Background/Objectives:Breast and cervical cancer screening programs are essential for early detection and timely treatment, yet participation rates remain suboptimal. Within a patient-centered care approach, engagement is increasingly viewed as a dynamic and emotionally grounded process. The literature conceptualizes three phases of engagement in healthcare decision-making: ‘recruit’, ‘retain’, and ‘sustain’. When these phases intersect with the structured pathway of cancer screening, they generate specific meaning-making challenges that shape how women relate to prevention and care. This study adopts the lens of Iterative Situated Engagement (ISE) to explore how women experience and negotiate these challenges, differentiating them across the three engagement phases.Methods: A theory-driven qualitative design was adopted. Data were collected through semi-structured interviews with 40 women aged 25–69 years participating in public breast and cervical cancer screening programs. Thematic analysis was conducted using the Framework Method.Results: In the ‘recruit’ phase, engagement was driven by Cancer Risk Monitoring, Self-care Motivation, Fear of Death Management, and Coincidence. The ‘retain’ phase emphasized Trust in Healthcare Providers, Accessibility of Services, Recurrent Invitations, and Informal Result Previews. About the ‘sustain’ phase, Continuity of Healthcare Providers, Driving Best Practices Dissemination, Flexible Organization of Healthcare Services, and Shorter Waiting Times for Results were highlighted as key factors in maintaining engagement over time.Conclusions: Women’s engagement in cancer screening emerges as a dynamic, multi-phase process shaped by psychological, emotional, and organizational levels. These findings contribute to the development of the ISE conceptual proposal, which frames participation as an iterative, situated, and meaning-making trajectory. Strengthening personalized health communication and improving the coordination of primary care services could enhance sustained participation in screening programs, supporting strategies to reduce health disparities and promote preventive practices.
**背景/目的：** 乳腺癌和宫颈癌筛查项目对早期发现和及时治疗至关重要，但参与率仍不理想。在以患者为中心的医疗模式中，参与日益被视为一个动态且基于情感的过程。文献将医疗决策中的参与划分为三个阶段：“招募”、“维持”和“持续”。当这些阶段与癌症筛查的结构化路径相交时，会产生特定的意义建构挑战，从而影响女性对预防和护理的态度。本研究采用“迭代情境参与”视角，探讨女性如何经历并应对这些挑战，并区分其在三个参与阶段中的差异。 **方法：** 采用理论驱动的质性研究设计。通过对40名参与公共乳腺癌和宫颈癌筛查项目的25-69岁女性进行半结构化访谈收集数据，并运用框架法进行主题分析。 **结果：** 在“招募”阶段，参与主要由癌症风险监测、自我保健动机、死亡恐惧管理和偶然因素驱动。“维持”阶段则强调对医疗提供者的信任、服务的可及性、定期邀请以及非正式结果预知。在“持续”阶段，医疗提供者的连续性、最佳实践推广的推动、医疗服务的灵活组织以及缩短结果等待时间，被认为是长期保持参与的关键因素。 **结论：** 女性对癌症筛查的参与是一个动态、多阶段的过程，受心理、情感和组织层面的共同影响。这些发现有助于发展“迭代情境参与”概念框架，将参与视为一种迭代的、情境化的、具有意义建构特征的轨迹。加强个性化健康沟通并改善初级保健服务的协调性，可提升筛查项目的长期参与度，从而支持减少健康差异和促进预防实践的策略。
Iterative Situated Engagement Perspective: Meaning-Making Challenges Across Cancer Screening Phases
肿瘤(癌症)患者之家