Structural Equation Model of Medical Seeking Delay in Elderly Breast Cancer Patients: The Mediating Role of Coping Mechanisms Between Health Literacy and Timeliness of Treatment

Background Breast cancer is a leading cause of cancer‐related mortality among women worldwide. Delays in medical care, particularly among elderly patients, significantly contribute to late‐stage diagnoses and poor outcomes. This study investigates the interplay between health literacy, coping mechanisms, psychological factors, and delays in breast cancer care, focusing on structural barriers and subgroup analyses. Methods This descriptive‐correlational study recruited 300 elderly breast cancer patients (aged 65+) from urban and rural clinics using purposive sampling. Data were collected through validated questionnaires, including the Health Literacy Questionnaire (HLQ), Brief COPE Inventory, Health Anxiety Inventory (HAI), and medical record reviews. Structural equation modeling (SEM) was employed to examine the direct, indirect, and moderating effects of health literacy and coping mechanisms on care delays. Subgroup comparisons were performed based on geographic location, socioeconomic status (SES), and age. Results Higher health literacy was associated with shorter delays ( β = −0.47, p < 0.01), with problem‐focused coping mediating this relationship ( β = −0.36, p < 0.01). Health anxiety and social stigma were significant predictors of diagnostic and patient delays, respectively ( p < 0.01). Rural patients and those with lower SES experienced the most extended delays across all stages of care. The SEM model demonstrated a good fit (CFI = 0.92, RMSEA = 0.06). Conclusion Health literacy, coping mechanisms, and psychological factors significantly influence delays in breast cancer care. Individualized interventions to increase health literacy, reduce stigma, and remove systemic barriers are necessary for early treatment. These findings provide a model for focused, equitable healthcare strategies in underserved populations.