Abstract
Introduction
Cancer is a public health issue of great concern in China and worldwide since it is the world's second-largest cause of death, with a high prevalence. 1 For decades, medical organizations and specialists have fought against various cancers. Their efforts have yielded deeper insights into the disease and advanced preventive and therapeutic strategies. With these efforts, cancer is now often managed as a chronic condition, 2 leading to prolonged survival and improved quality of life for people living with cancer (PLWC).3–5 Although medical knowledge of cancer has gradually improved, the general public's perceptions of cancer remain limited and biased. In particular, cancer goes beyond its medical meaning and has been extended into negative social metaphors. 6 It is often regarded as incurable and closely associated with metaphors of pain, hopelessness, and irreversible death. 7 Some negative signs of cancer are harmful to PLWC, leading to additional stress beyond the health consequences of cancer. 8 Therefore, attention to the public's understanding of cancer is essential, as it is closely tied to the well-being of PLWC beyond medical treatment.
The video blog, formed in a first-person narrative user-generated video, is a way for PLWC to self-narrate their cancer experiences.
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It presents their subjective beliefs and feelings derived from personal encounters.
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Cancer-related video blogs are beneficial for PLWC. On the one hand, they enable PLWC to present cancer characteristics through an
The current study focuses on the outcomes of the narrative of PLWC through dual dimensions: psychological outcome embodied in emotional expressions, and social interaction outcome reflected in social support receptions. Emotion expression is considered to be closely intertwined with patients’ self-narratives and reflects the appraisal outcomes of personal and environmental circumstances.18,19 Although emotions are crucial for understanding patients’ current states, the relationship between narrative components and emotional expressions remains understudied. Moreover, self-narratives trigger social interactions on social media, with supportive communication being one of the most important forms due to its critical role in PLWC's well-being. Previous research has demonstrated that forms and components of PLWC's narratives caused different functional online social support provisions.12,20 Nevertheless, because narrative is deeply embedded in social and cultural contexts, 21 the relationship between narrative components and social support may be situational rather than constant.
Accordingly, the current study analyzes cancer-related video blogs to examine how narrative components are associated with emotions and the reception of social support. Notably, this study focuses on the Chinese context, one of the world's largest cancer-burden countries, with the annual new cases twice that of the US.22,23 The scarcity of culturally grounded research on PLWCs’ online self-narrative practices in China creates an urgent need for such context-specific investigations.
Self-narrative cancer
A self-narrative is an immersive personal storytelling of a specific sequence of events rather than an objective description of facts. It is meaningful because it represents the concerns of the narrator. 16 Narrative medicine is a research approach that addresses the self-narrative of patients. It is believed that the narrative is crucial because it allows researchers to assess patients’ life status and understand their feelings about the illness. 19 The self-narrative of PLWC involves the entire process of cancer, including the diagnosis, disease course, progress, and coping. 16 It is not only an adaptive coping mode used by PLWC to address problems caused by cancer24,25 but also helps medical practitioners build a patient-centered communication mode by standing from the perspective of PLWC.16,26 Notably, the scenarios of self-narratives of PLWC have changed significantly in the digital age. Social media enables them to share their stories beyond clinical settings, 27 and narrative medicine research also extends to their attention to narratives on social media. 28
The self-narrative is a construction of personal concerns, and its narrative component reflects what the narrator considers important.16,19 Previous studies on the narrative of cancer self-narratives have shown that there are four main narrative components:
The
The
The
The
Previous studies have shown that the online self-narratives of PLWC have the following characteristics. First, narrative can take various forms (e.g. text, videos, and photos). Second, the narrative scenarios differ, for example, health-themed online communities (i.e. patient groups and disease forums) and non-health-themed online communities. Third, the sizes of audiences are distinct. Private communication in a group has a few audience members, whereas videos posted on social media reach large audiences. It is important to clarify that the cancer-related video blogs in this study are video-form narratives for the public in non-health-themed communities, which remain understudied in China. Therefore, to explore the narrative components of cancer-related video blogs in China, this study proposes the following research questions: RQ1: What is the frequency of different narrative components presented in cancer-related video blogs in China?
Narrative components and emotional expressions
Many researchers have realized the importance of narratives and have analyzed different forms of narratives in previous research. However, most of the studies have concentrated on narrative features, functions, and contents rather than outcomes and interconnections with other factors in storytelling. 17 Yet these outcomes and interconnections are more critical to patients’ well-being. Medical narrative criticizes this trend in medical research as the overemphasis on objective statistics, but ignores humanizing care and well-being. 43 Notably, due to the uncertainties of self-narrative, the outcomes of unidimensional research on how patients describe their experiences would be doubted as not sufficiently stable to present the overall situations of PLWC's online self-narrative. Harter and her colleagues highlighted the indetermination and contextuality of patients’ self-narratives,17,44,45 and they used “curators” and “gatekeepers” 17 to describe patients’ subjectivity in self-narrative practices. Therefore, it is important to extend the narrative research of cancer-related video blogs to other factors to achieve a robust conclusion for presenting an overall picture of online cancer self-narrative.
The narrative components in cancer vlogs evoke specific emotional expressions.6,16,33,46,47 The appraisal theories of emotions 46 point out that emotions arise from appraisals of individuals, the environment, and their relationships. When feeling, coping, behavior, or mental responses change during the appraisal process, corresponding emotions are activated. In turn, these emotions can also lead to changes in other components. Since cancer self-narrative reflects not only how external stimuli change the appraisal processes, 26 but also represents how individuals cope with the circumstance-caused stimuli, emotions are inevitably involved in this process.
Based on the cognitive–motivational–relational theory, 48 emotions are classified into three categories: positive, negative, and problematic. If the situation is congruent with the goal, the emotions are classified as positive. Positive emotion is present if the situation is congruent with the goal and contains happy–joy, pride, love–thankfulness, and relief. When the situation is incongruent with the goal, negative emotions will be presented, including anger, fright–anxiety, and guilt–shame. A special case is problematic emotion, represented by hope. Although incongruent with the current goal, hope reflects a forward-looking expectation of possible positive change. It is considered a problematic emotion because hope does not align fully with either the consistency of positive emotions or the inconsistency characteristic of negative emotions. As Lazarus proposed, hope reflects the motivational tension arising from an unfulfilled or threatened goal while simultaneously maintaining an orientation toward potential improvement. 48 Detailed information about emotions is shown in Figure 1.

Emotion classification framework for cancer-related video blogs.
Appraisal theories of emotion emphasize the stable relationships between appraisal processes and emotions, with specific appraisals generating specific emotions. 46 Narratives are outward expressions of the external stimuli that PLWC encounter, 16 reflecting how individuals perceive and respond to these events. 6 The narrative component is a set of similar narrative content features that stem from comparable external stimuli. Since emotions arise from individuals’ appraisal of the certainty of a stimulus and the motivation congruence, 49 similar external stimuli are likely to trigger the same internal appraisals and emotions. Therefore, specific narrative components should be associated with corresponding patterns of emotional expression.
Notably, the present study adopts the appraisal perspective to investigate how the external stimuli rooted in the narratives influence the emotional expressions. Roseman 49 developed the emotion system model to explain the emotion outcomes based on the appraisal factors, including motivation consistency, control potential, uncertainty, attribution, and problem and motivation types. Among them, motivation consistency determines the valence of the emotion, and uncertainty caused by the stimuli gives rise to whether the problematic emotion, hope, arises. The relationships among narrative components, external stimuli, uncertainty, motivational consistency, and potential emotions are summarized in Table 1.
Narrative components, external stimuli, emotion appraisals, and potential emotions.
The
H1: Cancer-related video blogs containing the
Compared with
H2: Cancer-related video blogs containing the
The
H3: Cancer-related video blogs containing the
RQ2: Does the suggestion-offering narrative component differ in its patterns of co-occurrence with emotional expressions?
Online social support
Since the 1970s, research on social support has gained significant prominence. 57 In recent decades, the functional definition of social support has been extended and enriched. Cobb 58 believed that social support is the information that makes people feel cared for, loved, esteemed, and networked, which was one of the earliest definitions of social support. He focused on the information properties and emotional outcomes of social support. House 59 focused on action outcomes and extended the forms of social support to include instrumental, informational, appraisal, and emotional support. Cutrona and Suhr 60 integrated previous studies on social support and categorized it into action-facilitating and nurturant support. Action-facilitating support refers to outcomes that facilitate problem-solving, while nurturant support refers to emotional outcomes that reassure individuals in coping with mental discomfort. 60 This functional classification has been widely applied in offline social support research.
Although Cutrona and Suhr's 60 definition was systematic in the offline context, online social support differs greatly from offline social support in terms of participants, quantity, quality, space, and flow. Most participants in online social support have weak-tie relationships, while strong-tie relationships dominate offline social support.61,62 Online social support involves massive amounts of information due to the massive number of participants involved, 63 while offline social support involves limited information. The qualities of online social support are precarious. Individuals can receive high-quality social support, such as professional medical help, 61 while they can also receive low-quality social support, such as misinformation.64,65
Therefore, Wright et al. 61 analyzed computer-mediated social support systematically and suggested that opinions, insights, experiences, and perspectives shared in online social communities involve exchanges of online social support. Moreover, he proposed classifying online social support as informational, instrumental, or emotional. The definition and classifications of online social support have been widely adopted in research.66–68 Therefore, this study also utilizes classification to examine the different types of online social support.
Social support is essential for PLWC, as it helps them solve problems and maintain mental health, thereby enhancing quality of life. Previous studies have suggested that online social media platforms are one of the main channels through which PLWC receives social support.15,67 Users of social media platforms construct online communities that allow people to freely communicate and exchange social support. PLWC present their feelings and propose their requests in video blogs, and other social media users provide their help. Although previous studies have discussed the preferences of social support providers in different contexts,69–71 few studies have discussed whether the request for the corresponding functional type of social support can directly lead to a greater presence of that type of social support in the community. Optimal matching theory of social support, developed by Cutrona, 72 points out that social support works best when the type of support provided matches the demands of the recipient's coping needs. 72 Previous studies in the context of cancer have also provided empirical support for this proposition.73,74 Taken together, these findings underscore the importance of the match between support seeking and support provision in online contexts. Therefore, this study examines the matching between support requests and support provision triggered by cancer-related vlog narratives and proposes the following research question:
RQ3: Do narrators’ requests for (a) information, (b) instrumental, and (c) informational support in video blogs influence the provision of these three types of support in the comment section?
Moreover, online social support provision in the comment sections was regarded as an outcome elicited by the self-narratives of PLWC. Previous studies have shown that different narrative components and forms influence online social support reception.12,15 However, these studies lack attention to instrumental support reception and were mostly discussed in the context of Western societies. This study undertakes an exploratory examination of the relationship between specific narrative components and the types of social support provided in response in the Chinese context, for two main reasons. First, as emphasized in narrative medicine, both self-narratives and the responses they elicit are highly context-dependent, suggesting that any observed associations may be contingent rather than universally generalizable. 19 Therefore, previous research on the relationship between narrative components and social support reception has also tended to adopt an exploratory approach. 15 Second, the objective of this research is not to offer strategies for instructing the self-narratives of PLWC, but to identify the underlying structural issues embedded in the process of social support exchange. Based on the above, this study proposed the following research question:
RQ4: Do the (a) discomfort, (b) problem facing, (c) new normal, and (d) suggestion offering narrative components influence the reception of informational, instrumental, and emotional support in the comment section?
Method
This study utilized quantitative content analysis to test the hypotheses and address the research questions. The research was conducted from February to June 2022. The study design was completed in February 2022, data collection was conducted in March 2022, the coding process took place from March to June 2022, and data analysis was conducted in June 2022. This study was conducted at Macau University of Science and Technology, located in Macau SAR, China.
This study received a waiver of ethics approval from the Research Ethics Committee of the Faculty of Humanities and Arts at Macau University of Science and Technology (Certificate No. MUST-FA-2025004), as it did not involve human participants. In terms of data protection, this study collected and processed data in accordance with national and regional regulations (e.g. the Personal Information Protection Law of the People’s Republic of China and the Personal Data Protection Act of Macau SAR) and the AoIR guidelines. During data collection, the principle of data minimization was applied, and only the information necessary to answer the research questions and test the hypotheses was collected. Accordingly, we did not store the video files and retained the uniform resource locators for coders to view the videos online. In addition, an anonymization procedure was applied to remove highly identifiable information (i.e. usernames and user IDs), which were replaced with numerical identifiers before coding. Regarding data management, anonymized datasets were provided to coders, who are prohibited from sharing the data with any other party.
Sampling
This study sampled videos and comments on
This study collected data on 25 March 2022, covering all cancer-related video blogs uploaded prior to the sampling date. Stratified random sampling was conducted based on the number of video plays to capture a range of audience reach and engagement levels. The first step involved using the keywords “cancer vlog (癌症vlog)” and “living with cancer (患癌)” to search and collect 2448 related videos. The second step was to divide these 2448 related videos into 10 groups according to their play count (top 10%, 11%–20%, 20%–30%, …, 91%–100%). The third step utilized simple random sampling to obtain 10% of the videos in each group. Therefore, 245 videos were sampled. The fourth step was to manually exclude videos that were not accessible (

Videos and affiliated comments sampling procedure of the current study.
Coding
In this study, (a) each video and (b) each comment were two separate coding units. The researcher established different coding schemes for videos and comments after reviewing previous studies and gaining a simple qualitative understanding of the sample.
According to the video coding scheme, the coders were asked to code each video according to its content, title, and description. Cancer types were coded according to the International Statistical Classification of Diseases and Related Health Problems (10th Revision). 76 Protagonist characteristics were coded as expressions in the video content or categorized as unspecified if the coders could not tell. Emotional expression was coded as positive, negative, or problematic emotions, following Lazarus's research (see Figure 1). 48 If a video expressed more than one emotion, the stronger emotion expressed in this video was adopted. Four narrative components, discomfort, problem facing, new normal, and suggestion offering, were coded according to whether they were present in the video. The social support request was coded for whether the video content requested information, emotional, or instrumental support. After training, the author and another native Chinese coder with medical knowledge separately coded the same 29 (20%) video samples to examine the intercoder reliability. Then, the two coders split the rest of the video samples and separately coded them according to the coding scheme. The coding scheme for videos is presented in Table 2.
Coding scheme for analyzing narrative components and social support in video blogs.
According to the comment coding scheme, the coders were asked to code whether each comment provided informational, emotional, or instrumental support. Detailed information is provided in Table 3. After training, the author and two other native Chinese coders separately coded the same 800 (5%) comments to examine the intercoder reliability. Then, the three coders split the rest of the video samples and separately coded them according to the coding scheme.
Coding scheme for analyzing social support in comments.
Intercoder reliability
This study utilizes Bennett et al.'s
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Intercoder reliability (Bennett et al.'s
A MATLAB function
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was used to calculate the
This study also calculates the
Data analysis
SPSS Version 26 was used to analyze the data. Differences in categorical variables were examined using chi-square tests. Assumptions for the chi-square tests were checked to ensure that no more than 20% of the expected cell counts were below five. Multiple linear regressions (MLRs) were performed to assess the relationships between continuous dependent variables and multiple independent variables. For the MLRs, multicollinearity was assessed using variance inflation factors, and the independence of residuals was evaluated using the Durbin–Watson test. Effect sizes were reported in the Results section, as Cramer's
Results
Descriptive
In general, most video blogs presented the sex and age characteristics of protagonists. A total of 53.4% of the cancer video blogs (
Descriptive statistics results of the cancer vlog samples in the current study.
The different types of social support provided in the comments were uneven. Emotional support was most prevalent, as 52.4% of the comments (

Number of social support provisions in comments on cancer-related video blogs.
Narrative components and emotional expression
The results showed that
A total of 48.1% of the video blogs (
Chi-square tests were conducted to test H1, H2, H3, and answer RQ2. The results show that there were significant differences in
Specifically, compared with positive emotions,
Frequencies, percentages, and chi-square test results of narrative components in cancer-related vlog samples associated with different emotions.
Narrative components and social support
MLR models were used to answer RQ3 and RQ4. The narrative components and social support requests in cancer video blogs were the independent variables. The protagonist characteristics and cancer types were control variables. The informational, instrumental, and emotional support received in comments were separately set as dependent variables, and detailed information is provided in Tables 7 to 9.
Multiple linear regression model predicting informational support reception from narrative components and social support requests in cancer-related vlog samples.
Multiple linear regression model predicting instrumental support reception from narrative components and social support requests in cancer-related vlog samples.
Multiple linear regression model predicting emotional support reception from narrative components and social support requests in cancer-related vlog samples.
The MLR results indicate that the videos that involved the
The MLR results also showed that videos involving the eyes, brain, and other parts of the central nervous system (type: C69–C72) positively influenced the reception of informational (
Discussion
This study combines the narrative medicine approach and emotion appraisal theories to analyze the relationship between narrative components and emotional expression in a more systematic way. The results showed that, unlike traditional media, where PLWC is constructed as weak and painful images and expresses negative emotions, 80 nearly half of the cancer-related video bloggers expressed mainly positive emotions. However, the key narrative components, discomfort, problem-facing, and new normal, were less likely to be associated with positive emotions. According to the proposition of the appraisal theories of emotion, we suggest that the appraisal outcome of the self-experience of cancer may be more strongly associated with negative and problematic emotions. This suggests that PLWC's mental health should be focused on because their daily life is strongly associated with negative emotions.
Our findings analyze and verify the appraisal processes and emotional outcomes associated with discomfort and problem facing from the emotion appraisal perspective. In line with our hypothesis,
Partially inconsistent with our hypothesis, the
This study also reveals the exchange of social support in cancer-related video blogs with different narrative components. A noteworthy finding is that although discomfort due to physical and psychological discomfort from PLWC makes audiences aware of their need for help, cancer-related video blogs containing the discomfort component decreased the reception of instrumental and emotional support. This may be because discomfort is often accompanied by negative emotions that evoke health anxiety and fear. Overwhelming fear and anxiety may cause the audience to avoid and reject information,
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which in turn may lead to a decrease in social support. In particular, this study reveals social support exchanges in online communities. We find that the narrative component of
Notably, this study presents the matching status of social support requests and provision in non-health-themed online communities. Our findings demonstrate that the online social support exchange does not always follow the optimal matching principle, and we identify two distinct matching modes in this context: optimal matching and counterproductive matching. On the one hand, we observe the optimal matching in instrumental support requests and provision. When PLWC requests economic and other tangible support, community members are more likely to offer the corresponding functional support. This finding echoes the previous research on cancer-related instrumental support exchanges across online and offline communities.85,86 On the other hand, we observe the counterproductive matching in information support requests. When PLWC requests effective information to solve their health issues, community members did not correspondingly increase their provision of informational support. Rather, their provision of instrumental and emotional support decreased. We believe that the reasons for this phenomenon are multifaceted. First, the absence of corresponding support may be explained by low capacity. Informational support typically pertains to medical problems and thus requires greater capacity to provide, as it involves specialized knowledge or personal experiences.70,87,88 Most members of non-health-themed communities lack the requisite expertise, which limits their ability to meet informational requests. Second, the reduction in instrumental and emotional support can be interpreted from a cultural perspective: Chinese culture places a strong emphasis on relationship maintenance, extending beyond close ties to include interactions with strangers. 89 There is a tendency to avoid interference if one cannot help.89,90 This reflects the relational motive of preserving harmony and avoiding embarrassment. 91 Consequently, when individuals are unable to provide effective informational support, they may prefer silence and disengagement, which causes a reduction in social support provision. Third, algorithmic visibility further reinforces this dynamic. Social media algorithms are driven by popularity and engagement metrics.92–94 Due to informational requests often involving specialized scientific or medical knowledge, they are less likely to be promoted under these algorithms’ preferences. This algorithmic bias reduces exposure, thereby objectively lowering the likelihood of receiving diverse forms of support. Previous studies demonstrate that optimal matching of social support is essential for positive outcomes. When the type of support aligns with the recipient's specific stressor, well-being improves. 95 Conversely, mismatching social support may undermine coping effectiveness and exacerbate distress.61,96 The present study reveals that the alignment of online social support exchanges elicited by cancer self-narratives is limited and even results in a decline of social support. This situation may generate adverse effects on narrators. Future research may need to explore further and reveal its mechanisms.
Limitations
This study has several limitations. First, due to data constraints, it only focuses on the four major narrative components in PLWC's self-narratives, which may obscure alternative components associated with emotion. Second, the study adopted a cross-sectional design, restricted to videos uploaded before March 2022. This limitation of the cross-sectional design may reduce the generalizability of the findings. Third, self-selection bias should be noted: only PLWC who were willing to publicly narrate their experiences contributed data, which reflects context-specific communication patterns rather than the broader population of PLWC. Fourth, the analysis was based on
Conclusion
This study examined the relationships between different narrative components and emotion expressions in cancer-related video blogs, as well as between narrative components and online social support reception. The results indicated that the
Supplemental Material
sj-pdf-1-dhj-10.1177_20552076251386655 - Supplemental material for Self-narrating cancer on social media: Examining the relationships among narrative components, emotional expressions, and social support reception
Supplemental material, sj-pdf-1-dhj-10.1177_20552076251386655 for Self-narrating cancer on social media: Examining the relationships among narrative components, emotional expressions, and social support reception by Yuanming Guo and Xiao Yang in DIGITAL HEALTH
Supplemental Material
sj-pdf-2-dhj-10.1177_20552076251386655 - Supplemental material for Self-narrating cancer on social media: Examining the relationships among narrative components, emotional expressions, and social support reception
Supplemental material, sj-pdf-2-dhj-10.1177_20552076251386655 for Self-narrating cancer on social media: Examining the relationships among narrative components, emotional expressions, and social support reception by Yuanming Guo and Xiao Yang in DIGITAL HEALTH
Footnotes
Acknowledgments
Ethical considerations
Consent to participate
Consent for publication
Author contributions
Funding
Declaration of conflicting interest
Data availability
Supplemental material
References
Supplementary Material
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