Iris Kanera

4 95 Use and appreciation of the Kanker Nazorg Wijzer survivors reported being less aware of the beneficial effects of a healthy lifestyle (Hawkins et al., 2015; Niu et al., 2015). In addition, research revealed that cancer survivors might be less aware of available psychosocial support and solutions to psychosocial problems, while, for example, addressing maladaptive illness perceptions and adopting a more adaptive self- management may lead to better health outcomes (Mehnert & Koch, 2008; Thong, Kaptein, Vissers, Vreugdenhil, & van de Poll-Franse, 2016). Consequently, curiosity about available self-management support needs to be encouraged (Kohl et al., 2013). In accordance with the I-Change Model, the MRA could increase knowledge about the current level of well- being, psychosocial conditions, and lifestyle behavior. Besides that, the MRA could elevate the risk perception, and may serve as a cue to action with regard to the relevant topics, given that the solutions to the problems are provided (relevant self-management module; de Vries et al., 2003). These awareness/solution triggers might positively influence the motivation and intention to perform desired behavior, which is in line with the findings of Walthouwer, Oenema, Candel, Lechner, and de Vries (2015a), who identified awareness as an important moderator in the relationship between psychosocial determinants and specific dietary behavior (eating in moderation) in the general population. Results in the present study illustrate, that these awareness/solution triggers are most likely to be followed when a red or orange MRA was provided. Thus, the MRA successfully referred those respondents with elevated as well as severe complaints and/or needs. In particular, highly fatigued respondents (red MRA) were more likely to use the module Fatigue compared to participants with less fatigue (orange MRA). Additionally, those participants who were already (partly) engaged in a healthy diet (orange MRA) were more likely to use the module Diet compared to participants with less engagement in a healthy diet (red MRA). The topic diet could be of general interest of the participants, while the topic fatigue might be most interesting for participants with specific complaints. Consequently, the MRA may be a meaningful intervention component to increase motivation, subsequent module use, and problem-solution, while MRA adherence might be related to the specific behavior. Using topic-specific KNW modules has shown to be beneficial in decreasing fatigue, depressive feelings, and in increasing moderate PA, fruit and fish consumption (Kanera et al., 2016b; Willems et al., 2017). Within the KNW, participants were referred on average to 2.9 modules, while on average 2.1 modules were used. The appreciation rates were high and the presented results showed that a higher number of modules used did not contribute to a higher appreciation; however, a higher perceived personal relevance did contribute to a higher appreciation. This is in line with Wilson et al. (2015), reporting that a moderate number of recommendations in multiple behavior interventions might produce the highest level of change, while engagement with a higher number of recommendations might be too demanding. Within the KNW, respondents were allowed to make their own choices, despite the provided MRA.