Iris Kanera

75 The Kanker Nazorg Wijzer protocol 3 apply in other situations. Fifth, elements of the KNW are based on existing interventions that already have been proven effective. Sixth, by evaluating the KNW through an RCT, we will be able to draw conclusions of the intervention’s effectiveness. However, there are also some weaknesses that should be mentioned. First, the intervention contains much written information. Since PST and CBT are quite extensive forms of therapy, it was a challenge to reduce the amount of information while still holding to the theoretical framework of these methods. Much information might particularly be a problem for people with low health literacy (Verkissen et al., 2014), since they might not be able to adequately process all the information given. To avoid an overload of information, participants could freely choose which modules to visit, which steps to follow, and which assignments to make. Participants could stop anytime and continue at the point where they stopped. The use of video material might also be beneficial in the understanding of the information for survivors with low health literacy (Davis, Williams, Marin, Parker, & Glass, 2002; Hart, Blacker, Panjwani, Torbit, & Evans, 2015). Second, although the KNW is based on PST and CBT, there is no real patient-therapist interaction. Except by self-report, it is not possible to investigate whether the learned skills were applied in the right way (Finfgeld, 1999). In addition, it is difficult to anticipate the experienced emotions and non-verbal behavior of the participant or to give further explanation on why a certain advice is given. With computer tailoring, it is only possible to anticipate reactions that are highly expected. Third, while a greater proportion of cancer survivors are elderly (The Dutch Cancer Society, 2011), this group in general has fewer computer skills (AGE Platform Europe, 2008), and is less likely to use the Internet as a source for health-related information (Chou et al., 2011) than younger cancer survivors. To address this problem, the KNW was developed in such way that it is relatively easy to use. The invitation for participation was accompanied with a quick guide for using the KNW and the program provides instructional videos explaining how the KNW works. Also, support through telephone and e-mail is provided. It should be noted that this is only a temporary issue, as computer skills and use are increasing rapidly, especially among older adults (Statistics Netherlands, 2016). In conclusion, the KNW is a theory and evidence based web-based computer tailored intervention that seems a promising tool to support cancer survivors to cope with cancer- related issues during life after treatment. The results of the RCT, which will be presented in other papers, will provide more insight into the effectiveness and working mechanisms of the KNW and its appreciation by its users.