Iris Kanera

86 Chapter 4 2008; Wendel-Vos et al., 2003; Zigmond & Snaith, 1983). A green MRA signifies that the respondent reported no complaints, or minor complaints or needs, concerning the specific topic. Therefore, following the correspondent module is not a high priority. An orange MRA was provided when the respondents reported elevated but not severe complaints, or when respondents partially adhered to the lifestyle recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (World Cancer Research Fund, 2009; Rock et al., 2012). The orange advice praises respondents’ reasonably positive scores; however, it is recommended that they follow the corresponding module for further improvement. This orange category includes a wide coverage of score ranges, allowing for participants with higher, but not severe scores to still receive some positive and encouraging feedback and not lose their motivation to follow a module due to feedback that might be perceived as too stringent. A red MRA was provided only when severe psychosocial complaints, problematic functioning, or low/no adherence to lifestyle recommendations was reported, thus indicating that the respondent might be in high need of support concerning the specific topic. In that case, it was strongly recommended to follow the corresponding module. More detailed information on the underlying measures and cut-off points are described in Appendix 4.1. Throughout the different KNW interventionmodules, principles of Problem SolvingTherapy, Cognitive Behavioral Therapy, social cognitive theories, and self-regulation theories were applied (Baumeister, Heatherton, & Tice, 1994; Bleijenberg et al., 2007; D’Zurilla & Nezu, 2007; deVries et al., 2003). According to the I-ChangeModel (deVries et al., 2003), awareness factors such as knowledge, cues to action, and risk perception might be important determinants in the dynamic process of behavior change by influencing motivation and intention. By applying the MRA, participants were made aware of their current psychosocial status and lifestyle behaviors in relation to the norms and guidelines, with the aim of guiding the participants toward the appropriate self-management modules. When using the modules, self-management skills training was provided by encouraging respondents to observe their current behavior more in detail, choose themes to work on, set goals, and to prepare action and coping plans, followed by monitoring their experiences and possible progress in the changed strategies and behaviors. Within the modules, the information and support was tailored to the current emotional status, lifestyle behavior, and motivational determinants (attitude, self-efficacy, intention) by the application of computer tailoring. Furthermore, the feedback was tailored to personal characteristics (gender, age, marital status, children, education level), and cancer-related and medical issues (type of cancer, comorbidities). Four weeks after completing (parts of ) one module, the participants were invited to reflect upon their behavioral change plans and experiences in a brief personalized evaluation session. They were also encouraged to continue applying the previously recommended self-management skills. Furthermore, valuable generic information about lifestyle and psychosocial issueswas accessiblewhen visiting the user forumand themonthly news items.