BACKGROUND The rapid growth of user-generated online health information increases the complexity of cancer information seeking. One promising strategy for promoting high quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the online spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing online health behavior change interventions to improve individuals’ knowledge and prevent cancer. OBJECTIVE The objective of this study was to develop and pilot test a theory-based online intervention to reduce six cancer risk factors among rural emerging adults through community-engaged research. METHODS This mixed-methods evaluation describes the development of an online cancer prevention intervention aimed at rural emerging adults aged 18-26 in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and co-created with emerging adult and stakeholder organization advisory boards to ensure relevance, accessibility, and appropriateness. We report on formative surveys, a pilot intervention, and the community-engaged process for intervention development. RESULTS We developed posts (n=400) for a Facebook feed aimed at reducing six cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from our advisory boards. Formative surveys with rural emerging adults (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. CONCLUSIONS This online cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural emerging adults. This study provided key insights into the design and implementation of online cancer prevention interventions for emerging adults. It highlights the importance of theory-based design, community engagement, and platform-tailored dissemination strategies for maximizing intervention effectiveness. CLINICALTRIAL ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 INTERNATIONAL REGISTERED REPORT RR2-10.2196/50392
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