Table 3 Integration of factors related to help-seeking in rural areas

Barriers

Intrapersonal

Age

・Age > 63 years; dismissive of problems [29]

・People aged < 18 or > 50 years refrain from help-seeking [34]

Low educational level

・Low educational level [29, 30]

Difficult financial conditions

・Financial burden [23, 25, 28, 32, 34, 35]

Minority

・Feeling that their race, language, or culture will not be understood by doctors [23, 35]

Fatalism

・Thinking that they will not survive if it is their fate to develop cancer [25, 28, 32]

Self-reliance

・Self-medication [23]

・Trying to control cancer by themselves [26, 29, 34]

・Stoicism [31]

Symptom appraisal

・Dismissive of problems/optimism [27, 29, 31]

・Symptoms not linked to cancer [26]

A lack of knowledge

/awareness

・Inadequate awareness of cancer and its symptoms [28, 30, 32, 33]

・Did not perceive any benefits of cancer screening or diagnosis [35]

Fear

・Fear of tests and treatments [28, 31]

・Fear of the financial burden of screenings and treatments [32, 34]

Habits related to health services

・Not accustomed to visiting the hospital [34]

Interpersonal

A lack of understanding from family members

・Cannot seek help without family members’ permission [23, 25, 28]

・Family not supportive, even after developing cancer [25]

Influence of surrounding people

・Having a family member who could not be saved [35]

・Family with a long history of not availing medical services [34]

Role obligations

・Roles in the family and other role obligations [23, 25, 26, 31, 34]

Unreliable experts

・A lack of trust in doctors or caregivers [28, 29, 34]

・Having had an unpleasant experience with a doctor [28]

Groups/ cultures/ organizations

Prejudice/social stigma

・Community prejudice/social stigma against cancer [25, 28, 32]

Shame

・Shame and timidity towards sex organs [25, 26, 31, 35]

Lack of anonymity

・Lack of confidentiality due to strong community ties [34]

Social norms

・Villagers not wanting to let women leave the village [28]

・Machismo [31, 35]

policy/ environment

Lack of medical services

・There is no specialized hospital in the area that can provide treatment [26, 28, 34, 35]

・There are no doctors, laboratories, or pharmacies in their area of residence [28, 34]

・There is no place to obtain information on treatment or screenings [35]

Physical distance from medical institutions

・Medical institutions are located far away [28, 34]

・Insufficient means of transportation to the hospital [34]

Time burden

・It takes time to seek help and receive test results [26, 34]

・Long waiting time to be attended to by specialists [26, 32]

Facilitators

Intra

personal

Presentation of symptoms

・Presentation of symptoms such as pain [26, 31, 32]

Inter

personal

Understanding from surrounding people

・Support from neighbors, family members, and healthcare professionals [32]

・Told by people around that it was cancer [26, 35]