Background: Breast cancer is the most commonly diagnosed cancer among women in China, particularly in low-resource settings where access to screening is limited. 
Methods:
We conducted semi-structured qualitative interviews with women aged 35-64 (n=17) from four low-resource areas in Sichuan, Yunnan, and Shanxi provinces using a purposive sampling strategy to ensure variation in screening status and socio-demographic backgrounds. Interviews were guided by the Health Belief Model (HBM), and data were analyzed thematically using a hybrid deductive–inductive approach aligned with HBM constructs. Data collection continued until thematic saturation.
Results:
Thematic analysis revealed three main findings:(1) digital information platforms served as the primary entry point for breast cancer-related knowledge, yet access to accurate screening information was highly uneven and shaped by prior health engagement and algorithmic exposure, leading to the invisibility of screening cues among less digitally engaged women; (2) women’s cognitive appraisals and emotional responses conditioned how information was interpreted and whether screening was perceived as personally relevant; and (3) family networks, local health providers, and structural constraints in daily life jointly influenced women’s ability to act on screening intentions, particularly among non-participants.
Conclusion:
Breast cancer screening engagement among rural women is an evolving and situated process shaped by everyday information environments and lived conditions. Rather than responding directly to screening messages, women’s awareness and participation emerge through ongoing interactions between digital media exposure, personal interpretation, social relationships, and practical life demands. The findings point to the value of approaches that combine trusted interpersonal engagement, such as family members and primary-level health workers, with digitally delivered, professionally authoritative information to support more flexible and context-sensitive pathways to screening participation beyond existing algorithmic echo chambers.