Background <p>Long-acting injectable antipsychotics (LAIs) have proven more effective for treating patients with schizophrenia than oral formulations. However, the use of LAIs in China remains low and this phenomenon is still under-researched. This study endeavors to provide a better understanding by systematically amalgamating the difficulties and barriers encountered by patients with schizophrenia in China when accessing LAIs from a process-oriented perspective, thereby making a significant contribution to filling the critical void in the existing literature.</p> Methods <p>Schizophrenia patients receiving rehabilitation services at community mental health rehabilitation centres in Guangzhou, China, were sampled using a convenience sampling method. Semi-structured qualitative interviews were conducted to explore participants’ attitudes and experiences with LAIs treatment, and data were coded and analysed using thematic analysis.</p> Results <p>Between December 18, 2023, and April 23, 2024, 88 participants were recruited, including 33 patients, 33 primary caregivers, 11 community psychiatric management physicians (CPMPs), and 11 psychiatrists. Four major themes emerged from the study: (1) poorly coordinated organisational structures; (2) negative perceptions of patients regarding LAIs; (3) cautious and concern-ridden enrolment decisions; (4) unclear medication side effects. Serving as the foundation of the entire process, the poorly coordinated organisational structures described in Theme 1 provide the context for subsequent themes, which further identify specific process barriers that complicate access to LAIs.</p> Conclusions <p>This study explores barriers to LAIs treatment for schizophrenia from a process-oriented perspective, incorporating stakeholder attitudes and providing empirical evidence for clinical practice and policy improvement.</p> Clinical trial number <p>Not applicable.</p>