Designing for Autonomous Motivation: Qualitative Interview Study on Pre-Enrollment Preferences of Survivors of Cancer for Digital Health Behavior Change Programs.

Background: Despite elevated recurrence risks associated with modifiable lifestyle factors, many survivors of cancer do not adhere to health promotion recommendations. Digital health interventions hold promise for supporting behavior change, but few studies involve survivors in intervention design, potentially limiting real-world effectiveness. Understanding the preferences and support needs of survivors of cancer is crucial for developing effective digital health behavior change interventions. Objective: The aim of the study is to understand pre-enrollment perspectives of survivors of cancer on support needs and preferences regarding optimal treatment features in digital health behavior change interventions. Methods: We conducted in-depth semistructured interviews with 16 survivors of cancer who were contemplating participating in a multiple behavior change intervention pilot study. Participants were asked about their past experiences with behavior change and to envision ideal intervention features relative to their survivorship journey. This study followed an inductive thematic analysis framework, and findings were reported from a self-determination theory perspective. Six researchers were involved in the coding process to ensure analytical rigor. Results: The study identified 4 main themes about needs and preferences for digital behavior change interventions. These primarily mapped onto three psychological needs from self-determination theory: (1) competence through technology-enabled tracking, skill development, and expert accessibility; (2) autonomy through personalized, flexible program design acknowledging existing knowledge; and (3) relatedness through human-centered systems featuring health promotionists and health care team integration. A fourth subtheme emerged that highlights participants' desire for integrated, comprehensive care systems that connected behavior change programs with broader health care ecosystems rather than functioning as stand-alone digital programs. Conclusions: This study demonstrates that survivors of cancer have an ample understanding of their motivational needs and can offer valuable guidance for intervention design when given the opportunity to articulate their preferences. Our findings address a critical gap in the literature, where survivor perspectives remain underrepresented in digital health design. By centering survivor voices in the pre-enrollment phase, this study provides actionable insights for developing interventions that support progression from externally driven participation to sustained, autonomous engagement. Overall, this work offers a roadmap for designing flexible, human-centered, and integrated digital health interventions that can better support long-term behavior change in cancer survivorship.