Research question #2: What prolongs the help-seeking interval (i.e., time from perceiving a need for medical evaluation to first consultation)?

Theme 6: Most young adults did not experience delays within the help-seeking interval, but some delayed contacting a provider because they lacked health care access or had low confidence in healthcare. The majority of participants had the resources (e.g., insurance and a routine provider, e.g., primary care or OBGYN) to arrange a timely appointment once they perceived a need for medical consult. Several of these young adults described high self-efficacy for navigating the health system and access to social support as primary drivers of their prompt arranging of medical evaluation: “And like, as a 20-year-old I had scheduled [an appointment] by myself and had a friend take me. And so I had a lot of confidence about that.” [Participant 25, diagnosed at 27, ovarian cancer] Young adults without a routine provider sometimes sought timely medical care once perceiving a need; however, they typically presented directly to an emergency room or urgent care provider: “I had started to become a frequent flyer at an urgent care clinic.” [Participant 3, diagnosed at 25, leukemia].

Young adults who delayed contacting a provider often did not have adequate health care access and support for attending the appointment:I should note that when the lump started showing up, I did not have health insurance. Not having health insurance, and with life being everything that it was, I was just like, I can’t even be bothered with this._ [Participant 11, diagnosed at 37, melanoma]_

Some had recently moved for work, school, or relationships and had not yet established primary care, while others were unable to miss work, such as one who was experiencing increasingly severe symptoms:I had an intractable fever and chills, was not responding to Tylenol, was becoming more short of breath, and having more chest pain. But I did not want to go to the hospital because I just thought I was sick, and I couldn’t miss more work._ [Participant 1, diagnosed at 35, leukemia]_

Others described negative past healthcare experiences that instilled low confidence in medical care. One participant was hesitant to seek help because growing up in poverty and using Medicaid often led to feeling dismissed by doctors: “I did have those experiences with doctors not taking me very seriously, because I was poor and not worth their time,” [Participant 22, diagnosed at 32, breast cancer] Another avoided care because they felt every doctor attributed all symptoms to their weight status: “My experience had been—every time that I would go to a new doctor or try a new doctor, everything would come back to my weight.” [Participant 15, diagnosed at 32, uterine] One participant thought the risk of a dismissive encounter, like they had experienced previously, did not justify the financial cost of care: “If there’s a chance I’m going to be told it’s anxiety, why would I bother with a co-pay to be told this?” [Participant 5, diagnosed at 20, sarcoma].