Cancer does not discriminate—it is prevalent across demographics and geographies [1]. Cancer is also pernicious—it could overwhelm the physiological health and psychological well-being of patients with cancer and cancer caregivers [2-7]. Informal caregivers, for instance, often have to shoulder a considerable amount of care burden—depending on the disease trajectory of the patients, approximately 55%-95% of caregivers shoulder mental health disorders such as distress [8-10]. In the context of this study, the term health care professionals describes health care personnel, including doctors, nurses, and all other formal caregivers, whereas informal cancer caregivers, cancer caregivers, and caregivers are used interchangeably, referring to informal cancer caregivers such as family and friends, who often regularly provide a wide range of assistance to a patient with cancer. Although, overall, a variety of interventions hold promise to alleviate caregiver burden, ranging from print materials and face-to-face consultations to telephone-based assistance [11-20], technology-based interventions are considered the most practical and promising solution available to caregivers.

The emphasis on technology-based interventions for cancer caregivers has become particularly pronounced amid the COVID-19 pandemic, a global health crisis that has effectively crippled many, if not all, of the traditional health care services available to patients and caregivers [21-23]. During the pandemic, many cancer caregivers have found much-needed solace and support in technology-based health care services, ranging from online support groups to videoconferencing with patients or health care professionals [24-26]. It is important to note that there is a growing body of research investigating the benefits of technology-based health solutions [24-29]. For instance, a systematic review revealed that caregivers significantly improved their cancer knowledge and communication outcomes after receiving technology-based interventions [27]. Throughout the pandemic, many scholars worried about whether the lack of personal touch might undermine technology-based interventions [28]. However, it is worth noting that, although face-to-face interactions have advantages, the social dynamics of these consultations could also hinder health care outcomes. For instance, in a study that compared the intervention efficacy of face-to-face consultations and technology-based interventions, researchers found that, among these 2 types of interventions, caregivers were more likely to truthfully report their stress symptoms to a web-based support system and have these symptoms addressed and treated [29].

Although research on technology-based interventions for caregivers is gaining momentum, it faces many obstacles [30]. One of the most prominent hurdles that could considerably undermine the research field is the lack of a clear and consistent definition of the term technology-based interventions. It is important to note that, although the application of technology-based interventions is on the rise, the term is seldom defined when applied in cancer research or practice. A review of the literature [31-34] shows that alarmingly, much of the research on technology-based interventions for patients with cancer fails to provide a clear definition of the term to shed light on key questions: (1) Are technology-based interventions the same as terms such as web-based interventions? (2) What are the key characteristics of technology-based interventions? (3) What constitutes a technology-based intervention? The lack of conceptual clarity of the term technology-based interventions could substantially undermine the research field, as one of the most espoused truisms in academia is arguably that, particularly in light of scientific integrity and solidarity, scholars cannot measure what they cannot define [35-37]. As one scholar, the prominent British physicist and mathematician Lord William Thomson Kelvin, succinctly put it, “What is not defined cannot be measured. What is not measured cannot be improved. What is not improved is always degraded” [38].

One of the most concerning phenomena in cancer research on technology-based interventions is the fact that several studies have investigated the concept without clearly defining and delineating its conceptual parameters [52-55]. In other words, without a clearly delineated conceptual definition of the term, a wide range of measurements have been used for technology-based interventions [30]. This practice is extremely worrisome and problematic. Without large-scale systematic reviews or meta-analysis studies [56-58], it is difficult to determine the degree of discrepancies between the true effects of technology-based interventions and what has been measured and reported. What is clear, however, is that the lack of definitions, compounded by the heterogeneity of the measures adopted to gauge the barely or poorly defined concept, could substantially undermine the reproducibility and replicability of research on technology-based interventions [56-58], not to mention the quality of review studies on technology-based interventions for cancer caregivers.

The importance of reproducibility and replicability in research cannot be overstated [35]. These 2 research criteria are indispensable to scientific research, ranging from concept building, evidence collection, and data analysis to the interpretation and application of research findings [35-37]. In essence, reproducibility and replicability are instrumental in advancing the literature, elevating the research field, and building the collective knowledge base of the society [35]. However, because of barely or poorly defined key research concepts, researchers might risk missing the valuable opportunity to (1) understand and interpret current research findings on technology-based interventions for cancer caregivers, (2) pinpoint effective components of the interventions, and (3) apply these components to future intervention studies to further the research field [35-37]. Thus, to bridge the research gap, this study aims to examine technology-based interventions in the context of cancer caregiving via the lens of concept analysis.

The aim of our study is to explore the meaning of technology-based interventions in the context of cancer caregiving and provide a definition.

One of the most well-accepted and widely adopted approaches to establish conceptual clarity is concept analysis [59-61]. Concept analysis is an important analytical tool in understanding the nuanced conceptual and theoretical meaning of a term [59], which could be understood as a research process that “entails the systematic examination of the attributes or characteristics of a given concept for the purpose of clarifying the meaning of that concept” [61]. Conceptual clarity of key research variables is indispensable to the development of science and research. In other words, concept analysis generates a structured meaning that establishes rules and guidelines for the correct use and applications of the concept. In this study, the concept analysis method was adopted to clarify the meaning of technology-based interventions in the context of cancer caregiving and to provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice.

A review of the literature shows that technology-based interventions for cancer caregivers can be categorized into 3 groups in terms of the explicit aims they focus on the following: (1) helping the caregivers themselves, (2) helping caregivers help the patients, and (3) helping caregivers to facilitate the abilities of health care professionals to improve the patient-provider relationship or the health outcomes of patients with cancer. On the surface, these 3 subgroups of technology-based interventions for cancer caregivers seem to have substantial divergences. However, it is important to note that the similarities between these subgroups are more pronounced and meaningful: (1) all of these interventions have cancer caregivers as their first-degree target audience, (2) these subgroups share the same intervention mechanisms, and (3) their overall aims are in line with one another—to improve the abilities of caregivers, patients, and health care professionals to better address the caregiving needs and preferences of patients with cancer and in turn, patients health and quality of life. Thus, all these subgroups of interventions were considered in this study. A framework that can help health care professionals better understand these interventions is shown in Figure 1.

Although there are many concept analysis approaches available in the literature, the method by Walker and Avant [59] was adopted as the theoretical framework in this study. The decision was based on the following considerations: (1) the method by Walker and Avant is the most used concept analysis framework [60]—and adopting this method could help facilitate research replicability in the field, (2) using a method that the audience is familiar with can help the readership better focus on the gist of the study—clarifying and defining the concept of technology-based interventions in cancer caregiving, which in turn could (3) help readers better understand the need for a clear definition of technology-based interventions and the merits of the concept analysis methodology, and (4) the method by Walker and Avant is more linear and structured compared with other models [62], which can help researchers build a more straightforward presentation of the research process and study findings.

There are 8 steps in the concept analysis method by Walker and Avant [59]: (1) selecting the concepts; (2) determining the aim of the research; (3) identifying available uses of the concepts; (4) determining the defining attributes of the concepts; (5) constructing a model case example; (6) creating borderline, related, and contrary case examples; (7) presenting antecedents and consequences; and (8) defining empirical referents. The definitions of key concept analysis terms adopted in this study can be found in Textbox 1. To better illustrate the research procedures, we also created a schematic figure to delineate the methodological steps we took to obtain our research findings (Figure 2).

On the basis of the guidelines by Walker and Avant [59], a literature synthesis was adopted to capture available conceptual dimensions of technology-based interventions. An extensive and cross-disciplinary review of the literature was conducted to capture the full breadth of technology-based interventions. Partially because of a lack of relevant literature, publications in the fields of computer science, psychology, and behavioral sciences were all included in the review. The databases PubMed, PsycINFO, CINAHL, and Scopus were searched between June and July 2020. The search terms used were as follows: (cancer/tumor) AND (caregiver/carer/family/spouse/partner) AND (technology-based intervention OR trial/treatment/therapy); search terms varied slightly in different databases.

Both the research objectives and search terms were developed in 2 stages. The first research stage was where we accidentally encountered the conceptualization issue associated with the term technology-based interventions. Our initial research objective was to conduct a systematic review study on technology-based interventions for cancer caregivers [24]. During this process, we found that, although there is a rich body of research on technology-based interventions for cancer caregivers, most of the authors fail to offer a clear conceptualization of the term. As we delved deeper into the issue, we realized that our team also had yet to develop a clearly delineated definition of technology-based interventions—we assumed that we knew what we ventured out to study. This revelation, combined with insights gained from additional research on the subject matter, yielded the conclusion that a concept analysis study was needed to proceed with our original research plan, which was contingent on an evidence-based and clearly defined conceptualization of the term technology-based interventions. Thus, to address this research gap, we conducted this study. To date, 3 sets of search terms have been developed and used specifically for this study: 1 for the systematic review, 1 to search for definitions, and 1 for our concept analysis.

The search terms were developed based on insights gained from the literature, web-based group discussions, and brainstorming sessions (including all authors and the school’s academic librarian) as well as examples set by previous literature [63]. Articles were reviewed for broad research focus (eg, research context and design) and detailed descriptions of technology-based interventions (eg, the role of technology in the intervention). Key information (eg, use of technology and intervention content) from eligible articles was extracted and analyzed. Two principal reviewers (ZS and XL) conducted the review. Discrepancies were resolved via group discussions that included all authors until a consensus was reached. Through this process of synthesis and comparison, a clear conceptualization of the term emerged. The details of the data screening and analysis processes are illustrated in Figure 3.

Articles were excluded if they failed to provide conceptual insights on technology-based interventions; more specifically, the exclusion criteria were as follows: the study was (1) not written in English, (2) not peer-reviewed, (3) not focusing on technology-based interventions (eg, papers focusing on face-to-face strategies for cancer caregivers), and (4) not centering on cancer caregivers. The inclusion criteria are listed in Textbox 2.

The reviewed articles consisted of titles, abstracts, and full-text articles in English from 2010 to 2020, resulting in 10,078 records. The key articles included in the review are listed in Multimedia Appendix 1 [19,27,31-34,45,64-101]. A total of 45 articles met the eligibility criteria (Multimedia Appendix 1). In addition, a manual search of the reference lists of eligible articles located further articles of relevance. Drawing insights from the literature [102-104], Google Scholar was used to reverse-trace articles that cited papers included in the final review as an additional measure to ensure a comprehensive literature search strategy. On the basis of the study results, the concept of technology-based interventions was defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. In the following sections, detailed information on the use of the concept, defining attributes, relevant cases, antecedents and consequences, as well as empirical referents is presented and discussed.

Overall, the available definitions of technology-based interventions often revolve around 2 components: the use of technology and the purpose of the intervention. Limited emphasis placed on aspects such as the integration of technology into the intervention or end-user involvement in the application of the technology complicates the research area. When examining the effectiveness of behavioral interventions, researchers define technology-based interventions as approaches that use “information and communication technology applications to promote behavioral outcomes” [105]. Researchers also discussed technology-based interventions in terms of the technology platforms they adopted. In a study focusing on mental health, the term technology-based intervention is used synonymously with the concept of internet-based interventions [106]. The study outlines that both approaches include computer-based and web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies [48].

Some definitions allow technology platforms integrated with technology-based interventions to be more inclusive, where platforms such as computers, web-based apps, mobile phones, and wearable sensors are all considered possible venues for intervention delivery [107-110]. In addition to the emphasis on the use of technology, technology-based interventions are often defined with a focus on intervention objectives and projected outcomes. Aiming to examine the influence of an intervention on informal caregivers of stroke survivors, researchers describe technology-based interventions as “some form of telepractice that uses information and communication technologies to help eliminate distance barriers and to help with scheduling logistics, thus extending the scope for provision of quality healthcare” [111]. Overall, although promising studies are emerging in the literature, there is a dearth of insights that could provide conceptual clarity to the term technology-based interventions, particularly in the cancer caregiving research field.

Defining attributes are recurring themes that mirror the heart of concept analysis [43]. On the basis of insights gained from the literature review and data synthesis, accessible [64,65,112], affordable [66,112], convenient [66,67,113], and user-friendly [40,68-71,114] were identified as the defining attributes of technology-based interventions. Although additional characteristics were identified, these attributes were the most frequent traits found across the interventions analyzed. One of the key attributes of technology-based interventions was accessibility: compared with conventional solutions, technology-based interventions can be accessed whenever and wherever [64,65,112]. In other words, cancer caregivers can access technology-based interventions without having to worry about transportation or other logistical issues (eg, availability of appointments).

The second defining attribute of technology-based interventions was affordability. In addition to resources related to transportation, considering that many technology-based interventions can be accessed free of cost (eg, smartphone app [115]), caregivers often do not have to worry about financial resources needed for them to adopt these interventions [66,112]. The ability to be accessed whenever and wherever and often without charge subsequently makes technology-based interventions convenient to use and access [66,67,113]. In addition to these traits (ie, accessible, affordable, and convenient), technology-based interventions often adopt a user-friendly design to improve user engagement [40,68-71,114], such as incorporating gamification mechanisms that can improve the user experience of cancer caregivers while learning ways to improve their health and well-being.

Another aspect of being user-friendly centered on the respect technology-based interventions have for end-user input—some interventions were developed in a co-design fashion, where health promotion strategies were discussed and built by cancer caregivers, health care professionals, and academic scholars collaboratively [69]. This method is an important participatory approach for intervention development, and it has many advantages, the most noticeable ones centering on the ability of the co-design to yield more optimal anticipated outcomes and less unintended consequences compared with interventions that only involve limited groups of stakeholders [116-118]. Although it is difficult to determine which of these defining attributes is the most appealing to cancer caregivers, it is clear that these characteristics have collectively made technology-based interventions appealing to cancer caregivers.

In this section, whenever antecedents and consequences are mentioned, they refer to antecedents to technology-based interventions and consequences of technology-based interventions, respectively. Two types of antecedents to technology-based interventions were identified. First, antecedents to the need for interventions involve factors such as cancer-related psychosocial distress [72] and lack of couple-based interventions [65]. Second, antecedents to the adoption of technology-based interventions operate as opposed to conventional interventions and take into consideration the physical or geographical constraints [64] and the prevalence of technology, such as smartphones [66]. In addition, resonating with these antecedents, 2 types of consequences of technology-based interventions were found. First, consequences of the intervention stimuli as a whole addressed aspects such as improved quality of life [68] and reduced stress [69] among caregivers. Second, focused on consequences of the use of technology-based interventions rather than conventional interventions such as positive Google Analytics results [69] and intention to use the telemedicine tool in the future [67]. Detailed information on the identified antecedents and consequences is presented in Table 2.

Empirical referents can be considered real-world demonstrations of a concept [59]. For technology-based interventions, empirical referents can be interventional medical apps developed for caregivers. In 2017, there were an estimated 325,000 medical apps available on smartphones, which could translate into over 3.7 billion medical app downloads among smartphone users [122]. Of these 325,000 apps, those that are commercially available, interventional in nature, and designed for cancer caregivers could be considered empirical referents to technology-based interventions.

Although technology-based interventions are essential to health care research and practice, there is a lack of definition of the concept, particularly in the context of cancer caregiving. In this paper, we set out to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can facilitate evidence-based oncology research and practice. Considering that the lack of conceptual clarity of the term could undermine the effectiveness of technology-based interventions in addressing the health challenges of cancer caregivers, timely research is needed to bridge the gap. To the best of our knowledge, this is the first study to examine technology-based interventions from a concept analysis perspective. Aiming to obtain conceptual clarity for the term, we adopted the method by Walker and Avant [59] as the guiding framework; carefully reviewed the literature; identified defining attributes; and developed key case examples, antecedents, and consequences that are indispensable to the conceptual infrastructure of technology-based interventions.

The key defining attributes that characterize technology-based interventions are accessible, affordable, convenient, and user-friendly. Combining the identified antecedents and consequences, the following definition was proposed: technology-based interventions are defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. A detailed illustration of the interplay of the key defining attributes that characterize the concept of technology-based interventions is shown in Figure 4. Overall, Figure 4 underscores that, in essence, technology-based interventions are health promotion strategies augmented with technology platforms to make them more effective (ie, accessible, affordable, convenient, and user-friendly) in improving the health and well-being of cancer caregivers.

This definition and the defining attributes could be a solution to address some of the critical issues regarding the conceptualization of the term, both in the current and broader research contexts of technology-based interventions [123,124], which compromises the ability of the existing research to enrich the literature. A growing number of papers have begun to acknowledge and address the importance of adopting clear and structured methodological procedures and frameworks to ensure research reproducibility and replicability [125,126]. The absence of a clear definition could lead to poor replicability and low comparability of intervention studies, which in turn, limits the applicability and generalizability of these studies and their corresponding interventions [35]. Viewed as a mechanism to connect current research findings and generate new insights, systematic review research has the potential to further contribute to the growth of research inquiry [56].

However, evidence suggests that systematic review studies often fall victim to the lack of conceptual definitions in the literature [126]. Results show that 40%-89% of poorly described interventions are not replicable, which means that they cannot be adequately used in systematic reviews or offer substantial contributions to the development of the research field [127]. The availability of a clear definition of the research topic enables research studies to report their findings accurately and meaningfully to facilitate further research endeavors, such as systematic reviews and meta-analysis studies [126,127]. From this perspective, the results of this study offer opportunities to address key methodological issues in the literature, such as a lack of conceptual definitions of technology-based interventions in cancer caregiving research. By offering a clear and concise definition of technology-based interventions that clarifies the process using systematically identified antecedents, defining attributes, and consequences, the findings of this study can help guide future interventions that aim to improve the well-being and health outcomes of cancer caregivers.

The findings of this study underscore that technology-based interventions should be clearly conceptualized in terms of the following aspects: (1) the use of technology in the intervention (ie, as the communication platform), (2) the key components the intervention incorporates (ie, technology as the communication platform and health promotion strategies as the content), (3) the relationship between the key components (ie, a communication platform and content symbiosis; the role of technology is flexible, ranging from managing to supporting the intervention content), (4) the purpose of the intervention (ie, to produce health solutions for cancer caregivers), and (5) the defining characteristics of technology-based interventions (ie, accessible, affordable, convenient, and user-friendly key traits inherent to technology and the audience-centered communication approach). Overall, the insights provided by this study can help researchers better understand and interpret outcomes and technology-based interventions, identify effective intervention strategies, and apply them to future studies that have the potential to further improve the health outcomes of cancer caregivers.

Although this study fills significant voids in the literature, it is not without limitations. A concept analysis approach was adopted in this study to conduct a structured and comprehensive literature search. We conducted our literature search in the PubMed, PsycINFO, CINAHL, and Scopus databases for eligible articles and manually screened the articles that were referenced or cited in these articles. Although these databases are comprehensive, it is possible that articles were indexed exclusively in other databases that were not included in the analysis. We did not follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures [128] in presenting our data screening process. Rather, we modeled our flowchart based on example concept analyses [129] that used a more linear and simplified data screening process. Although our choice of data screening flowchart was justified, we understand that this screening procedure may not meet the expectations of some readers. In our future research endeavors, we will adopt the PRISMA procedures to ensure detailed screening information is presented in the manuscript. Finally, this concept analysis only included articles published in English. This eligibility criterion may further limit our data pool.

Technology-based interventions play an increasingly important role in addressing the health and well-being of caregivers across the cancer continuum. Although technology-based interventions can offer substantial benefits to patients with cancer and their caregivers, many limitations could hinder the design, development, and deployment of these interventions. The results of our study offer much-needed conceptual clarity on the term, which in turn, could help build a more rigorous and robust research environment for investigations on technology-based interventions, both in the context of cancer caregiving and beyond. Overall, conveying a clear definition of technology-based interventions to researchers, health care practitioners, and cancer caregivers is a foundational step in establishing a collaborative and coordinated effort to develop and deploy cost-effective interventions. On the basis of the study findings, technology-based interventions are defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. We believe this definition serves as a key step toward a mutual ground that elevates comparability between interventions and outcomes, which in turn, could further advance the research field and the knowledge base.