Abstract: Objective To explore the factors influencing treatment adherence in Tibetan patients with liver cirrhosis, analyze the unique interaction mechanisms among culture, traditional customs, and healthcare in Tibet based on the Health Belief Model (HBM), and provide evidence for developing culturally adapted intervention strategies. Methods Using purposive sampling, 15 Tibetan patients with liver cirrhosis hospitalized at Xizang Autonomous Region People's Hospital from January 2024 to January 2025 were enrolled. Semi-structured interviews were conducted using an interview guide designed around the six core dimensions of the HBM. All interviews were audio-recorded and transcribed by researchers proficient in both Tibetan and Chinese; two researchers coded independently and inter-coder consistency was assessed. Data were analyzed using Colaizzi’s phenomenological analysis. Results The interview data were organized into nine themes across three levels: modifying factors (knowledge about liver cirrhosis, illness experiences, and characteristics of healthcare institutions), personal beliefs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy, corresponding one-to-one to the five belief constructs of the HBM), and cues to action (opportunities to improve adherence). Patients exhibited a "knowledge-experience gap" in disease cognition, where personally experiencing complications served as the key trigger for adherence behavior. Family support acted as a double-edged sword, promoting adherence while potentially exacerbating psychological burden, leading to "altruistic non-adherence." A subset of respondents demonstrated that synergy between traditional cultural authority and medical authority enhanced the perceived legitimacy of medical advice, thereby strengthening patients’ willingness to adhere. Conclusion Treatment adherence in Tibetan patients with liver cirrhosis is profoundly influenced by cultural factors, traditional customs, and family dynamics. Future interventions should focus on developing visualized health education approaches, optimizing family support guidance mechanisms, and integrating cultural resources to improve treatment adherence in this population.