Women’s experiences toward cervical cancer care at the initiation of care: a qualitative study closing the gap policy and implementation in Indonesia

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INTRODUCTION: Cervical cancer remains a major public health concern in Indonesia despite ongoing national efforts toward elimination. While policy initiatives have expanded screening and treatment services, limited evidence exists regarding women's lived experiences during the early stage of cervical cancer care. Understanding women's perspectives is essential to strengthening a national care strategy. OBJECTIVE: To explore women's experiences during the early stage of cervical cancer care in Indonesia, from symptom recognition and abnormal screening results to diagnosis and initiation of treatment. METHODS: A qualitative descriptive study was conducted in a national tertiary referral center in West Java, Indonesia. Eighteen women diagnosed with cervical cancer were recruited using purposive sampling to capture diverse clinical and experiential backgrounds. Data were collected through in-depth, semi-structured interviews between August and October 2025. Interviews were transcribed verbatim and analyzed using Braun and Clarke's thematic analysis framework. Trustworthiness was ensured through member checking, audit trails, and collaborative theme validation. RESULTS: Three themes emerged: (1) women's experiences in accessing care services, (2) difficulties and coping mechanisms, and (3) unmet informational and psychosocial needs. Participants described normalization of early symptoms, misinterpretation at primary care level, fragmented referrals, and inconsistent staging information, contributing to diagnostic uncertainty and emotional distress. Although national health financing covered treatment costs, indirect financial burdens persisted. Women actively sought simplified explanations through digital platforms to compensate for communication gaps. Many entered treatment with limited preparation and inadequate counseling regarding side effects. CONCLUSION: Initiation of care represents a critical bottleneck within Indonesia's cervical cancer elimination efforts. Strengthening early clinical recognition by healthcare providers, referral continuity, structured counseling, early palliative care integration, and digital navigation systems is essential to bridge the policy-implementation gap and support achievement of the WHO cervical cancer elimination target of treating 90% of women diagnosed with cervical disease.

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