Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study

Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study View ORCID Profile Manae Hirayama , View ORCID Profile Daisuke Kasai , View ORCID Profile Ken-ichi Tabei doi: https://doi.org/10.1101/2025.07.31.25332471 Manae Hirayama 1 Graduate School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Manae Hirayama Daisuke Kasai 1 Graduate School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Daisuke Kasai Ken-ichi Tabei 1 Graduate School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ken-ichi Tabei For correspondence: tabei-kenichi{at}aiit.ac.jp Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract This pilot study explored the factors influencing the theoretical use of psychosocial support services among cancer survivors not currently using those services. It used the Fogg Behavior Model as a theoretical framework. A web-based questionnaire survey was conducted over one month using snowball sampling through social networking services of patient organizations, targeting cancer survivors aged 40 years and older. Free-text responses about support needs from participants who were not using psychosocial support were analyzed using a grounded theory approach. The texts were coded based on the three Fogg Behavior Model elements: “triggers” to initiate behavior, “motivation” to engage in behavior, and “ability” that hinders behavior. The structure serving as the starting point for behavior was modeled. The results revealed that many factors were based on emotional values, such as expectations and hopes for support. “Motivation” indicated the need to build trust with supporters and to organize feelings. “Ability” identified that barriers included self-sufficiency and difficulties verbalizing feelings. “Trigger” required supporters to show human qualities, and for there to be clear pathways to consultation and creative publicity methods. These findings suggest that acquiring psychological values such as reassurance, trust, and hope strongly motivates the use of psychosocial support. Designing appropriate support pathways based on cancer survivors’ behaviors and developing effective cognitive strategies are important ways to promote the future use of psychosocial support services. Introduction In recent years, advances in cancer drugs and treatments have improved the survival rates for many types of cancer, leading to an increase in the number of cancer survivors [ 1 ]. It is estimated that there are more than 50 million cancer survivors worldwide [ 2 ], including approximately 3.41 million in Japan [ 3 ]. Cancer survivors, regardless of whether they are still receiving treatment, may experience feelings of anxiety or depression, known as emotional distress. Approximately 30% of individuals continue to experience these symptoms even after treatment ends [ 4 ]. Emotional distress affects mental health and also has physical and behavioral impacts, leading to an overall decrease in the quality of life [ 5 ]. Psychosocial support is considered effective in improving quality of life [ 6 ], and providing this support is crucial [ 7 ]. In Japan, efforts are being made to promote the use of cancer consultation support centers by providing accurate information [ 8 ], but awareness is only 55.1%, and usage remains at 21.1%, indicating that these services are not being fully used [ 9 ]. Additionally, patients who need psychosocial support but do not receive it experience greater distress than those who do [ 10 ]. According to a survey by an insurance company, about 60% of cancer survivors stated they “hesitate to ask for help” [ 11 ]. Other studies have identified stigma attached to psychosocial support, such as the desire to keep personal affairs to themselves, or not wanting to have personal problems managed by others, as well as concerns about whether support is available to meet individual needs [ 12 ][ 13 ][ 14 ]. Another study investigating barriers to availability of psychosocial care services highlighted reasons such as healthcare providers prioritizing treatment or medical procedures over psychosocial care, and a shortage of professionals to provide this support. Even in high-income countries, the psychosocial needs of cancer survivors are generally not fully met [ 15 ]. Previous studies have reported low utilization rates, user trends, and the characteristics of those who do not need psychosocial support. However, it is not clear which specific behavioral factors would improve utilization rates. This study aimed to identify the factors that would encourage cancer survivors who do not currently use psychosocial support services to start to do so. We used a descriptive approach, with the Fogg Behavior Model (FBM) [ 16 ] as a theoretical framework to explain the use of psychosocial support services. The FBM is a theoretical model that indicates the three necessary elements to trigger behavior: motivation, ability, and trigger [ 16 ]. Using this framework clarifies the specific behavioral factors related to the use of psychosocial support by cancer survivors, systematizes the design and evaluation of interventions, and facilitates a common understanding among stakeholders [ 17 ]. This makes it easier to examine the effectiveness of intervention measures. Several recent studies have applied the FBM to cancer. For example, one study used a design based on the FBM to make proposals to improve compliance with a liver cancer screening intervention using a mobile health approach, focused on high-risk groups [ 18 ]. A pilot randomized controlled trial of a mobile app promoting genetic counseling use among ovarian cancer patients showed improvements in knowledge, self-efficacy, and family communication [ 19 ]. These suggest that applying the FBM to the use of psychosocial support by cancer survivors is also likely to be effective. This study aimed to clarify the specific motivational, ability-related, and trigger factors affecting the use of psychosocial support by cancer survivors. It therefore qualitatively analyzed the factors associated with willingness to use support services using the FBM, and proposed strategies to improve utilization rates. It is expected to contribute to the development of effective intervention strategies to improve use of support services. Methods Materials Using Google Forms and snowball sampling, the questionnaire was distributed to cancer survivors aged 40 years or older through the social networking services of multiple patient groups over a one-month period (May 1 to May 31, 2024). The questionnaire included (1) questions about the use of psychosocial support for cancer patients, with three questions for those who answered “yes” and two questions for those who answered “no,” and (2) one open-ended question about expectations of psychosocial support. We adopted a detailed methodological approach based on the FBM and analyzed the survey results. This approach enables a comprehensive understanding of the factors influencing cancer survivors’ use of psychosocial support services. The sample size for this pilot study was determined based on the following criteria. For continuous variables [ 20 ] [ 21 ], 12 participants were required in each group. We also required a total of 36 participants to ensure a 95% confidence interval (0.85–0.95) with a 5% margin of error [ 22 ]. Statistical analysis The basic attributes, use of psychosocial support, and situation from diagnosis to the present were analyzed using descriptive statistics. For the content analysis of psychosocial support needs among those not using counseling support, we used the grounded theory approach [ 23 ][ 24 ] to structure the psychosocial needs of cancer patients and the actual state of support. The free descriptions were open-coded. We defined code families and concepts based on the three elements of the FBM, motivation, ability, and trigger. Theoretical coding [ 25 ] was used to model the structure underlying the behavior ( Table 1 ). View this table: View inline View popup Download powerpoint Table 1. Code families used to categorize the requests of cancer survivors not using psychosocial support The first author was responsible for the survey design and initial coding of free descriptions. During the analysis, the data were reviewed and discussed multiple times with co-authors experienced in medicine and patient research to eliminate biased perspectives and unilateral interpretations of the data. R Version 4.3.2 was used for descriptive statistics, and MAXQDA was used for the theoretical coding of descriptive data. Ethical approval This study was approved by the Research Safety and Ethics Committee of the Tokyo Metropolitan University of Industrial Technology (Approval No. 23020). The questionnaire survey was conducted in accordance with the Declaration of Helsinki and relevant guidelines, and informed consent was obtained from all respondents. All response data were anonymized. Results Characteristics of participants Responses were obtained from 63 participants. The average age was 55.5 years, with 43 women (68.3%) and 20 men (31.7%) included in the study ( Table 2 ). Overall, 32 people (50.8% said that they had used psychosocial support services. The reasons for use were as follows: “Had questions or concerns” (15 people, 46.9%), “Wanted information about medical or welfare services” (6 people, 18.8%), “Wanted to learn about treatment or care options” (three people, 9.4%), “Needed support from family or those around them” (one person, 3.1%), and “Other” (seven people, 21.9%). The psychosocial support services used included the Cancer Consultation Support Center (18 people), cancer salons or patient groups (10 people), telephone services (two people), apps or online services (one person), and consulting medical professionals (one person). View this table: View inline View popup Download powerpoint Table 2. Basic attributes of participants In contrast, 31 (49.2%) participants said that they did not use these services. The reasons for not using them were: “I sufficiently understand my current situation” (four people, 12.9%), “I research and find information myself” (six people, 19.4%), “I do not feel the need for counselling support” (five people, 16.1%), “The support provided by medical professionals is sufficient” (four people, 12.9%), and “Other” (13 people, 41.9%) ( Table 3 ). View this table: View inline View popup Download powerpoint Table 3. Trends in the use of consultation support Barriers and facilitators to the use of psychosocial support This section focuses on insights gained from open-ended responses by individuals not using psychosocial support. We also qualitatively analyzed the specific factors that influenced the use of support. The results were categorized into themes such as “Motivation”, which underpins behavior, “Ability”, which enables or inhibits behavior; and “Trigger”, which prompts behavior. We also included “Interaction”, “Conditions”, “Outcomes”, “Means”, “Strategies”, “Barriers” and “Time” ( Table 4 ). Of the 32 open-ended responses, 16 (50.0%) were about motivation, 13 (40.6%) about triggers, and two (6.3%) about ability. Fig 1 shows a model of psychosocial support use behavior created by adapting the FBM using these results. The model indicates that when the ability barrier influencing behavior is lower, it is more likely that a trigger will succeed in driving action. Conversely, when the barrier is higher, it is more likely that a trigger will fail to drive action. This suggests that when motivation, the driving force behind the behavior, is high, a trigger is more likely to drive action, whereas when motivation is low, it is more likely to fail to do so ( Fig 1 ). Download figure Open in new tab Fig 1. Behavioral model of psychosocial support use based on Fogg’s Behavior Model View this table: View inline View popup Table 4. The coded text and themes The following section discusses each theme in more detail. Theme 1: Motivation—security and hope brought about by interaction and outcomes The primary motivations for using psychosocial support were centered around building trust through interaction and obtaining a sense of security and hope. For example, one user expressed expectations about the support provider’s character and ability to empathize with users: “ We should select people with ability, rather than just those with qualifications (such as social workers or nurses) or suitability .” (Interaction/Motivation) Expectations for psychosocial support included the provision of information or assistance with decision-making and also organizing feelings and gaining a sense of reassurance. “ When I want to ask something that’s difficult to bring up with the doctor, I can ask .” (Outcome/Motivation) These points indicate a desire to make a human connection and have some hope for the future, beyond just the “information” or “skills” provided by psychosocial support. Theme 2: Barriers to action (ability): obstacles to use caused by difficulty articulating feelings and a tendency toward self-reliance Two statements corresponded to “Ability”, and they shared themes such as “difficulty putting feelings into words” and “hesitation to rely on others”. “ I’ve constantly carried a vague sense of unease that I can’t put into words, so I don’t know how to ask for advice or seek support .” (Female/Barrier/Ability) “ I tend to think I understand things after researching them myself, so I don’t really try to rely on others .” (Male/Barrier/Ability) The former expresses frustration at the “difficulty explaining in words”, and the latter reveals hesitation because of a self-reliant attitude. Neither participant rejected psychosocial support itself, but both were in a psychological state in which it is hard to find an “opportunity” to access support. This highlights the complexity of “Ability” within the FBM. Theme 3: Trigger: promoting usage behavior through presentation of conditions, means, and strategies The trigger to encourage behavior required not only “conditions” and “means”, but also “strategically designed pathways”. Conditions “ It should be someone with human depth .” (Condition/Trigger) “ To receive advice based on expertise from someone trustworthy .” (Condition/Trigger) The person who responds and the attitude they take was an important starting point in making participants feel that it would be okay to consult with that person. Means “ It would be good to have a mechanism where orientation is received immediately after diagnosis .” (Means/Trigger)“ Support where necessary information can be searched together .” (Means/Trigger) Means help to develop a pathway to action, and supportive guidance acts as a trigger. Strategies “ If the service was publicized, I might want to use it .”(Strategy/Trigger) “ I want to see videos or interviews showing what a consultation support center looks like from the patient’s perspective .” (Strategy/Trigger) This indicates that “ingenious measures to encourage potential users” are crucial to promote the use of psychosocial support. Discussion Principal results In this study, we hypothesized that cancer survivors who do not use psychosocial support services experience challenges such as stigma about seeking support and a lack of trust in these services. Based on the FBM, we investigated the factors related to the use of psychosocial support. The analysis revealed that many respondents held emotional values such as expectations and hopes for psychosocial support. However, factors such as “a lack of appropriate pathways” and “an environment that does not create opportunities for action” emerged as barriers to its use in practice. Comparison with prior work First and foremost, motivation focused on building trust through interactions and obtaining a sense of security and hope as a result. Women, in particular, emphasized expectations of support to enable “emotional sorting” and developing a sense of security. Previous studies have also reported that female cancer survivors tend to feel anxious [ 26 ] and have a strong tendency to seek empathy and support for their feelings [ 27 ][ 28 ], which is consistent with our results. In contrast, men emphasized the need for information about clinical trials and the remission period of their illness, focusing less on psychological support. Previous studies have also shown that men have a low demand for psychological support [ 29 ], which is consistent with our findings. We also obtained insights about barriers to action related to ability, such as difficulties expressing emotions. This highlighted a psychological state of having no opportunity or not wanting to rely on others. The tendency for self-sufficiency may be attributed to the Dunning– Kruger effect [ 30 ]. However, those who self-rate their health literacy[ 31 ] as high [ 32 ] often do not realize the inadequacy of their understanding. This tendency has been reported in other studies [ 33 ][ 34 ], and was also reflected in our results. The inability to verbalize emotions, known as inhibited self-disclosure, has been noted as a factor hindering help-seeking behavior in patients with ovarian cancer [ 35 ], which is consistent with our findings. Triggers included aspects such as the humanity of supporters, clarification of consultation or counselling procedures, and promotional activities to encourage awareness. These findings suggest the need to balance a safe access environment with mechanisms that promote action when introducing psychosocial support. Surveys targeting patients with advanced cancer have also reported the importance of ensuring accessibility to support [ 36 ][ 37 ], which our findings confirm. Previous research also suggests the need for flexible support tailored to conditions and intentions rather than uniform responses for all patients [ 38 ]. Our findings indicate the potential to promote use of support services more effectively by presenting a combination of elements that trigger actions. This could serve as concrete guidelines for designing behavior-changing interventions for psychosocial support. Strengths and limitations This study involved several limitations. First, because it was a pilot study conducted via a web based questionnaire, selection bias may have occurred. Future research should address this issue by employing larger, more representative samples and a variety of data collection methods. Second, although we outlined a clear framework for discussing limitations, practical implications, and future research directions, our findings may not generalize to all cancer survivors who do not use psychosocial support services. Third, our analysis was restricted to the descriptive content provided in the one time survey responses, limiting the depth of insight. Complementary qualitative studies—such as in depth interviews or ethnographic observations—are needed to enrich these findings. Fourth, because the Google Form link was shared on third party platforms without trackable URLs, we could not perform click through analysis or calculate a response rate. Future surveys should use trackable links to obtain precise engagement metrics. Finally, building on these results, subsequent research should develop and evaluate practical interventions—such as tailored counseling services and informational tools—to optimize psychosocial support for cancer survivors. Conclusion In this study, we used the FBM to systematically organize the factors that promote the use of psychosocial support. This has provided insights that may be useful for understanding the initial design and intervention points for behavioral change in the future. In particular, psychosocial support is not merely a place to provide information. Based on the identified importance of motivation and triggers, it will be necessary to focus on enhancing trust and hope through individualized communication strategies and clearly defined pathways for initiating support for patients. Data Availability Due to the nature of this study, participants did not consent to the public sharing of data, so supporting data is not available. Acknowledgments We would like to express our deep gratitude to the patient organizations and respondents who cooperated with the recruitment and survey for this study. We also thank Melissa Leffler, MBA, from Edanz ( https://jp.edanz.com/ac ) for editing a draft of this manuscript. Footnotes We have updated the references in the sections Comparison with prior work and References. References 1. ↵ Cancer Information Service, National Cancer Center, Japan. Cancer statistics. National Cancer Registry, Ministry of Health, Labour and Welfare . 2025 July 3 https://ganjoho.jp/reg_stat/statistics/stat/summary.html 2. ↵ Bray F , Laversanne M , Sung H , Ferlay J , Siegel RL , Soerjomataram I , et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries . CA: A Cancer Journal for Clinicians . 2024 May 1; 74 ( 3 ): 229 – 63 . doi: 10.3322/caac.21834 OpenUrl CrossRef 3. ↵ 3. National Cancer Center Japan. Joint research with IARC identifying associations between lifestyle risk factors and the prognosis of cancer survivors . 2022 August 4 https://www.iarc.who.int/fr/news-events/iarc-and-the-national-cancer-center-japan-launch-a-joint-long-term-study-lifestyle-factors/ 4. ↵ Bower JE , Bak K , Berger A , Breitbart W , Escalante CP , Ganz PA , et al. Screening, assessment and management of fatigue in adult survivors of cancer: an ASCO clinical practice guideline adaptation . J Clin Oncol . 2014 ; 32 ( 17 ): 1840 – 1850 . doi: 10.1200/JCO.2013.53.4495 OpenUrl Abstract / FREE Full Text 5. ↵ Fujisawa D , Inoguchi H , Shimoda H , Yoshiuchi K , Inoue S , Ogawa A , et al. Impact of depression on health-utility value in cancer patients . Psychooncology . 2016 ; 25 ( 5 ): 491 – 495 . doi: 10.1002/pon.3945 OpenUrl CrossRef PubMed 6. ↵ Costa ALS , Heitkemper MM , Alencar GP , Damiani LP, da Silva RM , Jarrett ME. Social support predicts lower stress and better quality of life and resilience in Brazilian patients with colorectal cancer. Cancer Nurs . 2017 ; 40 ( 5 ): 352 – 360 . doi: 10.1097/NCC.0000000000000388 OpenUrl CrossRef 7. ↵ Ruiz-Rodríguez I , Hombrados-Mendieta I , Melguizo-Garín A , Martos-Méndez MJ . The importance of social support, optimism and resilience on quality of life in cancer patients . Front Psychol . 2022 ; 13 : 833176 . doi: 10.3389/fpsyg.2022.833176 OpenUrl CrossRef 8. ↵ Ministry of Health, Labour and Welfare. Revision of the Basic Plan for the Promotion of Cancer Control Measures in the “Living with Cancer” field . 2022 October 27 https://www.mhlw.go.jp/content/10901000/001005572.pdf 9. ↵ National Cancer Center Japan. Report on the Patient Experience Survey 2023 (preliminary) 2025 July 3 https://www.ncc.go.jp/jp/icc/policy-evaluation/project/010/2023/R5_all.pdf 10. ↵ Merluzzi TV , Philip EJ , Yang M , Heitzmann CA . Matching of received social support with need for support in adjusting to cancer and survivorship . Psychooncology . 2016 ; 25 ( 6 ): 684 – 690 . doi: 10.1002/pon.3896 OpenUrl CrossRef PubMed 11. ↵ Aflac Life Insurance Co. Survey results on concerns and anxieties of cancer patients: one in two cancer patients are “lost in cancer information” . 2022 .Oct 19 https://www.aflac.co.jp/news_pdf/20220819.pdf 12. ↵ Fennell K , Hull M , Jones M , Dollman J . Barriers to accessing services for mental and physical health conditions in rural Australian adults . Rural Remote Health . 2018 ; 18 ( 1 ): 4155 . doi: 10.22605/RRH4155 OpenUrl CrossRef PubMed 13. ↵ Langbecker D , Ekberg S , Yates P . “Don’t need help, don’t want help, can’t get help”: why brain-tumour patients do not use rehabilitation or psychosocial services . Patient Educ Couns . 2017 ; 100 ( 9 ): 1744 – 1750 . doi: 10.1016/j.pec.2017.04.004 OpenUrl CrossRef PubMed 14. ↵ Yigitbas C , Bulut A . Exploring psychological help-seeking behaviours and stigma perception among cancer patients: impact on psychosocial adjustment . Support Care Cancer . 2024 ; 32 ( 10 ): 694 . doi: 10.1007/s00520-024-08870-z OpenUrl CrossRef PubMed 15. ↵ Signorelli C , Lim Høeg B , Asuzu C , Centeno I , Estapé T , Fisher P , et al. International survey of psychosocial care for cancer survivors in low-/middle- and high-income countries . JCO Glob Oncol . 2024 ; 10 : e2300418 . doi: 10.1200/GO.23.00418 OpenUrl CrossRef 16. ↵ Fogg BJ . A behavior model for persuasive design . In: Proc 4th Int Conf Persuasive Technology . New York : ACM; 2009 ; 40 : 1 – 7 . OpenUrl 17. ↵ doi: 10.1145/1541948.1541999 OpenUrl CrossRef 18. ↵ Fogg BJ . Fogg Behavior Model . Stanford (CA): Behavior Design Lab, Stanford University ; 2019 . Technical report. 19. ↵ Feng GH , Zhao KH , Wang YF , Yue QQ , Chen YS , Huang LL , et al. mHealth interventions to improve liver-cancer screening among high-risk populations: protocol for an RCT . BMC Public Health . 2024 ; 24 ( 1 ): 2501 . doi: 10.1186/s12889-024-20025-7 OpenUrl CrossRef PubMed 20. ↵ Vogel RI , Niendorf K , Petzel S , Lee H , Teoh D , Blaes AH , et al. A mobile-health app to motivate genetic-counselling use among women with ovarian cancer: pilot RCT . Gynecol Oncol . 2019 ; 153 ( 1 ): 100 – 107 . doi: 10.1016/j.ygyno.2019.01.019 OpenUrl CrossRef PubMed 21. ↵ Montgomery R . Sample-size justification in feasibility studies: moving beyond published guidance . Pilot Feasibility Stud . 2025 ; 11 : 88 . doi: 10.1186/s40814-025-01675-9 OpenUrl CrossRef 22. ↵ Julious SA . Sample size of 12 per group rule of thumb for a pilot study . Pharm Stat . 2005 ; 4 ( 4 ): 287 – 291 . doi: 10.1002/pst.185 OpenUrl CrossRef Web of Science 23. ↵ Kunselman AR . A brief overview of pilot studies and their sample-size justification . Fertil Steril . 2024 ; 121 ( 6 ): 899 – 901 . doi: 10.1016/j.fertnstert.2024.01.040 OpenUrl CrossRef PubMed 24. ↵ Charmaz K . Constructing grounded theory: a practical guide through qualitative analysis . London: Sage; 2006 . 25. ↵ Morse JM Stern PN Corbin J Charmaz K . Grounded theory as an emergent method . In: Morse JM , Stern PN , Corbin J , et al. , editors. Handbook of emergent methods . New York : Guilford Press ; 2008 . p. 155 – 170 . 26. ↵ Glaser BG . Theoretical sensitivity: advances in the methodology of grounded theory . Mill Valley (CA ): Sociology Press ; 1978 . 27. ↵ Matsui T , Hirai K , Gondo Y , Sato S . Help-seeking behaviour and psychosocial-support service use among Japanese cancer patients . Jpn J Clin Oncol . 2020 ; 50 ( 10 ): 1175 – 1181 . doi: 10.1093/jjco/hyaa086 OpenUrl CrossRef PubMed 28. ↵ Katayama K , Ishikawa D , Miyagi Y , Takemiya S , Okamoto N , Ogawa A . Cancer telephone consultations: gender differences in counselling needs . Patient Educ Couns . 2020 ;S0738-3991( 20 ) 30278 -0. doi: 10.1016/j.pec.2020.05.012 OpenUrl CrossRef 29. ↵ Feng X , Hu Y , Pfaff H , Liu S , Wang H , Wang Y . Emotional or informational? Help-seeking behaviours in online health communities . Soc Sci Med . 2025 ; 371 : 117902 . doi: 10.1016/j.socscimed.2025.117902 OpenUrl CrossRef 30. ↵ Faller H , Koch U , Brähler E , Härter M , Keller M , Schulz H , et al. Satisfaction with information and unmet information needs in men and women with cancer . J Cancer Surviv . 2016 ; 10 : 62 – 70 . doi: 10.1007/s11764-015-0451-1 OpenUrl CrossRef PubMed 31. ↵ Kruger J , Dunning D . Unskilled and unaware of it: difficulties in recognising one’s own incompetence . J Pers Soc Psychol . 1999 ; 77 ( 6 ): 1121 – 1134 . doi: 10.1037/0022-3514.77.6.1121 OpenUrl CrossRef PubMed Web of Science 32. ↵ Nutbeam D . Health promotion glossary . Health Promot Int . 1998 ; 13 ( 4 ): 349 – 364 . doi: 10.1093/heapro/13.4.349 OpenUrl CrossRef Web of Science 33. ↵ Peng RX , Shen F . Why fall for misinformation? Information-processing strategies, health consciousness and overconfidence in health literacy . J Health Psychol . 2024 ;Epub ahead of print. doi: 10.1177/13591053241273647 OpenUrl CrossRef 34. ↵ Pennycook G , Ross RM , Koehler DJ , Fugelsang JA . Dunning–Kruger effects in reasoning: implications of failing to recognise incompetence . Psychon Bull Rev . 2017 ; 24 ( 6 ): 1774 – 1784 . doi: 10.3758/s13423-017-1242-7 OpenUrl CrossRef PubMed 35. ↵ Yin H , Zha Y , Zhou Y , Tao H , Zhu D . Barriers and facilitators to help-seeking for symptoms in ovarian-cancer patients in China: a qualitative study . BMJ Open . 2024 ; 14 ( 11 ): e087602 . doi: 10.1136/bmjopen-2024-087602 OpenUrl Abstract / FREE Full Text 36. ↵ Newton JC , O’Connor M , Saunders C , Moorin R , Ali S , Nowak AK , et al. Psychosocial support in people living with advanced cancer: patients’ perspectives . Psychooncology . 2021 ; 30 ( 3 ): 287 – 295 . doi: 10.1002/pon.5569 OpenUrl CrossRef PubMed 37. ↵ Sheridan R , McCaughan D , Hewison A , Roman E , Smith A , Patmore R , et al. Experiences and preferences for psychosocial support in chronic haematological cancers . BMJ Open . 2023 ; 13 ( 8 ): e070467 . doi: 10.1136/bmjopen-2022-070467 OpenUrl Abstract / FREE Full Text 38. ↵ Matsui T , Hirai K , Gondo Y , Sato S . Factors contributing to help-seeking for psychosocial support among Japanese cancer patients: segmentation approach . Psychooncology . 2020 ; 29 ( 11 ): 1905 – 1916 . doi: 10.1002/pon.5523 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted August 13, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study Manae Hirayama , Daisuke Kasai , Ken-ichi Tabei medRxiv 2025.07.31.25332471; doi: https://doi.org/10.1101/2025.07.31.25332471 Share This Article: Copy Citation Tools Development of a behavioral model for the use of psychosocial support services by cancer survivors: A grounded theory pilot study Manae Hirayama , Daisuke Kasai , Ken-ichi Tabei medRxiv 2025.07.31.25332471; doi: https://doi.org/10.1101/2025.07.31.25332471 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Health Informatics Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4425) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15221) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6588) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1368) Health Systems and Quality Improvement (1612) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15910) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (145) Nephrology (667) Neurology (6588) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3331) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5440) Public and Global Health (9219) Radiology and Imaging (2195) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (710) Sports Medicine (529) Surgery (710) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ffe1d282f6341e2',t:'MTc3OTQ3Njk1Mg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();