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

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.