Qualitative insights into a digital CBT program for AYAs with cancer: Participant perceptions of factors impacting feasibility and engagement

BACKGROUND: Adolescents and young adults (AYAs) with cancer face high levels of depression and anxiety. Yet developmentally appropriate and cancer-informed mental health services remain limited. Digital cognitive behavioral therapy (CBT) programs may help address known access barriers, but many lack the tailoring and engagement needed for meaningful retention of AYAs with cancer. Mind Your Total Health (MYTH) was partially tailored to reflect AYA cancer experiences. This study explored how AYAs perceived their experiences with MYTH and offered recommendations for refinements related to feasibility and engagement. METHODS: This article reports qualitative findings of a sequential exploratory mixed-method (quant → qual) study assessing MYTH's feasibility and preliminary efficacy. Eight AYAs (ages 19-25) who completed the MYTH program participated in semi-structured individual interviews. Interviews explored experiences with the program, perceived benefits and challenges, and recommendations for improvement. Data were analyzed using reflexive thematic analysis. RESULTS: Participants described MYTH as accessible and integrative to their daily lives. Participants highlighted MYTH's animated storyline and use of cliffhangers as elements that strengthened the program's sense of relatability and encouraged sustained engagement. A cancer-relevant storyline was identified as a crucial step for enhanced program feasibility and engagement. Brief weekly check-ins served as an important source of accountability and emotional grounding for engagement. CONCLUSIONS: AYAs' perspectives highlight the need for digital mental health programs that balance flexible, engaging design with content that reflects the realities of cancer.