Determinants of Delay in Seeking Care among women presenting with Advanced-stage cervical cancer in northwest Ethiopia, a mixed-methods study

Background Cervical cancer is largely preventable disease through HPV vaccination, regular screening, and early intervention. However, woman with advanced stage cervical cancer presentation remains high in resource limited settings including Ethiopia that contributing to high morbidity and mortality. Identifying the determinants associated with delays in seeking care is critical for targeted interventions. Objective To identify determinants of delays in seeking care among women presenting with advanced-stage cervical cancer at oncology center in Northwest Ethiopia. Method A facility-based concurrent mixed-methods study was conducted from April 22 to June 15, 2024, at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). A total of 397 women (99 cases with advanced-stage cervical cancer and 298 controls with early-stage disease) were enrolled using consecutive sampling. Quantitative data were collected using pretested semi-structured questionnaires and chart review, analyzed using STATA v17. Variables with p < 0.25 in bi-variable analysis were included in multivariable logistic regression with significance set at p < 0.05. While qualitative data were obtained via in-depth and key informant interviews, analyzed thematically and triangulated with quantitative findings. Result The mean age of participants was 46.5 ± 10.3 years. Most cases were rural residents (84.8%), had low income (< 5000 ETB; 69.7%), and large family sizes (> 4 members; 60.6%). Significant determinants of delayed care included rural residence (AOR: 3.54, 95% CI: 1.60–12.91), low income (AOR: 2.38, 95% CI: 3.62–13.31), family size > 4 (AOR: 2.30, 95% CI: 1.03–5.13), lack of family support (AOR: 4.59, 95% CI: 2.52–8.36), misdiagnosis or inappropriate treatment (AOR: 3.31, 95% CI: 1.68–6.53), and referral delays (AOR: 2.37, 95% CI: 2.07–7.61). Qualitative data highlighted poor awareness, financial constraints, heavy home responsibilities, and misdiagnosis as key contributors to delayed care. Conclusion Delays in seeking care among women with advanced-stage cervical cancer are influenced by both patient-related (rural residence, low income, large family size, lack of family support, poor awareness) and health system-related factors (misdiagnosis and referral delays). Interventions should focus on expanding oncology services, improving health insurance coverage, training healthcare providers and implementing community awareness programs to promote early diagnosis and treatment. Trial registration Not applicable. This was an observational mixedmethods study.