A Qualitative Protocol for Evaluating Online Social Work Interventions for Cancer Survivors Using an AI-Enhanced WeChat Mini-Application

Abstract

Cancer survivors in China face ongoing physiological, psychological, social, and spiritual challenges that significantly impact their quality of life. Despite the proliferation of online interventions, existing research lacks comprehensive exploration of integrating theoretical knowledge and practical experiences into the design of digital interventions for cancer survivors. To address these multidimensional needs and identified research gaps, this study presents a structured protocol for developing and evaluating an AI-enhanced online social work intervention delivered via a WeChat mini-application. Employing a three-phase, evidence-based qualitative methodological framework, the research begins with a systematic review and meta-analysis to establish comprehensive guidelines for intervention design. This is followed by an iterative multi-stakeholder co-creation process involving survivors, family members, social workers, healthcare professionals, and technology developers to optimize the mini-application. The final phase involves qualitative evaluations of the intervention to assess participant satisfaction, usability, perceived effectiveness, and sustainability of engagement. Findings from this study contribute both practically—by demonstrating how AI technology and stakeholder collaboration can deliver tailored digital interventions—and methodologically, by validating a structured, adaptable framework for designing culturally sensitive and user-centered health interventions.

Keywords

cancer survivors AI WeChat mini-application psychosocial support online health services intervention design

Introduction

The Challenges Facing Cancer Survivors in China and the Potential of Online Interventions

China has the highest incidence and mortality rates of cancer globally (DeBiasi, 2023). Despite its health system having made improvements in the 5-year survival rates for cancer patients in recent years, cancer survivors in China continue to face significant challenges, not least in part because the cancer experience has profound late effects on the physical, pschological, social, and spritualwellbeing of cancer survivors (Rogers et al., 2023). Therefore, researchers argue that a comprehensive survivor care framework should include not only medical follow-up but also holistic interventions that target emotional well-being, social functioning, and a sense of spiritual fulfillment to improve their wellbeing (Haywood et al., 2024).

Many cancer survivors encounter barriers to accessing traditional face-to-face interventions due to financial burdens, logistical challenges, or mental concerns (Tonorezos et al., 2022). As a result, online or digital technology-based interventions which encompass various aspects of comprehensive care, have emerged as a viable alternative. Online interventions offer advantages such as lower costs, convenience, and enhanced privacy protection (Pandya, 2021; Yu et al., 2021). Despite their benefits with respect to accessibility and autonomy, the effectiveness of online interventions across the full spectrum of care—beyond medical support—still requires further empirical validation (Bossi et al., 2022; Schleider et al., 2022). In recent years, many researchers and institutions have developed online social work intervention apps for cancer patients, survivors, and health social workers; however, users often struggle to find high-quality options, as many apps feature incomplete content and poor development (Navarro et al., 2020; Wong et al., 2021; Zhao et al., 2024).

Gaps in Current Research on Online Health Social Work Interventions

To assess the effectiveness of online interventions, most international studies have used randomized controlled trials or non-randomized studies (Gyawali & Hamdani, 2021). These studies generally lack detailed investigation of the design process for the online intervention and fail to address ways to integrate theoretical knowledge and practical experience into scientific online interventions (Kizilcec et al., 2020). As such, there is a strong need for current research on health social work interventions to focus not only on outcome measurement but also on the design process (English et al., 2022; Oliwa et al., 2020). In relevant literature, intervention design is undertaken by adjusting existing intervention frameworks to meet specific needs, following models and theories such as the Health Belief Model or Social Cognitive Theory (Nelligan et al., 2019), or taking hybrid approaches combining multiple theories to guide interventions. However, the theories on which health social work researchers rely may lack concrete guidance for the design of practical interventions. The challenge lies in finding ways to transform theoretical knowledge into actionable intervention strategies (Steinmo et al., 2015). Unlike purely theoretical methods, evidence-based strategies—rooted in systematic reviews of established research—yield practical guidelines for designing interventions, thus enabling robust assessment and measurement (He, 2024).

Aims

This study aims to systematically develop, implement, and evaluate an AI-enhanced online social work intervention delivered through a WeChat mini-application to comprehensively support cancer survivors in China. Specifically, the study’s objectives are: (1) to establish evidence-based guidelines for designing holistic digital interventions addressing survivors’ physiological, psychological, social, and spiritual needs through a systematic review; (2) to collaboratively create an AI-powered social work mini-application using input from multiple stakeholders including cancer survivors, family members, social workers, healthcare professionals, and technology developers; and (3) to qualitatively assess the effectiveness, usability, participant satisfaction, and sustainability of the mini-application through rigorous qualitative evaluations. This integrative, iterative approach aims to deliver a culturally sensitive and practical intervention that effectively addresses the diverse and complex needs of cancer survivors.

Methodological Framework

This study is structured into three main phases: the first and second phase has already been completed, and the third phase is planned for future implementation. In the first step, a systematic review comprehensively analyzed existing literature on social work or psychosocial interventions for cancer patients and survivors, summarizing theoretical frameworks and practical recommendations for online intervention design. In the second step, a rapid qualitative analysis with multi-stakeholder co-creation was to optimize and finalize the AI-powered social work intervention delivered via a WeChat mini-application. In the third step, this study will employ a qualitative intervention approach, using qualitative evaluation methods to assess intervention outcomes. Participants will include cancer survivors receiving the intervention, as well as social workers and health professionals facilitating it.

Rationale for Combined Methods

This study is structured into three main phases, with the first two phases completed and the third phase planned for future implementation. The first phase involved conducting a systematic review to establish an evidence-based theoretical foundation and identify gaps in current intervention strategies (Sheppard, 2003; Washburn et al., 2021). Recognizing that theory alone is insufficient to fully address the dynamic needs of cancer survivors (Czosnek et al., 2021), the second phase involved a rapid qualitative analysis and multi-stakeholder co-creation process to optimize and finalize the AI-powered social work intervention delivered via a “WeChat” mini-application. In the upcoming third phase, this study will employ a qualitative evaluation approach to assess specific outcomes, including participant satisfaction, perceived effectiveness of intervention modules, usability of the mini-application, and sustainability of engagement. Participants involved in this phase will include cancer survivors, social workers, and health professionals.

Empirical Phase One: Systematic Review

The systematic review comprehensively analyzed existing literature focusing on two primary research questions:

• What theoretical frameworks guide online social work interventions for cancer patients and survivors?

• What practical recommendations exist for comprehensive interventions targeting cancer patients and survivors?

Search Strategy

Searches were conducted initially between October 2021 and March 2022, and updated between September and October 2024, covering English databases (Web of Science, PubMed, Embase, MEDLINE, Cochrane Library) and Chinese databases (CNKI, Wanfang Data). Keywords for English databases included “social work,” “intervention design,” “online intervention,” and “cancer survivor,” while Chinese database searches used terms such as “社会工作,” “线上干预或服务,” “干预设计,” and “癌症幸存者.” Search engines (Baidu, Google, Microsoft Bing) were also utilized to identify existing domestic and international PTSD service mini-applications and relevant reports.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Studies on social work intervention frameworks, effectiveness, content, or design targeting cancer patients/survivors or PTSD clients;

• Studies involving offline or online interventions for these populations;

• Studies employing reflective, quantitative, qualitative research methods, or non-randomized control trials.

Exclusion Criteria

• Non-English or non-Chinese publications;

• Non-academic sources (conference papers, news articles);

• Publications without full-text access or incomplete data;

• Studies irrelevant to intervention design for targeted populations;

• Duplicate publications.

Analysis and Results Summary

The systematic analysis aimed to develop practical and operational guidelines for designing comprehensive online interventions, setting a robust foundation for subsequent phases. Using evidence-based social work methods, this study conducted systematic reviews of physiological, psychological, social, and spiritual health interventions for cancer survivors, aiming to provide scientific foundations for intervention design. During the data retrieval stage, approximately 500 papers related to the health outcomes of cancer survivors and relevant interventions were collected from major English and Chinese databases. After screening titles and abstracts, 150 relevant studies were selected. Further screening based on clear study objectives and interventions related to cancer survivors narrowed the total number reviewed down to 65 papers.

By deeply analyzing the results of the systematic reviews, adapting the Children’s Oncology Group Guideline, the International Harmonization Guidelines Group for late effects of childhood cancer, and the research by Tonorezos et al. (2022) published in Lancet, the researchers developed a guideline for physiological and psychosocial health interventions to support cancer survivors (Bhakta et al., 2017; Tonorezos et al., 2022). This table outlines health aspects, potential late effects, and suitable intervention strategies drawn from the literature, providing concrete operational guidance for intervention design (Table 1).

Table 1.

Health Risk-Based Follow-Up Guideline for Cancer Survivors

Health aspects	Potential late effects for cancer or cancer treatment-affected area	Recommendations
Physiological	Auditory	Yearly audiological assessment, limit exposure form loud sound, speech therapy, assistive devices
	Cardiovascular	Yearly cardiovascular examination, regular physical activities, healthy eating habits, avoid smoking, recreational drugs, and vapes
	Fertility	Consider hormone replacement therapy for survivors diagnosed with premature ovine failure
	Skeletal	Bone density scan on entry into long-term follow-up, a balanced diet with Vitamin D and calcium
	Renal	Annual blood pressure test and renal function examination, maintain hydration, avoid non-steroidal anti-inflammatories
	Subsequent malignant neoplastic	Physical exam, sun protection measures, advocate for insurance coverage of recommended testing, hepatitis screening, vaccinate against hepatitis B and human papilloma virus
	Endocrine	Tanner staging yearly until sexually mature, survivor education, annual blood pressure test, annual thyroid physical exam, consideration of hormone therapy, height and weight check yearly, sick-day rules for those on glucocorticoid replacement therapy
	Bladder	Yearly blood pressure check and renal function examination, maintain hydration
	Eyes	Annual eye examination, eye-protection measures
	Dental	Annual dental examination, dental hygiene, dink fluids often, avoid smoking and vaping
	Metabolic syndrome	Yearly body mass index and blood pressure check-up, regular physical activities
	Skin	Annual skin examination, survivor education, sun protection
	Peripheral nervous system	Neurological exam, physical therapy, use of ankle-foot-orthoses, avoid ill-fitting shoes, pain relief, massage, cool packs and soak
	Neurocognitive	Neuropsychological assessment, neurocognitive interventions, suitable medication, maintain communication
Psychological	Depression and mood disorders	Regular mental health screening
		Physical activities such as yoga or tai chi that encourage mind-body balance
		Psychotherapy, such as cognitive behavioral therapy or acceptance and commitment therapy,
		Peer support groups
		Family-based interventions to involve caregivers and reduce isolation
	Anxiety	Anxiety-focused psychotherapy such as exposure therapy or mindfulness-based stress reduction
		Introducing stress management techniques like meditation apps, journaling, or art therapy
		Support from a multidisciplinary team,
		Providing cancer survivors with access to mental health hotlines or digital mental health platforms
	Self-harm or suicidal ideation	Immediate crisis intervention with access to 24/7 support hotlines or emergency counseling services
		Dialectical behavior therapy (DBT) for cancer survivors prone to emotional dysregulation
		Training for family members and caregivers on recognizing signs of self-harm and suicidal ideation
		Close collaboration between school, social work, and health services to provide ongoing support
	Fear of cancer recurrence	Educational sessions on recurrence statistics and long-term health management to reduce catastrophic thinking
		Referral to psycho-oncology specialists to help cope with the fear of recurrence
		Incorporation of narrative therapy or trauma-informed therapy to help survivors construct a positive, coherent post-cancer narrative
	Concern about body image	Cognitive behavioral therapy for body image issues and distress
		Incorporating activities like art therapy
		Encouraging participation in physical rehabilitation programs
		Psychosocial education
	Reproductive concerns	Annual mental health screening
		Physical activities and healthy eating
		Sexual health education
		Access to endocrinologists and fertility specialists
Social	Poor school or work performance	Educational accommodations
		Vocational rehabilitation services
		Peer mentoring programs
		Cognitive remediation programs
	Social isolation	Social skills training
		Virtual support groups and online communities
		Collaboration with school social workers to encourage social reintegration activities
		Structured social reintegration programs
Spiritual	Trauma-related spiritual distress (such as losing faith)	Mindfulness programs integrated with spiritual counseling
		Spiritual support services (e.g., chaplains or religious leaders) within care teams
		Meaning-centered therapy
		Encouraging participation in religious or community-based activities
	Loss of meaning or purpose	Existential therapy
		Opportunities for survivors to engage in volunteer work or advocacy
		Incorporating resilience-building activities such as adventure therapy or creative expression

In constructing the AI + Social Work Intervention “WeChat” mini-application for cancer survivors, this study combined international practices in cancer survivor support services with app and mini-application design techniques. Based on the needs of cancer survivors synthesized from the systematic review stage, the researchers divided cancer survivor support services into the following core modules: physiological health, psychological recovery, social recovery, spiritual recovery, peer support and community interaction, which constituted the initial protocol for the AI + Social Work Intervention “WeChat” mini-application, as shown in Table 2.

Table 2.

Core Modules of the AI + Social Work Intervention “WeChat” Mini-Application

Core Module	Secondary Modules	Mini-application Features
Physiological health 生理健康	Treatment management, healthy lifestyle recommendations, regular check-up reminders	Text display, graphic display, video links, health plan reminders, medication reminders, caution reminders, AI assistant
Psychological recovery 心理康复	Emotional support and counseling, psychological therapy courses, crisis intervention, AI interactions	Self-diagnosis, AI psychological counselor, text display, graphic display, psychological evaluation tools, AI assistant
Social recovery 社会康复	Social support, social skills training, school work techniques	Self-diagnosis, AI psychological counselor, text display, graphic display, psychological evaluation tools, AI assistant
Spiritual recovery 精神康复	Spiritual support services, resilience building activities	Self-diagnosis, AI psychological counselor, text display, graphic display, psychological evaluation tools, caution reminders, AI assistant
Peer support and community interaction 同伴支持与社群互动	Peer support platform, online forums, events and interaction opportunities	Group invitations, knowledge forums, online interaction platform, AI assistant
Safety and privacy Protection 网络安全和隐私保护	Data security and privacy protection, privacy settings and anonymous participation, secure psychological support	Information entry, privacy settings, anonymous participation function, security and privacy

Note. Items highlighted in bold are added functions or sections based on the analysis undertaken in the second stage of this study.

Empirical Phase Two: Integrated Technology-Driven, Co-Creation, and Iterative Design

Building on the theoretical insights and practical guidelines from the first phase, this study constructed an AI-powered social work intervention delivered via a “WeChat” mini-application. Rapid qualitative analysis, featuring co-creation among multiple stakeholders, was used to optimize and finalize the intervention design.

Participants were purposively sampled and divided into four diverse focus groups recruited through relevant WeChat communities, hospitals’ official WeChat accounts, and technology partnerships:

• Group One: 24 cancer survivors;

• Group Two: 23 family members of survivors;

• Group Three: 20 social workers, 3 psychotherapists, and 5 health professionals;

• Group Four: 5 technical staff specialized in AI and mini-application development.

Each group discussion, lasting 90 to 120 minutes, gathered participant feedback on core module design and evaluated specific intervention goals set using the SMART criteria, ensuring practical relevance and effectiveness. Discussions were recorded, transcribed, and qualitatively analyzed to refine the intervention.

Analysis and Results Summary

Through four focus group discussions, this study explored the initial protocol of the AI + Social Work Intervention “WeChat” mini-application for cancer survivors. Thematic analysis identified three themes including a consensus on core modules, the identification of functional discrepancies, and the value/applicability of SMART analysis. Representative participant views and statements on each theme are presented in Table 3.

Table 3.

Discrepancies in Functional Design and SMART Analysis

Theme 1: Discrepancies in functional design
Sub-theme	Participant views	Interview quote
Detailed feature additions	Medication reminder functions should be added to the physical health module and crisis intervention functions added to the psychological support module.	“A medication reminder feature would be really helpful for cancer survivors who require long-term treatment.” (family member)
Privacy protection and personalization	Privacy protection, particularly in the online peer support group, should be strengthened by adding privacy settings for anonymous participation.	“Privacy protection is crucial in the psychological and social support module, especially in the Chinese context where cancer is heavily stigmatized. Can we add options for participants to remain anonymous?” (social worker)
Handling of (culturally) sensitive topics	Modules dealing with life and death or psychological trauma may trigger emotional responses in the Chinese cultural context. Participants suggested handling these topics with caution reminders in content design and presentation.	“There are sensitive topics in psychological recovery; could the program include warnings to ensure content doesn’t cause additional trauma?” (social worker)
Possibility for personalized design based on comprehensiveness	Most social workers and some cancer survivors emphasized psychological support, while others prioritized physical health. This highlights the need for tailored interventions to meet diverse needs.	“For me, managing my physical health is way more important than focusing on the emotional side right now. I don’t care about mental health.” (cancer survivor).
Theme 2: SMART analysis
SMART indicator	Analysis content	Interview quote
Specific: Defining module goals	The design goals should be clarified, especially for sensitive content like psychological support and privacy protection, with service scope and content refined.	“We need to more clearly define the functions of the psychological support module, particularly around privacy and user interaction.” (psychotherapist)
Measurable: Setting indicators	Specific evaluation indicators, such as psychosocial health improvement and user engagement, would be beneficial to track service effectiveness and make adjustments.	“We should quantify user psychological and social improvements through regular feedback to understand their mental health status, and also add psychological assessment entries.” (social worker)
Achievable: Technical feasibility	Prioritize developing low-complexity, high-user-value features like medication reminders and online peer support. Complex features like AI psychological counseling can be introduced gradually.	“It will take time to introduce AI counseling, but we can start with simple reminder functions to build the system and later add more complex features.” (technician)
Relevant: Ensuring function relevance	Ensure the mini-application’s functions directly address the core needs of cancer survivors, avoiding information overload and unnecessary complexity that could affect the user experience.	“Overly complex or excessive content might confuse users, especially younger people just recovering. Simplicity and ease of use are more important.” (cancer survivor)
Time-bound: Phased development	Adopt the MVP principle for phased development, starting with core functions like physical health and psychological support modules, then develop more complex functions such as those that are personalized.	“We should focus on the most critical functions first, then gradually expand as we go to ensure the mini-application becomes operational quickly.” (family member)

Note. MVP (minimum viable product, an approach where a product is initially developed with only its essential features while integrating defined performance metrics to enable systematic, evidence-based iterative refinements).

Theme 1: Participants pointed out some functional discrepancies in the mini-application design, mainly identifying the need for additional features, privacy protection, and personalized services. They also offered suggestions on handling sensitive topics.

Theme 2: SMART analysis of the transcripts from the four focus groups revealed that the mini-application’s design required further optimization in several areas, particularly in terms of specificity, measurability, achievability, and time-bound aspects.

Based on focus group feedback and the SMART approach, we propose several optimization strategies (see Table 2; functions added in phase three are in bold). To enhance specificity, we developed detailed feature descriptions—adding crisis intervention to the “Psychological Recovery” and “Spiritual Recovery” modules, caution reminders in the “Physiological Health” module, and a “Safety and Privacy Protection” module for anonymous participation. For measurability, a psychological self-assessment function and key evaluation metrics were introduced to gather regular feedback and assess effectiveness. To boost achievability, we prioritized technically feasible, high-value functions such as medication reminders, gradually increasing technical sophistication while managing expectations for AI. Lastly, to ensure relevance and time-bound progress, we developed the mini-application in phases according to the MVP principle, launching core functions first and expanding to additional modules over time.

The SMART and MVP strategy will continue to be essential for to achieving better effectiveness and efficacy of this mini-application. By enhancing design specificity, setting measurable service effectiveness indicators, ensuring technical feasibility, focusing on the relevance to goals, and establishing a reasonable time-bound framework, the success of this approach can be seen in Figure 1, which illustrates the advancements made in version 2.0.

Figure 1.

Some Mini Program Pages are Displayed

Empirical Phase Three: Qualitative Evaluation of Intervention Outcomes

The upcoming third phase will involve qualitative evaluation methods to assess specific outcomes of the finalized intervention, including participant satisfaction, perceived effectiveness of intervention modules, usability of the mini-application, and sustainability of participant engagement. Participants will include cancer survivors receiving the intervention and the social workers and health professionals facilitating it. Data gathered through qualitative methods will inform improvements in intervention design, practicality, and long-term viability.

Materials and Methods

Study Design

This research comprises three key phases, with the first two completed and the third scheduled for future implementation. The initial phase involved establishing an evidence-based theoretical foundation through a systematic review, identifying gaps in current intervention strategies.

The second phase consisted of rapid qualitative analysis and multi-stakeholder co-creation processes to refine and finalize the AI-powered social work intervention delivered via a “WeChat” mini-application.

The third phase that is about to be implemented will involve a qualitative evaluation to assess outcomes such as participant satisfaction, intervention effectiveness, usability, and sustained engagement after the actual intervention.

Research Sampling Strategy

In the third phases, a diverse and representative sample of cancer survivors will be recruited to participate in qualitative evaluations. Participants will be recruited through community health organizations, WeChat groups dedicated to cancer patients and survivors, and hospital-based communication channels. Recruitment advertisements will also be disseminated via healthcare networks and social media channels to maximize outreach and ensure broad representation. Purposive sampling will be employed to recruit specific sub-groups including 30 cancer survivors, 10 family members, 2 healthcare providers, 5 social workers, 1 psychotherapists, and 1 technology professionals involved in AI and mini-application development. Snowball sampling may be utilized to expand participant recruitment if initial responses are limited.

Study Population

The study will involve three participant groups in the Practice and In-Practice phases:

Cancer Survivors: Individuals who have experienced cancer, drawn from diverse backgrounds, including varying socio-economic statuses and urban and rural regions, providing lived experience.

• Inclusion Criteria: Cancer survivors residing in China, aged 18 and above, capable of providing informed consent. Familiarity with digital tools (e.g., WeChat) is preferred but not mandatory, as technical support will be provided.

• Exclusion Criteria: Individuals with severe cognitive impairments or unwillingness to engage in intervention discussions will be excluded.

Stakeholders: Health communication practitioners, social workers, healthcare professionals, government administrators, and IT developers specializing in WeChat and AI, contributing medical, technical, and policy expertise.

Family Members: Providing additional context on the social dynamics influencing cancer survivors’ well-being.

Data Collection and Storage

Focus groups and qualitative interviews will be conducted online using Tencent and WeChat conferencing tools, and all sessions will be audio-recorded for transcription. Recordings will be securely stored in a password-protected, university-managed storage system accessible only to authorized researchers via two-factor authentication. Transcripts will be anonymized by assigning unique participant codes and removing any identifying information to ensure confidentiality. Additional data, such as digital whiteboard screenshots and researcher notes, will also be securely stored. All collected data will be securely maintained for a minimum of five years before being permanently deleted.

Data Quality Control

Verbatim transcripts will be generated from audio recordings using transcription software, followed by manual verification to correct any software-generated errors. This dual verification process minimizes transcription inaccuracies and ensures data reliability. To reduce translation bias, transcripts will be reviewed independently by two researchers from different professional backgrounds—one specializing in health communication and the other in social work. To protect confidentiality and maintain data integrity, participants will not review transcripts.

Data Collection Limitations and Challenges

Potential challenges include recruitment difficulties due to the sensitive nature of the intervention and technological barriers faced by older or less tech-savvy participants. To mitigate these issues, recruitment efforts will integrate both digital and in-person strategies, and technical support will be provided as needed. The research team, comprising members from diverse professional backgrounds, will collaboratively address confirmation bias risks, ensuring accurate and reliable data collection and interpretation.

Outcome Measures

Outcome measures for this study will focus on evaluating participant satisfaction, perceived effectiveness of intervention modules, usability and accessibility of the WeChat mini-application, participant engagement levels, and sustained utilization. Additional outcomes may include enhanced psychosocial well-being, improved communication with healthcare providers and family members, and increased confidence and ability in managing long-term survivorship challenges.

Qualitative Data Analysis

Qualitative data analysis will be conducted using classic grounded theory methods. Initially, transcripts will be reviewed and openly coded to identify key concepts. Through constant comparative analysis, codes will be categorized into emerging themes and subthemes. Axial coding will follow, examining relationships among categories and refining them into coherent conceptual frameworks. Finally, selective coding will integrate categories to construct a substantive theoretical model, grounded in the participants’ experiences and perspectives, elucidating critical dimensions of intervention effectiveness and user engagement.

Ethical Considerations and Quality Assurance

Ethical approval will be obtained from the Southwestern University of Finance and Economics’ institutional review board prior to commencing the study. Informed consent will be clearly explained and documented from all participants, emphasizing confidentiality, voluntary participation, and the right to withdraw at any point without consequence. The research will strictly adhere to ethical standards, ensuring participants’ anonymity, safeguarding sensitive information, and maintaining transparency in research processes. Continuous quality assurance will be implemented throughout the study, with regular evaluations and team meetings to ensure rigorous adherence to methodological protocols and ethical guidelines.

Rigor of the Study

To ensure rigor and trustworthiness in this qualitative research, credibility will be established through triangulation of data sources, including multiple stakeholder perspectives and iterative member checks within the research team. Dependability and confirmability will be enhanced through comprehensive audit trails documenting all research decisions, coding procedures, and analytic interpretations. Transferability will be supported by providing rich, detailed descriptions of the study context, participant characteristics, and intervention development processes, facilitating applicability to similar research settings and populations.

Results and Discussion

Recruitment for the qualitative phases will begin in Aug 2025, with intervention recruitment scheduled for August 2025. Data collection and analysis are expected to conclude by November 2025. The findings from the co-design and iterative process will be finished in 2026.

This study designed and optimized an AI + WeChat mini-application intervention to address cancer survivors’ diverse needs—including physiological, psychological, social, spiritual, peer support, and privacy aspects—based on literature review and stakeholder input. Findings from three stages revealed challenges in meeting personalized needs, technical feasibility, and managing sensitive information and privacy. SMART analysis was used to propose targeted improvement strategies, offering both practical and methodological contributions.

Methodological Contributions

This study proposes an evidence-based qualitative methodological framework (Figure 2; He, 2024) that provides both theoretical and practical support for designing interventions for cancer survivors, with potential modifications for use with other populations. The framework is innovative in its fusion of scientific rigor and practical complexity. It integrates validated theoretical models and systematic evidence from the literature with empirical, co-creative strategies involving multiple stakeholders. This organic integration of research methods ensures that theoretical guidance is balanced with practical demand, thereby addressing the complex, multi-layered challenges of providing palliative care services in China (Birtwell et al., 2022; Schexnayder et al., 2023). By following a “theory-practice-in practice” logic, the framework begins with a literature-based theoretical guideline to develop an initial intervention model, which is then optimized through empirical research and multi-stakeholder analysis in a time-bound framework. Qualitative evaluation methods involving cancer survivors, social workers, and healthcare professionals were employed to assess participant satisfaction, perceived effectiveness, usability, and sustainability of engagement with the intervention.This continuous feedback loop demonstrates a robust integration between theory and practice. Furthermore, the framework emphasizes multi-level adaptability, from cultural resonance to technical sustainability, making it a scalable, versatile model for digital intervention design that is both scientifically validated and practically robust, and suitable for adaptation across diverse fields. This comprehensive framework further enhances intervention design by continuously integrating valuable stakeholder feedback and systematic iterative refinements.

Figure 2.

An Evidence-Based Qualitative Methodological Framework for Front-End Intervention Research and Design (Adopted from He, 2024)

Conclusion

This study presents an effective approach for developing a user-centered digital intervention tailored specifically for cancer survivors, highlighting the importance of iterative co-design and qualitative evaluation. The study’s innovative integration of evidence-based guidelines, AI technology, and stakeholder collaboration provides a robust framework applicable in similar intervention contexts.

However, several limitations must be noted. First, recruitment and participation challenges due to the sensitive nature of cancer survivorship may limit participant diversity and representation. Second, technological barriers experienced by some users could affect sustained engagement with the intervention. Lastly, the qualitative design may limit generalizability beyond the specific populations and contexts studied. Future research should aim to address these limitations by enhancing participant support mechanisms and exploring the intervention’s adaptability across diverse cancer survivor groups and broader healthcare settings.

Footnotes

ORCID iDs

Longtao He

Yu Hu

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the National Social Science Fund of China - Post-funding Key Project (grant: 23FSHA002), the Philosophy and Social Science Fund of Sichuan - Post-funding Project (grant: SCJJ23HO37), and the Fundamental Research Funds for the Central Universities of Southwestern University of Finance and Economics (grant: JBK2406119). The funders had no role in the research design, the writing of the article, or the decision to submit the article.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Bhakta

Liu

Ness

K. K.

Baassiri

Eissa

Yeo

Chemaitilly

Ehrhardt

M. J.

Bass

Bishop

M. W.

Shelton

Huang

Caron

Lanctot

Howell

Folse

Joshi

Robison

L. L.

(2017). The cumulative burden of surviving childhood cancer: An initial report from the St Jude Lifetime Cohort Study (SJLIFE). The Lancet, 390(10112), 2569–2582. https://doi.org/10.1016/S0140-6736(17)31610-0

Birtwell

Morris

Armitage

C. J.

(2022). Combining timelining and storyboarding to create a novel method for INtervention DesIGn with stakehOlders: INDIGO. International Journal of Qualitative Methods, 21, Article 16094069221127147. https://doi.org/10.1177/16094069221127147

Bossi

Zaninotto

D’Arcangelo

Lattanzi

Malizia

A. P.

Ricciardi

(2022). Mindfulness-based online intervention increases well-being and decreases stress after Covid-19 lockdown. Scientific Reports, 12(1), 6483. https://doi.org/10.1038/s41598-022-10361-2

Czosnek

Richards

Zopf

Cormie

Rosenbaum

Rankin

N. M.

(2021). Exercise interventions for people diagnosed with cancer: A systematic review of implementation outcomes. BMC Cancer, 21(1), 643. https://doi.org/10.1186/s12885-021-08196-7

DeBiasi

(2023). US and global epidemiology and incidence rates of lung cancer. In MacRosty

C. R.

Rivera

M. P.

(Eds.), Lung cancer: A comprehensive guide for the clinician (pp. 1–24). Springer International Publishing. https://doi.org/10.1007/978-3-031-38412-7_1

English

Nzinga

Oliwa

Maina

Oluoch

Barasa

Irimu

Muinga

Vincent

McKnight

(2022). Improving facility-based care: Eliciting tacit knowledge to advance intervention design. BMJ Global Health, 7(8), Article e009410. https://doi.org/10.1136/bmjgh-2022-009410

Gyawali

Hamdani

(2021). Use of evidence based practice by physical therapist in Delhi and NCR, India: A crossectional survey. Journal of Health and Allied Sciences, 11(1), 79–85. https://doi.org/10.37107/jhas.205

Haywood

Kotov

Krueger

R. F.

Wright

A. G.

Forbes

M. K.

Dauer

Baughman

F. D.

Rossell

S. L.

Hart

N. H.

(2024). Reconceptualizing mental health in cancer survivorship. Trends in Cancer, 10(8), 677–686. https://doi.org/10.1016/j.trecan.2024.05.008

L. T.

(2024). Research on the intervention design of online services for palliative care social work with AI. Journal of East China University of Science and Technology (Social Sciences Edition), 39(6), 1–10.

10.

Kizilcec

R. F.

Reich

Yeomans

Dann

Brunskill

Lopez

Turkay

Williams

J. J.

Tingley

(2020). Scaling up behavioral science interventions in online education. Proceedings of the National Academy of Sciences, 117(26), 14900–14905. https://doi.org/10.1073/pnas.1921417117

11.

Navarro

Sheffield

Edirippulige

Bambling

(2020). Exploring mental health professionals’ perspectives of text-based online counseling effectiveness with young people: Mixed methods pilot study. JMIR Mental Health, 7(1), Article e15564. https://doi.org/10.2196/15564

12.

Nelligan

R. K.

Hinman

R. S.

Atkins

Bennell

K. L.

(2019). A short message service intervention to support adherence to home-based strengthening exercise for people with knee osteoarthritis: Intervention design applying the behavior change wheel. JMIR mHealth and uHealth, 7(10), Article e14619. https://doi.org/10.2196/14619

13.

Oliwa

J. N.

Nzinga

Masini

van Hensbroek

M. B.

Jones

English

van’t Hoog

(2020). Improving case detection of tuberculosis in hospitalised Kenyan Children—Employing the behaviour change wheel to aid intervention design and implementation. Implementation Science, 15(1), 1–16. https://doi.org/10.1186/s13012-020-01061-4

14.

Pandya

S. P.

(2021). Social worker stress and an online meditation programme. Journal of Social Work, 21(3), 271–293. https://doi.org/10.1177/1468017319890080

15.

Rogers

L. Q.

Courneya

K. S.

Oster

R. A.

Anton

P. M.

Phillips

Ehlers

D. K.

McAuley

(2023). Physical activity intervention benefits persist months post-intervention: Randomized trial in breast cancer survivors. Journal of Cancer Survivorship, 17(6), 1834–1846. https://doi.org/10.1007/s11764-022-01329-2

16.

Schexnayder

Perry

K. R.

Sheahan

Majette Elliott

Subramaniam

Strawbridge

Webel

A. R.

Bosworth

H. B.

Gierisch

J. M.

(2023). Team-based qualitative rapid analysis: Approach and considerations for conducting developmental formative evaluation for intervention design. Qualitative Health Research, 33(8–9), 778–789. https://doi.org/10.1177/10497323231167348

17.

Schleider

J. L.

Mullarkey

M. C.

Fox

K. R.

Dobias

M. L.

Shroff

Hart

E. A.

Roulston

C. A.

(2022). A randomized trial of online single-session interventions for adolescent depression during COVID-19. Nature Human Behaviour, 6(2), 258–268. https://doi.org/10.1038/s41562-021-01235-0

18.

Sheppard

(2003). The significance of past abuse to current intervention strategies with depressed mothers in child and family care. British Journal of Social Work, 33(6), 769–786. https://doi.org/10.1093/bjsw/33.6.769

19.

Steinmo

S. H.

Michie

Fuller

Stanley

Stapleton

Stone

S. P.

(2015). Bridging the gap between pragmatic intervention design and theory: Using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six”. Implementation Science, 11(14), 1–12. https://doi.org/10.1186/s13012-016-0376-8

20.

Tonorezos

E. S.

Cohn

R. J.

Glaser

A. W.

Lewin

Poon

Wakefield

C. E.

Oeffinger

K. C.

(2022). Long-term care for people treated for cancer during childhood and adolescence. The Lancet, 399(10334), 1561–1572. https://doi.org/10.1016/S0140-6736(22)00460-3

21.

Washburn

Parrish

D. E.

Oxhandler

H. K.

Garrison

A. K.

(2021). Licensed master of social workers’ engagement in the process of evidence-based practice: Barriers and facilitators. Journal of Evidence-Based Social Work, 18(6), 619–635. https://doi.org/10.1080/26408066.2021.1918598

22.

Wong

J. P. H.

Jia

C. X.

Vahabi

Liu

J. J. W.

A. T. W.

Cong

Poon

M. K. L.

Yamada

Ning

Gao

Cheng

Sun

Wang

Fung

K. P. L.

(2021). Promoting the mental health of university students in China: Protocol for contextual assessment to inform intervention design and adaptation. JMIR Research Protocols, 10(5), Article e25009. https://doi.org/10.2196/25009

23.

Chen

Zheng

Zhu

(2021). Social work involvement in the COVID-19 response in China: Interdisciplinary remote networking. Journal of Social Work, 21(2), 246–256. https://doi.org/10.1177/1468017320980657

24.

Zhao

Qiu

Liu

Nian

Chen

Xie

Yang

(2024). Application of a WeChat mini program to provide pharmaceutical care for cancer pain patients: A randomized controlled trial. Digital Health, 15(10), Article 20552076241255654. https://doi.org/10.1177/20552076241255654