Development of a Web-Based Experiential Learning Intervention for the Public to Reduce Cancer Stigma: Tutorial on the...

Stigma may negatively impact individuals throughout the continuum of cancer care and survivorship. Multitheory and multilevel intervention programs are necessary to reduce stigma but remain globally limited.

This tutorial aims to illustrate the development of a web-based experiential learning intervention, "Friend Supporter," designed for the public, which simulates scenarios to foster empathy and helping intentions. We applied the intervention mapping (IM) approach, which is rooted in the socioecological model, using the first four steps.

In step 1, key issues faced by cancer survivors and influential factors were identified through empirical evidence and literature reviews on cancer stigmas and psychological theories. A multidisciplinary planning team assessed issue-related logic. In step 2, a logic model of change was created based on step 1 findings. In step 3, we designed program themes and a structure using systematic reviews and needs surveys among the public (n=1076) and cancer survivors (n=473), while applying theoretical change methods and practical strategies. Step 4 integrated prior findings. Inputs from an expert panel (n=5) and the public (n=13) using the think-aloud approach were used to refine the materials and functions, with educational resources for program providers also developed.

Step 1 revealed that public misconceptions and attitudes worsened the quality of life of cancer survivors. Step 2 identified 3 long-term outcomes: reduced public bias, improved responses to disclosure via acquired skills, and support aligned with survivors' aspirations. The short-term primary outcome was helping intention. Personal factors (knowledge, skills, and self-efficacy) were also expected to improve helping intention as mediators. In step 3, the literature review showed that multicomponent online interventions effectively reduced stigma. The survey indicated the public most needed information on "how to interact with friends diagnosed with cancer" (317/1076, 29.5%), regardless of whether they had a friend diagnosed with cancer (χ21=0.98; P=.32). Participants with no friends diagnosed with cancer were more likely to require information concerning "survival rates of all types of cancer" (χ21=7.3; P=.007). Preferred delivery modes were booklets or leaflets (529/1076, 49.2%) and the internet (texts and figures: 460/1076, 42.8%). Cancer survivors wanted their friends to understand "the possibility of a cure as a result of early detection and treatment" (193/473, 40.8%). To produce program materials, we applied stigma and discrimination, protection motivation, social cognitive, and learning theories. The 5-module program included self-learning, role-plays, worksheets, and written feedback from clinical psychologists. Step 4 confirmed the feasibility of the program with minor refinement. We then developed a practical guide for program providers' future implementation.

IM is useful for systematically developing web-based multitheory and multilevel interventions. "Friend Supporter" offers a promising approach to enhance supportive behaviors and reduce cancer stigma. Quantitative evaluation is underway using the final 2 IM steps (implementation and evaluation) to determine real-world effectiveness.