Explanatory models of cancer and implications for healthcare-seeking: A qualitative study from an informal settlement in urban Dhaka, Bangladesh

Globally, over 19 million new cancer cases and 10 million deaths occurred in 2020, with 70% reported from low- and middle-income countries such as Bangladesh. Understanding community perceptions regarding cancer, including its Explanatory Model (EM), is essential for developing effective prevention and early detection strategies. This study explored the EM of cancer and its influence on healthcare-seeking behaviour among adults living in the Korail slum in Dhaka during October 2023 - January 2024. Fourteen in-depth interviews and two focus group discussions were conducted with a total of 26 participants (13 women and 13 men) aged 18-66 years, selected purposively to ensure diversity in age, gender, and occupation. Data were collected using semi-structured guides on perceptions and healthcare-seeking behavior related to cancer. Interviews were transcribed, coded, and analyzed thematically using inductive and deductive approaches guided by Kleinmans Explanatory Model framework. Three major themes emerged. First, cancer was perceived as fatal, incurable, and often divinely predetermined. Participants attributed it to fate, moral wrongdoing, food adulteration, pollution, and unhealthy habits such as smoking or betel nut use. Second, gendered and moralized beliefs shaped understandings of cancer causation, where womens reproductive functions and menstrual or sexual practices were viewed as risks, while mens substance use was associated with masculinity. These perceptions reinforced gendered blame and stigma. Third, although participants were aware of nearby cancer facilities, care-seeking was often delayed due to misconceptions, fatalistic beliefs, distrust in healthcare providers, financial hardship, and lack of awareness or health education. Community EMs strongly influence cancer-related perceptions and health-seeking in urban poor settings. Customized, culturally grounded awareness and screening initiatives are essential to dispel misconceptions and improve early diagnosis. The findings offer critical insights for designing community-based cancer prevention strategies in similar low-income urban contexts.