions PO 3.4 Identify behaviors that interfere with sleep and replace these with helpful behaviors PO 3.5 Use relaxation or mindfulness techniques