How delays in seeking medical care for cervical cancer patients are affected by their health-seeking behaviour: a qualitative study

Abstract

Background

Cervical cancer is a global health challenge for women, characterized by high morbidity and mortality rates, along with long-term health consequences and economic burden. Early screening and timely treatment can effectively manage cervical cancer, making it crucial for patients to seek medical attention promptly. Positive health-seeking behaviors (HSB) involve the awareness of health issues, self-assessment of health status, and the proactive gathering of information and taking appropriate actions to maintain health. Positive HSB are key to reducing the risk of delayed healthcare access for cervical cancer patients. However, delays in seeking medical care remain prevalent globally.

Objective

This study aimed to explore the underlying factors contributing to delayed medical care in cervical cancer patients. The findings provide a basis for improving the timely access to care for these patients.

Methods

The study was conducted between July 2024 and October 2024 at a tertiary oncology hospital in China. Cervical cancer patients who experienced delays in seeking medical care were purposively sampled and interviewed. Health-seeking behaviours were collected through semi-structured interviews. Data were analyzed using a theory-driven thematic approach, guided by the Health Belief Model (HBM).

Results

Seventeen cervical cancer patients participated in the study. Four themes emerged: (1) perception and assessment of symptoms (lack of knowledge, benign attribution of symptoms, ignorance of symptoms); (2) perceived threat of the disease (feeling healthy, low susceptibility, no symptomatic threat); (3) perceived benefits and barriers to health-seeking behaviours (reduced disease threat, alleviated psychological and financial burden, low awareness of healthcare access, health insurance coverage, limited healthcare resources); and (4) cues to action (family support, symptom exacerbation). In general, patients with cervical cancer who lack knowledge about the disease and have a diminished perception of the threat of the disease may or may not choose to seek timely medical care after assessing the benefits of health-seeking behaviours and the barriers they face.

Conclusion

This study identifies key barriers to health-seeking behaviours among cervical cancer patients, including limited awareness of early symptoms and underestimated perceptions of risk and severity. It suggests that future interventions should adopt a multifaceted approach targeting healthcare providers, patients, and their social support systems. This strategy should emphasize disease-related knowledge and timely health-seeking behaviours. Clinically, greater emphasis on culturally sensitive communication and patient education is needed to reduce stigma and fear associated with gynecological care. At the policy level, expanding access to affordable screening services and strengthening rural healthcare infrastructure could help reduce disparities and promote earlier diagnosis and treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-23783-0.

Background

Cervical cancer is one of the most common malignant tumors of the female reproductive system [1]. It ranks fourth globally in both incidence and mortality rates [2] and represents a major health challenge for women, along with a significant social burden. In 2020, there were 660,000 new cervical cancer cases and 350,000 deaths worldwide [2]. In 2015, of the 270,000 cervical cancer-related deaths, about 90% occurred in developing countries, where the mortality rate is 18 times higher than in developed nations [3]. The disease burden in developing countries far exceeds global averages. As the world’s largest developing country, China has taken proactive measures in the field of cervical cancer prevention and control. For instance, it has implemented a free HPV vaccination program for adolescents and a free cervical cancer screening project for women aged 35–64 in rural areas [4]. Nevertheless, the current prevention landscape remains challenging [5], with China documenting approximately 110,000 new cervical cancer cases and 60,000 related deaths annually - accounting for 18% and 17% of global totals respectively [6].

Cervical cancer develops through persistent infection with high-risk human papillomavirus (HPV). The progression from HPV infection to cancer is gradual and can be detected through screening, allowing for timely treatment. Thus, Precancerous cervical lesions and early-stage cervical cancer can achieve high cure rates through effective screening and treatment interventions [2]. Furthermore, the treatment outcome is closely linked to the clinical stage at diagnosis, with significant variation in the 5-year survival rates across stages: 39% overall, 81% in Stage I, 68% in Stage II, 23% in Stage III, and only 20% in Stage IV [7]. Delays in seeking medical care are a key factor influencing the stage at diagnosis. However, significant disparities exist among different populations in access to cervical cancer screening services and timely medical care. Some women, especially those from rural or resource-poor areas, often face various barriers such as insufficient healthcare resources, economic burdens, limited health literacy, and long distances to healthcare facilities [8]. In addition, a lack of knowledge about the disease and insufficient family or social support also cause some women to delay seeking medical care after experiencing related symptoms [9].

Early diagnosis and treatment are widely recognized as the most cost-effective and efficient strategies for cancer prevention and control [10]. However, cervical cancer is frequently diagnosed at advanced stages, which significantly compromises treatment outcomes. Studies report that the delay in medical care for oncology patients ranges from 30 to 60% [11–13], with an average delay of 1 to 4 months [14]. The incidence of delayed care in cervical cancer patients is as high as 45% [15]. Such delays not only shorten survival and reduce quality of life but also increase healthcare costs and place greater strain on healthcare systems. In China, the average annual healthcare costs per cancer patient range from $7,421 to $10,297 [16]. Therefore, timely identification and early medical consultation of cervical cancer at initial or precancerous stages by patients is critical for reducing both incidence and mortality rates.

The concept of delay in seeking medical care was first introduced by PACK et al. [17], referring to the time interval between the onset of the patient’s first symptom and the first doctor visit, ≥ 3 months. In current studies on breast cancer, colorectal cancer, oral cancer, and hepatocellular carcinoma, a delay is still defined by a 3-month threshold [18–21]. Based on these studies, the present research defines delay in medical care as a time interval of ≥ 3 months between the patient’s first discomfort and the first visit to a healthcare facility.

Health-seeking behaviour(HSB)is a positive behavioural pattern in which an individual, under the influence of a chronic health problem, actively seeks to adjust his or her habits or improve the surrounding environment in order to achieve a better state of health [22]. In China, compared to the extensive data available on other cancers and chronic diseases, there is a lack of publicly available information on the HSB of cervical cancer patients. Since HSB may significantly impact the rate of delayed consultations in cervical cancer patients, and given the existing knowledge gaps, further urgent research is needed in this area.

Previous studies have shown that the HSB of cervical cancer patients is a complex process, influenced by factors such as economic and cultural background [23], disease perceptions [24], attitudes towards healthcare [25], awareness of disease screening [26], characteristics of the healthcare system [27], and social support [28]. However, most studies have relied on quantitative methods to explore the factors contributing to delayed HSB in cervical cancer patients. In contrast, fewer studies have employed qualitative methods to explore the mechanisms behind these delays and patients’ personal experiences. By using a qualitative approach with open-ended questions, we could consider a broader range of psychosocial influences, uncovering additional potential issues and details, and achieving a more comprehensive understanding of the evolution of HSB in cervical cancer patients. This approach not only allows for more accurate and comprehensive conclusions but also provides a deeper analytical perspective and insight into the HSB of these patients.

The Health Belief Model (HBM), proposed by Hochbaum and his team, uses social psychology methods to explore how health beliefs influence health behavior patterns and their various determinants. The core components of the health belief model and their definitions are presented in Table 1. This model is one of the foundational theories for explaining behaviors related to health maintenance and improvement [29]. The Health Belief Model (HBM) and theoretical frameworks like the Theory of Planned Behavior (TPB) are among the most widely used conceptual models for explaining and describing health-related behaviors [22]. Compared to TPB, which is better suited for analyzing planned behaviors (e.g., regular screenings), HBM focuses more on perceptions of health threats (e.g., disease severity) and cost-benefit assessments of behaviors. This makes HBM better aligned with our study’s analysis of patients’ health behavior decisions regarding delays in seeking medical care. The HBM has been widely used to explain and predict individual health behaviors related to medical seeking and treatment adherence [30], making it a valuable framework for studying delays in healthcare seeking among cervical cancer patients [31]. This study adopts a qualitative research design to systematically collect information from cervical cancer patients, from the first appearance of abnormal signs to their first doctor visit. The goal is to explore in depth the intrinsic motivations behind their delayed medical care and the factors influencing this delay, providing a theoretical basis and practical reference for optimizing strategies to ensure timely medical care for cervical cancer patients.

Table 1.

Core components of the health belief model and their definitions

Component	Definition
Perceived Susceptibility	Individual’s belief about the likelihood of developing a disease.
Perceived Severity	Individual’s perception of the seriousness and potential consequences of the disease.
Perceived Benefits	Belief that adopting a health behavior will reduce the risk or impact of the disease.
Perceived Barriers	Perceived difficulties or costs (e.g., financial, psychological) in adopting a health behavior.
Cues to Action	Internal or external triggers that prompt the individual to adopt a health behavior.

Methods

Study design

This qualitative analytical study used a semi-structured interview methodology to collect and understand the views, attitudes, underlying thoughts, and intrinsic motivations of participants regarding their HSB. Face-to-face interviews were conducted, and all interviews were audio-recorded to ensure completeness and accuracy. The recordings were transcribed into textual data within 24 h after the interviews were completed. Data were analyzed using a theory-driven thematic analysis based on the Health Belief Model (HBM), with inductive coding applied to identify emerging content and develop a conceptual framework. The study design and reporting strictly adhered to the Comprehensive Reporting Standards for Qualitative Research (COREQ) guidelines.

Settings

The study was conducted in the gynaecological oncology department of a hospital in Sichuan, China. The Sichuan Cancer Hospital is a national specialized oncology hospital that provides a range of services, including cancer prevention, treatment, rehabilitation, research, and teaching. The hospital has an annual outpatient capacity of nearly 760,000. As a specialized oncology provider, it serves patients from diverse socio-demographic backgrounds and addresses a broad spectrum of health needs and medical experiences.

Participants

Purposive and maximal variation sampling strategies were used to include cervical cancer patients with diverse characteristics. Eligibility criteria: (1) Diagnosis of cervical cancer confirmed by pathology; (2) Visit time ≥ 3 months; (3) Age ≥ 18 years; (4) Capacity for clear thinking, normal mental state, and sufficient understanding and expression abilities; (5) Voluntary participation in this study. Exclusion criteria: (1) Patients with other cancers; (2) Non-primary cervical cancer; (3) Patients with recurrence or metastasis after systemic treatment (e.g., surgery, radiotherapy, chemotherapy, endocrine therapy, targeted therapy).

The term “visit time” refers to the interval between the first onset of symptoms and the first medical consultation. A visit time of ≥ 3 months (90 days) is considered a delay.

Interview guideline

A semi-structured interview guide was developed and pre-piloted to systematically collect data on individual HSB. The guide consisted of open-ended questions designed to explore respondents’ personal experiences, knowledge of cervical cancer, and the opportunities and challenges they faced in accessing healthcare services. (For the specific content of the interview guidelines, see Supplementary File 1). According to the HBM [32], an individual’s decision to adopt a specific health behavior is influenced by two core elements: personal beliefs about the effectiveness of the behavior and the willingness to avoid the risk of worsening the disease.

As shown in Fig. 1, the likelihood of adopting health-seeking behaviors (HSB) among cervical cancer patients is strongly influenced by their perceived threat of the disease and how they assess the potential benefits and barriers associated with HSB. In this context, ‘perceived benefits’ refers to the overall consideration of the positive effects and potential costs of adopting HSB, while ‘perceived threats’ encompasses awareness of the susceptibility and the severity of the disease. Moreover, patients’ in-depth knowledge of cervical cancer plays a key role in their propensity to engage in HSB. Based on these factors, an interview guide was developed for the study. Given the high prevalence of cervical cancer, patients’ behavioral cues may significantly influence their adoption of HSB. Thus, basic demographic information was systematically collected during the interview process to provide a more comprehensive understanding of the context and motivation behind their health-seeking decisions.

Fig. 1.

Structural Outline of the Interview Protocol Derived from the HBM

Data collection

Potential participants were first screened, provided with a detailed explanation of the study, and invited to participate. Interviews were conducted by two researchers between July and October 2024, with each session lasting 30 to 35 min on average. Open-ended questions were used to allow participants to express their genuine feelings. Interviewers listened, observed, and noted non-verbal behaviors, such as facial expressions, emotional responses, and body movements. Participants were encouraged to share their inner thoughts. Based on each interview’s specific circumstances, the content and procedures were adjusted to ensure the interviews were conducted thoroughly. All interviews were recorded using digital audio equipment, and the audio recordings were transcribed by two researchers. After 15 interviews, data saturation was reached, confirmed by two additional interviews in which the codes or themes become repetitive and no new information emerged. A total of 17 interviews were ultimately conducted.

Data analysis

To ensure data authenticity, the audio recordings were transcribed into text within 24 h without modification or deletion. The data underwent a theory-driven thematic analysis based on the HBM, following a six-step process: familiarization with the data, initial coding, thematic exploration, reviewing, defining and naming themes, and writing the study. The transcribed texts were imported into NVivo 11.3.0 software for coding. Two researchers (FJ and CYY) independently and repeatedly read the transcripts to identify and code meaningful excerpts, categorizing them into different code labels. These initial codes formed the basis of the analysis, from which FJ and CYY identified connections to relevant theories and frameworks. FJ proposed recurring themes, which were discussed with CYY to determine the final themes. FJ and CYY then considered the definitions of each component and inductively mapped the themes onto the domains of the Health Belief Model framework. Any disagreements regarding domain mapping between FJ and CYY were resolved through discussion with a third author (LY). An iterative approach was applied throughout the coding process—that is, the research team continuously reviewed, revised, and optimized the codes and thematic structure—to enhance coding quality and rigor. Themes were categorized based on initial codes, while subthemes emerged from data sharing common meanings. All themes and subthemes were reviewed against the original codes and transcripts. To verify the credibility and reliability of the findings, participant validation was conducted.

Rigor

This study followed the HBM framework to ensure scientific rigor and objectivity. Data analysis was conducted independently by two researchers, with discrepancies resolved by discussions with a third researcher to minimize subjective biases. An iterative approach was adopted to deepen the analysis and reduce potential researcher bias. The research team consisted of associate professors and above, with extensive qualitative research experience, as well as graduate students trained in systematic qualitative research. This diversity helped reduce potential research bias by examining the data from multiple perspectives. Qualitative research experts were invited to assess the initial codes and transcribed texts, reviewing the identified themes and subthemes to ensure data accuracy and the plausibility of relationships among themes. To ensure the credibility of the findings, participants were asked to confirm the results, and all participants felt that the findings were consistent with their initial perceptions.

Ethical considerations

The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Sichuan Cancer Hospital under approval number SCCHEC-02-2023-127. Interviews were scheduled according to the patients’ treatment and examination schedules to avoid interference with their clinical care. Prior to the interviews, researchers introduced themselves, explained the study’s purpose, content, and process, and ensured the anonymity of participants. All participants signed an informed consent form. The interviews were conducted in a quiet ward conversation room to provide a natural, undisturbed environment. Family members were encouraged to be present during the interviews to help patients feel comfortable and communicate openly.

Results

A total of 17 patients diagnosed with cervical cancer participated in the study. The participants’ demographic characteristics were as follows: ages ranged from 36 to 70 years; education levels varied from no formal education to a bachelor’s degree; and participants came from diverse professional backgrounds, including laborers, agriculturalists, pensioners, and entrepreneurs. A comprehensive overview of the demographic data is presented in Table 2.

Table 2.

Participants’ characteristics

	age	Marital status	Educational level	occupation	Monthly family income(RMB)	Ever had a cervical cancer screening
P1	70	Married	No formal education	Farmer	<3000	No
P2	54	Married	Middle School	Farmer	3000–5000	No
P3	61	Married	Middle School	Retiree	3000–5000	Yes
P4	57	Married	Primary School	Farmer	<3000	No
P5	50	Married	Middle School	Labourer	<3000	No
P6	36	Single	Bachelor	accountants	3000–5000	No
P7	49	Married	Primary School	Labourer	3000–5000	No
P8	61	Divorced	Middle School	Retiree	3000–5000	Yes
P9	56	Married	Primary School	Farmer	<3000	No
P10	58	Divorced	Primary School	Farmer	<3000	No
P11	62	Divorced	Bachelor	Retiree	3000–5000	No
P12	60	Married	High school	Retiree	<3000	No
P13	56	Married	High school	Retiree	<3000	No
P14	54	Married	High school	Retiree	3000–5000	Yes
P15	41	Married	Middle School	Farmer	<3000	Yes
P16	55	Married	Middle School	self-employed	3000–5000	No
P17	53	Married	High school	Labourer	<3000	No

Perception and assessment of symptoms

Lack of knowledge about symptoms

The majority of participants lacked knowledge regarding cervical cancer and its symptoms.

“I had no idea about it. I didn’t even know what HPV was until I had the surgery. I thought it was HIV or something. Some people were like, “How can you go to college and not know about HPV?” But I really didn’t know anything about it either.”(P6, a 39-year-old single patient.)

“When it comes to cervical cancer, I didn’t really know much about it at first. I just had a bit of back pain, but I didn’t think much of it.”(P2, a 54-year-old married patient.)

Only two participants correctly understood the knowledge questions, while the rest lacked comprehension.

Benign attribution of symptoms

Some participants (n = 6) delayed seeking medical attention due to misperceptions about their symptoms, attributing them to benign causes.

“When I went to the bathroom, I noticed a little bit of blood. At first, I thought it might be hemorrhoids, but it didn’t seem to be bleeding too heavily. I wiped again, and it seemed to have stopped.”(P9, a 56-year-old married patient.)

Cervical cancer most commonly occurs around menopause, and many people in China believe that irregular menstruation at this age is normal, often avoiding medical check-ups and delaying treatment.

“At the time, I didn’t know what was going on. I thought it was just irregular periods or some sort of gynaecological issue.”(P6, a 39-year-old single patient.)

Patients sometimes self-diagnose based on previous medical experiences, which can lead them to overlook or misinterpret their current condition, delaying medical attention.

“Nobody wants to get sick. I have fibroids, and they say they bleed all the time, so I really thought it was caused by my fibroids.” (Sighs)(P7, a 49-year-old married patient.)

Ignorance of symptoms

Participants who were unaware of their symptoms did not perceive the potential danger they posed. This lack of awareness hindered their ability to understand the underlying causes of their symptoms, leading to delays in seeking care.

“I just didn’t take it seriously because I thought it wouldn’t bleed for long if I didn’t touch it. I was usually fine, so I didn’t pay attention to the symptom.”(P16, a 55-year-old married patient.)

The symptoms presented were insufficient to prompt concern in some participants, who dismissed them as not serious.

“It bled a little bit at first, but only a little bit, and there was no pain or discomfort, so I didn’t worry about it. I just kept working, thinking it was nothing.”(P1, a 70-year-old married patient.)

Perceived the threat of disease

Perceived susceptibility

When asked about their susceptibility to cervical cancer, most participants (n = 15) perceived their likelihood of developing the disease as low. This perception was influenced by factors such as family history, age, health status, lifestyle, and personal psychological conditions.

“I thought the probability of getting the disease was higher for younger people, but after I got it, I realized that cervical cancer can affect older people as well.”(P11, a 62-year-old divorced patient.)

Some participants underestimated their risk due to misconceptions and overconfidence in their health status.

“I haven’t had a disease in decades, I barely take medication and don’t go to the hospital for vaccinations. How did I get this disease?”(P3, a 61-year-old married patient.)

Perceived severity

Some participants (n = 7) felt that delaying medical care could have serious consequences. They feared it would negatively impact multiple aspects of their lives, including long-term health problems, psychological stress, and financial burdens.

“I am sometimes very anxious, anxious to the point of no return. Sometimes I think of the pain of having cancer, but I also think of the pain of having to spend money on treatment.” (Tears)(P3, a 61-year-old married patient.)

More than 50% of the participants reported experiencing symptoms they considered minor, with little impact on their daily activities. They had limited knowledge of the initial signs of cervical cancer. Due to their current health status, they tended to underestimate the seriousness of their symptoms and were less sensitive to the signs they were experiencing.

“We are all girls. I went to the toilet and found a little bit of secretion, not normal, with a little blood, very little, not obvious. I didn’t pay too much attention to it. It wasn’t frequent, and I didn’t feel uncomfortable otherwise.”(P2, a 54-year-old married patient.)

Perceived benefits and barriers of health-seeking behavior

Perceived benefits

Participants had varying views on the benefits of HSB. They believed that seeking medical care could reduce the thteat of disease, slow its progression, help patients understand their actual health status, and improve their knowledge of cervical cancer. It also reduced health concerns for themselves and their families, promoted positive lifestyle changes, and prevented greater financial and caregiving burdens on their families.

“It is the best way to go to the hospital for a check-up when something is wrong with your body. If I had received treatment earlier, I wouldn’t have spent so much money, my body wouldn’t have suffered, and the treatment would have been more effective. I still suffer from chemotherapy, and my family has to take care of me.”(P8, a 61-year-old divorced patient.)

Cancer was perceived as an incurable disease, leading some participants to question the value of seeking medical care. They did not believe that timely healthcare could improve their condition and felt that cancer would inevitably lead to death.

“With this disease, I don’t know how long I can live, I can only wait to die.” (crying)(P13, a 56-year-old married patient.)

Perceived barriers

When inquiring about obstacles to engaging in HSB, several concerns emerged among participants. The primary barrier mentioned was a lack of awareness regarding the need for medical attention. Many participants (n = 11), especially those in rural area, rarely underwent health check-ups, adhering to the mindset of ‘no discomfort, no intervention’. Cervical cancer screening was notably rare, with only four participants having been tested.

“No, I basically didn’t go for medical check-ups before, I waited until I was really unwell.” (P2, a 54-year-old married patient.)

Participants identified fear of gynecological examinations as a major barrier. Influenced by traditional Chinese beliefs that female reproductive organs should remain private and that gynecological diseases, often associated with sexual impurity, were shameful, they were reluctant to visit hospitals for check-ups or treatment. Some participants chose to conceal their condition to avoid others discovering it, further delaying consultation.

“I felt a bit of pain and some bleeding down there (vagina) and I wanted to go for a check-up, but I didn’t. I didn’t want to because it’s a private part. I didn’t want to check it out, I didn’t want to go mainly because of that thought. I would have gone if it weren’t a private part. I felt a bit scared to go to the gynecologist for a check-up. It would have been painful and a little embarrassing. I didn’t want to go anyway.” (P9, a 56-year-old married patient.)

Participants also delayed seeking medical attention due to concerns about their health status and fear of a serious diagnosis. They were worried that a disease diagnosis could be a significant psychological burden and cause mental stress.

“Just afraid of finding out it’s cancer, terrified of the outcome, and thinking that the treatment will cost a lot of money too.”(P16, a 55-year-old married patient.)

Negative experiences and misconceptions about healthcare from family, friends, and others in their social circles hindered some participants from seeking timely medical care. Rather than relying on their own judgment, they often depended on the guidance and advice of those around them.

“At that time, I even talked to my friends, and they all said that it might be caused by age and the thin walls of the vagina caused the bleeding, so I believed them and didn’t take it seriously.”(P17, a 53-year-old married patient.)

Some participants, particularly those in rural areas, expressed concerns about the high medical expenses, with the most alarming issue being the substantial out-of-pocket costs due to low reimbursement rates from medical insurance. This contributed to delays in seeking medical care.

“The reimbursement rate of the New Rural Cooperative Medical Scheme we joined is not high, with many out-of-pocket expenses, and it does not cover outpatient services.” (P5, a 50-year-old married patient.)

Low accessibility of healthcare resources and lack of transportation were considered barriers, especially for elderly or remote patients. Restricted medical conditions, lack of medical resources, long travelling times, and inconvenient access to healthcare facilities prevented them from seeking care.

“We live in a small county where it is more backward. For example, we don’t have an oncology hospital there. Even to do a vaginal ultrasound, the hospitals don’t even have this medical equipment.” (P15, a 41-year-old married patient.)

Some participants were reluctant to seek healthcare mainly because they did not want to put financial pressure on their family members. They were concerned that care and support required would consume a lot of their family members’ time and energy, interfering with their work and daily life.

“I didn’t tell my family at first, so they wouldn’t have to worry, and going to the hospital is a big expense.” (P2, a 54-year-old married patient.)

Cues to action

Many participants (n = 13) reported that their views on health behaviors were significantly influenced by individuals in their environment, including family members, fellow patients, companions, and healthcare professionals. Participants often sought health-seeking advice from family, friends, and healthcare professionals and relied on the second-hand experiences of their peers to guide their personal health-seeking behavior.

“I told my son about my situation, but he had been too busy working and was unavailable to take me to the hospital. So, I called my daughter-in-law and asked her to drive me to the hospital.” (P4, a 57-year-old married patient.)

Effective self-management behaviors reduced their symptoms to some extent, which in turn delayed the time to seek medical care. Some participants only sought medical help after unsuccessfully trying self-medication and when their symptoms worsened.

“In the beginning, I told people around me that I had vaginal discharge, and then I bought medication for it. After I used it, I felt as if I was normal again and left it alone.” (P7, a 49-year-old married patient.)

Having a health worker in the family with better access to information or a good experience with HSB also promoted early healthcare access.

“There is a medical staff member in the house, so I can ask if I don’t know anything, and they give me recommendations on where to go.” (P11, a 62-year-old divorced patient.)

As shown in Fig. 2, this framework provides an in-depth analysis of the decision-making pathway of cervical cancer patients concerning their HSB. The chart highlights the potential limitations in cervical cancer patients’ understanding of early disease signs, which are partly due to misconceptions about early symptoms and unclear knowledge of the disease. This affects their ability to accurately assess disease threat and understand the potential benefits of HSB. The key factor determining whether cervical cancer patients engage in HSB is their perception of current symptomatic threats. When deciding whether to seek healthcare, patients consider both the potential benefits and obstacles associated with HSB, aiming to achieve the best overall health status. This step is crucial in the decision-making process. Additionally, behavioral cues play a vital role in guiding cervical cancer patients to make informed HSB choices. These cues not only enhance patients’ perception of disease threats and understanding of HSB benefits but also reduce barriers to accessing healthcare services. When the perceived benefits of HSB outweigh the perceived threats, patients are more likely to take prompt action and seek medical care in a timely manner. Conversely, if the perceived benefits are outweighed by the threats, patients may choose to maintain the current status, leading to delays in seeking medical care.

Fig. 2.

Cervical cancer patients' health-seeking decision pathway

Discussion

A qualitative study was conducted to explore the development of HSB in cervical cancer patients. Using the HBM as a foundational framework, the study integrated patients’ understanding of disease knowledge related to cervical cancer, their perceived threat from symptoms, perceived benefits of HSB, behavioral cues to HSB, and the impact of these factors on patients’ decision-making processes. The aim was to gain insight into the dynamics of health-seeking decision-making in cervical cancer patients.

Due to limited disease knowledge, cervical cancer patients often misinterpret their condition, leading to an underestimation of the severity of early symptoms and their susceptibility to the disease. This misunderstanding causes patients to ignore their symptoms, view early signs as benign or mild, believe that the disease will not significantly impact their lives, or to attribute the symptoms to other benign causes. As a result, cervical cancer patients fail to recognize the potential threat of symptom progression and the protective role of HSB, often leading to delays in seeking healthcare.

The perception of cervical cancer as an incurable disease, along with a lack of awareness, causes patients to underestimate the benefits of HSB. Additionally, the necessity of seeking timely medical services is also questioned. Other barriers, such as weak health consciousness, fear of gynecological examinations, economic constraints, limited healthcare access, transportation obstacles, and other impediments, often serve as ‘stumbling blocks’ for patients seeking timely medical care.

The health-seeking behavior choices of cervical cancer patients are influenced by their overall consideration of the benefits and barriers to HSB. For example, action cues such as support and encouragement from family, friends, and healthcare professionals can help mitigate barriers or enhance the understanding of the benefits of timely healthcare-seeking behaviors, thereby facilitating the effective implementation of these behaviors.

Comparison with existing studies

Knowledge of cervical cancer is a cornerstone of health-seeking behavior. In this study, participants often misidentified early symptoms as common gynecological conditions, such as ‘menstrual disorders’, ‘vaginitis’, or ‘haemorrhoids’. This may be due to the fact that early symptoms of cervical cancer, such as irregular vaginal bleeding, are similar to menstrual disorders. When these symptoms occur intermittently and resemble previous benign conditions, patients often misattribute them to benign causes rather than seek immediate medical help [9]. As a result, many individuals have difficulty distinguishing between common gynecological conditions and early symptoms of cervical cancer, leading to delays in seeking medical care. This finding is consistent with the study by Yao et al. [33], which reported that irregular vaginal bleeding is often mistaken for a symptom of common gynecological diseases rather than an early sign of cervical cancer. Additionally, some respondents mistook these symptoms as a normal part of menopause, leading to benign attribution or self-medication, further exacerbating the issue of delayed healthcare access.

Although some participants were aware of their abnormal symptoms, they did not interpret them as cancer due to the ‘painless nature’ of the symptoms. This is consistent with the findings of Scott et al. [21], who noted that cancer patients with abnormal symptoms, but no other physical discomfort, misinterpreted these symptoms as ordinary illnesses. As a result, participants ignored their abnormal symptoms until they significantly worsened, caused pain, affected emotional well-being, and reduced quality of life, prompting them to seek medical help. A similar phenomenon was observed in a qualitative study by Karla et al. [34].

Most participants had a low susceptibility to cervical cancer and did not consider themselves at risk of developing the disease. This was mainly because they did not have a family history of cervical cancer and perceived themselves to be in good health. Some studies have found that patients with a family history of cancer are less likely to experience delays in seeking health care [9]. Patients did not seek medical attention because they did not recognize the severity of the disease or believed that the symptoms would resolve on their own, which is consistent with the study by Maghous et al. [35]. This suggests that patients with cervical cancer have limited knowledge of symptom warning signs and disease severity, which may reduce their perceived threat, hinder HSB, and contribute to delays in seeking healthcare. This result is consistent with similar studies conducted in Africa [36–38].

For cervical cancer patients, the perceived benefits and perceived barriers of HSB largely determine whether they engage in HSB. This study found that, due to the belief that cancer is incurable, cervical cancer patients tend to underestimate the benefits of HSB. Several studies have reported a strong link between perceived benefits and barriers, which significantly influences the adoption of HSB [39, 40]. In the current social environment, which emphasizes health literacy, perceived barriers are a primary reason why people do not adopt healthy behaviors. Even when individuals clearly perceive their susceptibility to illness and fully understand the benefits of HSB, potential barriers may prevent them from taking action [41].

Weak health awareness is a major barrier to cervical cancer patients seeking healthcare. Many participants in this study have a common misconception that health check-ups are only necessary when they feel unwell. However, this misconception is particularly prevalent among individuals with lower education levels, especially in rural areas, where patients often neglect the importance of health management due to a lack of adequate health education resources and awareness. Even some patients with higher education levels or those living in urban areas, despite having access to more health resources, may still fail to fully understand the importance of health management due to information overload or insufficient risk perception regarding health issues. The fact that only a few participants in this study participated in the cervical cancer screening program reflects the participants’ low awareness of cancer prevention. A study by Arndt et al. [42] found that women who participated in general health check-up screenings were more likely to seek healthcare in a timely manner. Weak health awareness led to blind optimism about disease management, which may have reduced their risk awareness and hindered their HSB, preventing them from addressing potential health threats.

In addition, fear of gynecological examinations, fear of diagnosis, and fear of burdening their families created significant obstacles to timely consultations for cervical cancer patients. Currently, few studies have included fear of gynecological examinations as a potential factor contributing to delays in seeking medical care. In the Chinese sociocultural context, gynecological examinations are often associated with a sense of shame, particularly among women with limited prior experience. This sense of shame is partly rooted in traditional societal norms that emphasize female chastity and bodily privacy, making pelvic examinations a source of significant discomfort and embarrassment for some patients. Studies have reported that women often feel ashamed and uneasy during gynecological exams [43, 44], but it tends to be more pronounced in culturally conservative societies. For rural cervical cancer patients, the cost of healthcare and limited accessibility to healthcare resources were identified as major barriers. The low income and high out-of-pocket expenses (high reimbursement threshold and low reimbursement rate of the new rural cooperative medical care) placed greater financial pressure on rural cervical cancer patients when seeking healthcare. Moreover, the development of medical technology in rural areas lags behind that in urban areas, and there are significant disparities in medical resources between rural and urban regions, including medical equipment and human resources [45]. These factors make it even more difficult for rural patients to access healthcare, exacerbating delays in seeking care.

On the other hand, informational support, instrumental support (such as financial assistance), and emotional support from family, friends, other patients, and healthcare providers are particularly important for cervical cancer patients when deciding to seek health behaviors. This support generates strong motivation for these patients to seek healthcare and provides them with indirect experience, thereby influencing their beliefs about HSB. According to current research, cues to action can promote HSB among cervical cancer patients by reducing barriers to seeking healthcare, which aligns with a previous study [34]. However, inappropriate cues to action may create additional barriers. For example, in the present study, most participants first discussed their abnormal symptoms with non-professionals, such as family and friends, rather than seeking medical help immediately. Ideally, they should have received prompt advice to consult healthcare professionals. Instead, in some instances, their descriptions of what they considered ‘normal symptoms’ were confirmed, they were advised to take certain medications, or simply told to continue observing their condition.

Implications for clinical practice

This study underscores several key factors that should be prioritized in the design of intervention strategies. The findings indicate that improving women’s knowledge of cervical cancer, enhancing health awareness, reducing the cultural stigma associated with gynecological examinations, promoting healthcare policy reforms, and integrating medical resources are all essential to encouraging timely health-seeking behavior. Multilevel and synergistically implemented interventions are more likely to prompt early medical consultation, thereby increasing the rates of early detection and treatment of cervical cancer.

Current evidence clearly shows that patients’ limited knowledge of the disease and inadequate awareness of their healthcare needs are major barriers to timely care-seeking. Therefore, it is important to strengthen collaboration among hospital healthcare providers, women’s associations, village committees, and communities to widely disseminate cervical cancer prevention and control knowledge to every household and individual. This will help awaken and reinforce public awareness of health management. In addition, community outreach efforts should be enhanced—such as mobile clinics and regular health promotion activities—especially in rural and underserved areas, to improve healthcare accessibility and disease awareness.

Healthcare providers should receive training in empathetic counseling and community engagement to build trust and promote positive health-seeking behaviors. By integrating these measures, healthcare services can more effectively bridge gaps in knowledge and cultural barriers, facilitating the early detection and treatment of cervical cancer. To reduce the cultural stigma associated with gynecological exams, it is recommended to assign female medical staff who have received specialized training to conduct cervical cancer screenings, particularly in conservative or rural areas, to help alleviate embarrassment and improve acceptance [46]. Additionally, peer education and storytelling initiatives led by cancer survivors or local female health advocates can help normalize gynecological exams and reduce stigma through relatable stories and role models.

Healthcare policy support plays a critical role in promoting early screening for cervical cancer and reducing disparities in access to care. China’s current “Free Cervical Cancer Screening Program for Rural Women of Appropriate Age” has achieved certain success in increasing overall screening coverage. However, to further address regional development disparities and differences in healthcare accessibility, more targeted policy measures are needed [47]. For example, moderately lowering the reimbursement threshold and increasing the reimbursement rate for cervical cancer-related screening and treatment under the New Rural Cooperative Medical Scheme could ease financial burdens and encourage rural women to participate in early screening. Moreover, integrating cervical cancer screening into the routine public health services of primary care facilities and extending service reach through mobile screening units and telemedicine can help ensure more equitable access to screening services in remote and resource-limited areas.

Regarding healthcare resource integration, the transformation of rural healthcare services should be promoted from quantitative expansion to quality improvement. The development positioning should be clarified, the construction of county medical communities should be accelerated, and the flow of high-quality medical resources to rural areas should be encouraged. In addition, advanced management models and technological innovations should be actively explored and introduced. The integration and application of Internet-based medical services should be strengthened to improve service efficiency and quality [48]. These measures will promote the balanced development of health services and ensure that rural residents can access fair, high-quality healthcare [49].

Strengths and limitations

This study employs qualitative methods to explore the evolution of delayed healthcare-seeking behavior among cervical cancer patients. It provides an in-depth understanding of how patients perceive their condition and the factors that influence their decision to delay medical treatment. By applying the HBM, the study identifies various factors that impact patients’ HSB. However, the study has some limitations. Specifically, the sample size is small, and all participants are from a single region in China, which may limit the generalizability of the findings. Additionally, social desirability bias may have influenced participants to provide responses they believed the researchers wanted to hear. To enhance understanding, future research should first expand the geographical scope and conduct comparative analyses across urban and rural areas or regions with varying health insurance policies. Secondly, an inductive approach can be used to help identify new patterns, themes, or theories, while a mixed-methods approach can also be employed to validate qualitative findings with quantitative data, thereby enhancing the rigor and credibility of the research. In addition, future studies should investigate the causal mechanisms underlying delayed healthcare-seeking behavior to comprehensively uncover its contributing factors and underlying dynamics.

Conclusion

This study, grounded in the Health Belief Model (HBM), provides an in-depth understanding of the health-seeking behaviors of cervical cancer patients who experience delays in accessing healthcare, as well as the factors influencing these behaviors. The findings indicate that patients commonly lack awareness of early symptoms and underestimate their personal risk and the severity of their condition. These perceptual gaps reflect deficiencies in perceived susceptibility and perceived severity within the HBM framework, alongside a complex evaluation of the benefits and barriers to seeking timely care.

The results offer robust theoretical support for targeted health education and timely healthcare interventions, emphasizing the importance of enhancing patients’ risk perception, increasing their willingness to seek care, reducing barriers during the health-seeking process, and strengthening cues to action. These measures are critical for effectively mitigating delayed healthcare seeking. Future efforts should build on these findings to promote the implementation of multifaceted, systemic interventions that standardize and optimize patients’ health behaviors.

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were carried out by FJ, CYY and LY, with YQ conceptualising the research questions and reviewing the interpretation of the results. The first draft of the manuscript was written by FJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.Other author footnotes (delete if not used):1Jing Fang, Yuying Cheng contributed equally to this study and should be regarded as the co-first authors.

Funding

This research was financially supported for publication. This work was supported by National Natural Science Foundation of China (grant number 72304060 to QY).

Data availability

The datasets generated and analysed during the current study are not publicly available due to paticipant confidentiality but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Sichuan Cancer Hospital under approval number SCCHEC-02-2023-127. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.