Iris Kanera

82 Chapter 4 survivors of any type of cancer (Willems et al., 2015). The KNW consists of seven self- management training modules covering the topics return to work, fatigue, anxiety and depression, social relationship and intimacy issues, physical activity (PA), diet, and smoking cessation (see Figure 4.1), supplemented with one general information module on residual symptoms. Based on the responses to a screening questionnaire, cancer survivors receive personalized advice on which KNW modules are most relevant for them to use. This Module Referral Advice (MRA) is designed in a fashion analogous to traffic lights as displayed in Figure 4.2. This MRA aims to guide participants through the broad-scoped KNW portal, based on experienced complaints and identified needs, as assessed by the screening questionnaire. The KNW has been shown to be effective in reducing fatigue and depressive symptoms and in improving quality of life domains (i.e., emotional and social functioning; Willems et al., 2017a). In addition, strong indications were found that KNW users are engaged in more moderate PA, and have a higher intake of vegetables, fruits, and fish six months after they started using the KNW (Kanera, Bolman, Willems, Mesters, & Lechner, 2016b). Besides assessing the effects of the KNW, it is important to understand how this complex intervention was used and appreciated by the participants, whether use and appreciation was predicted by certain user characteristics, and to evaluate relevant key intervention components (Brouwer et al., 2011; Hulscher, Laurant, & Grol, 2003; Kohl et al., 2013; Linnan, 2002). Moreover, it is essential to examine specifically whether the provided information was perceived as personally relevant in order to evaluate the computer tailoring. Previously published web-based interventions in the areas of lifestyle, mental health and chronic conditions differ with regard to the number of (cancer-related) topics, the composition of the target group, the intervention components, and the delivery mode (Goode et al., 2015; Kim & Park, 2015; Kohl et al., 2013; Kuijpers et al., 2013; McAlpine et al., 2014; van den Berg, Peters, Kraaijeveld, Gielissen, & Prins, 2013). Generally, typical web- based interventions are modular in setup, are updated weekly, require weekly visits, last for about 10 weeks, and include interaction with the system, peers, or a counselor (Kelders, Kok, Ossebaard, &Van Gemert-Pijnen, 2012). The actual use of most interventions was low or data on the use has been poorly reported (Kelders et al., 2012; Kohl et al., 2013). The extent of use might be influencedbydifferences inparticipant and interventioncharacteristics (Ritterband, Thorndike, Cox, Kovatchev, & Gonder-Frederick, 2009). Prior studies among cancer survivors have shown that different user characteristics were related to different user patterns: e.g., a higher usage was found among those with low levels of self-reported social support and a high illness burden, and among survivors whowere working andwho received radiotherapy (Berry, Blonquist, Patel, Halpenny, &McReynolds, 2015; Borosund, Cvancarova, Ekstedt,Moore, & Ruland, 2013). Being female, middle aged or older, having mid to high levels of education,