Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial
Open accessAbstract
BACKGROUND: A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return to work, fatigue, anxiety and depression, relationships, physical activity, diet, and smoking cessation. Participants were guided to relevant modules by personalized module referral advice that was based on participants’ current complaints and identified needs. OBJECTIVE: The aim of this study was to evaluate the adherence to the module referral advice, examine the KNW module use and its predictors, and describe the appreciation of the KNW and its predictors. Additionally, we explored predictors of personal relevance. METHODS: This process evaluation was conducted as part of a randomized controlled trial. Early cancer survivors with various types of cancer were recruited from 21 Dutch hospitals. Data from online self-report questionnaires and logging data were analyzed from participants allocated to the intervention condition. Chi-square tests were applied to assess the adherence to the module referral advice, negative binominal regression analysis was used to identify predictors of module use, multiple linear regression analysis was applied to identify predictors of the appreciation, and ordered logistic regression analysis was conducted to explore possible predictors of perceived personal relevance. RESULTS: From the respondents (N=231; mean age 55.6, SD 11.5; 79.2% female [183/231]), 98.3% (227/231) were referred to one or more KNW modules (mean 2.9, SD 1.5), and 85.7% (198/231) of participants visited at least one module (mean 2.1, SD 1.6). Significant positive associations were found between the referral to specific modules (range 1-7) and the use of corresponding modules. The likelihoods of visiting modules were higher when respondents were referred to those modules by the module referral advice. Predictors of visiting a higher number of modules were a higher number of referrals by the module referral advice (β=.136, P=.009), and having a partner was significantly related with a lower number of modules used (β=-.256, P=.044). Overall appreciation was high (mean 7.5, SD 1.2; scale 1-10) and was significantly predicted by a higher perceived personal relevance (β=.623, P=.000). None of the demographic and cancer-related characteristics significantly predicted the perceived personal relevance. CONCLUSIONS: The KNW in general and more specifically the KNW modules were well used and highly appreciated by early cancer survivors. Indications were found that the module referral advice might be a meaningful intervention component to guide the users in following a preferred selection of modules. These results indicate that the fully automated Web-based KNW provides personal relevant and valuable information and support for early cancer survivors. Therefore, this intervention can complement usual cancer aftercare and may serve as a first step in a stepped-care approach. TRIAL REGISTRATION: Nederlands Trial Register: NTR3375; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3375 (Archived by WebCite at http://www.webcitation.org/6jo4jO7kb).
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Low adherence can skew interpretations of efficacy if it is not clearly measured and reported.
“Low adherence has clear implications for research and clinical practice, as it can: (i) skew interpretations of efficacy if not clearly measured and reported, and (ii) moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits [20, 23-26].”
From Uptake and adherence to an online intervention for cancer-related distress: older age is not a barrier to adherence but may be a barrier to uptake (2017) · cites this paper as [23]
Low adherence can moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits.
“Low adherence has clear implications for research and clinical practice, as it can: (i) skew interpretations of efficacy if not clearly measured and reported, and (ii) moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits [20, 23-26].”
From Uptake and adherence to an online intervention for cancer-related distress: older age is not a barrier to adherence but may be a barrier to uptake (2017) · cites this paper as [23]
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- Authors
- Kanera, I. M., Willems, R. A., Bolman, C. A. W., Mesters, I., Zambon, V., Gijsen, B. C., & Lechner, L.
- Affiliations
- Open University of the Netherlands (NL)
- Maastricht University (NL)
- Zuyderland Medisch Centrum (NL)
- Netherlands Comprehensive Cancer Organisation (NL)
- Corresponding author
- Kanera, Iris Maria
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-08-23
- Volume
- 18
- Issue
- 8
- Pages
- e229
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5013245
- OpenAlex
- W2511621904
- Cited by
- 59
- References
- 60
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 8 · 2019: 4 · 2018: 7 · 2017: 13
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- DSpace (Open University in the Netherlands) (publishedVersion, other-oa)
- DSpace (Open University in the Netherlands) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- KWF Kankerbestrijding (NOU2011‐5151)
- Universitair Medisch Centrum Groningen
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- self-management interventions, intervention adherence, intervention use, perceived personal relevance, psychosocial problems, return to work, fatigue, anxiety and depression, healthy lifestyle, smoking cessation, physical activity, diet, couple relationships, process evaluation
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Neoplasms, Self Care, Telemedicine, Survivors, Internet
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