Developing a Theoretical Model of Cancer Health-Seeking Behaviour Delay in Nigeria: Mixed Methods Evidence from Five Geopolitical Zones

Late-stage cancer presentation is the dominant driver of poor survival outcomes in Nigeria, yet the theoretical understanding of the psychological, social, and structural mechanisms producing patient-level diagnostic delay remains underdeveloped in the African context. Existing Western models such as the Model of Pathways to Treatment inadequately account for the cultural, spiritual, and structural dimensions of Nigerian illness behaviour. This study develops and empirically tests an original theoretical model of cancer health-seeking behaviour delay using mixed methods evidence from five geopolitical zones (South East, South West, South South, North Central, and North East). The qualitative strand comprises 150 in-depth interviews with late-stage cancer patients (lung, cervical, prostate, colorectal, and breast) and their caregivers, interpreted through Constructivist Grounded Theory to generate the theoretical model. The quantitative validation strand applies a cross-sectional survey of 800 cancer patients using a theoretically derived instrument to test model fit through structural equation modelling in AMOS. Cultural health beliefs, spiritual attribution, prior traditional healer engagement, symptom normalisation, financial catastrophe avoidance, and gender dynamics are examined as structural model components. The original theoretical contribution is the Nigerian Cancer Health-Seeking Delay Model, the first empirically grounded and formally tested theory of diagnostic delay calibrated to Nigerian sociocultural contexts. Findings will support the Federal Ministry of Health's National Cancer Control Plan in targeting patient delay reduction strategies. Keywords: cancer, health-seeking delay, theoretical model, Nigeria, mixed methods.