Structural factors shaping health-seeking behaviour among breast cancer survivors in the Gaza Strip: A qualitative study utilising the right to health framework

This paper aims to analyse the enabling and disabling factors for health-seeking behaviour among Palestinian breast cancer survivors in the Gaza Strip. Specifically, it investigates how the availability of and accessibility to healthcare services influence health-seeking behaviour during the detection and treatment stages. The core components of the Right to Health-accessibility, availability, acceptability, and quality serve as the theoretical framework for this study. Data were gathered through forty semi-structured interviews, predominantly with breast cancer survivors (38 participants). The collection of this data occurred between September 2020 and April 2021. These interviews were analysed using a framework analysis approach. The study's findings reveal that a portion of the participants were initially reluctant to seek healthcare before their diagnosis as they perceived more barriers than threats, combined with other priorities of family and work stepping in and due to lack of clear guidance and information on the starting point and overall procedures. However, following the confirmed diagnosis, there was a solid sense of determination among the participants to obtain necessary care, whether within Gaza or elsewhere, due to the perceived threat to life. The engagement in post-treatment follow-up was strongly affected by existing barriers again, such as the economic status of each individual. It was frequently driven by peer and family support, mainly through guidance and financial assistance, which played a crucial role in bridging affordability gaps and addressing limited access to information on specific services. The results indicate that participants actively sought healthcare once a life-threatening diagnosis was confirmed. However, barriers to the Right to Health components significantly influenced their health-seeking behaviour both before diagnosis and during post-treatment periods. These findings highlight the crucial impact of socioeconomic and health system-related factors such as accessibility and availability of health services on the health-seeking behaviour of patients in Gaza.