Objective To analyze the learning attitude and influencing factors of struggling medical students from order-delivery package program for rural areas, so as to provide basis for effective academic early warning education . Methods The semi-structured interview method was used. By purposive sampling, the interviews were conducted with 21 struggling students from order-delivery package program for rural areas in Guangxi Medical University from October to November 2021. After the interview, thematic analysis method was used to analyze the textual data. Results Three major themes and ten sub-themes were extracted, including learning attitude of these struggling students (the quitter, the daydreamer, the wanderer, the gambler), of which the proportion of quitters ranked first [9(42.9%)]; factors affecting academic performance (lack of learning motivation and its source, lack of learning methods, and vulnerability to classmates and environment), among which, lack of learning motivation and its source accounted for [13(61.9%)]; and strategies for improving academic performance (formulating goals and plans, putting into practice, and carrying out paired learning of which [15(71.4%)] believe that paired learning can improve the quiz performance at this stage. Conclusions Among the struggling medical students, the quitters accounts for a large proportion. The lack of learning motivation and its source is the main factor affecting academic performance. Paired learning is an effective strategy to improve academic performance in the short term. Educators in medical colleges and universities should help these struggling students to cultivate a sense of life goals, provide ways to explore the source of learning motivation, and innovate paired learning methods.