Patient personas of delayed healthcare-seeking behavior among patients with breast cancer-related lymphedema: A qualitative study

Objective: This study aimed to explore the heterogeneity of delayed healthcare-seeking behaviors among patients with breast cancer-related lymphedema (BCRL) and to develop patient personas that elucidate distinct barriers and care needs. Methods: A qualitative descriptive study was conducted using purposive sampling with maximum variation. Patients with BCRL were recruited from a tertiary hospital lymphedema clinic in mainland China between March and May 2025. Semi-structured interviews explored patients' experiences from symptom onset to health care seeking. Data were analyzed using content analysis with NVivo 20 to generate themes and construct personas based on key dimensions, including patient characteristics, behavioral patterns, and care needs. Results: Seventeen patients with BCRL participated in the study. Three distinct personas of delayed healthcare-seeking behavior were identified: (1) Unaware-Inattentive, characterized by limited symptom awareness and low health literacy; (2) Avoidant-Denial, characterized by symptom recognition but delayed action due to denial, minimization, or optimistic bias; and (3) Resource-Constrained, characterized by willingness to seek care but impeded by financial, geographic, or healthcare access barriers. These personas demonstrated distinct cognitive, emotional, and behavioral profiles, underscoring the need for tailored intervention strategies. Conclusions: Delayed healthcare-seeking behavior in patients with BCRL is a heterogeneous and multifactorial process shaped by cognitive, psychological, and structural barriers. Persona-based approaches offer a practical framework for designing targeted nursing interventions to may support long-term self-anagement.