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 [36,37,38].
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.