Equitable Access to NHS Health Checks in a Super-Diverse City: Perspectives from Global Majority Communities

Abstract Background The NHS Health Check programme is a national preventive intervention for adults aged 40–74 years in England. Although qualitative studies have identified barriers to uptake, limited evidence examines how barriers accumulate across multiple communities within the same super-diverse service setting while also integrating the perspectives of professionals responsible for delivery. This study explored barriers and facilitators to equitable access in Birmingham. Methods Twenty-two focus group discussions were conducted: 20 with adults from ten community groups and two with healthcare professionals involved in NHS Health Check delivery. The community sample comprised 180 participants aged 35–74 years, including 153 adults eligible for NHS Health Checks and 27 adults aged 35–39 who were approaching eligibility; 13 healthcare professionals also participated (193 participants overall). A hybrid deductive–inductive Framework Analysis compared accounts across community, age, gender and service-delivery perspectives. Levesque et al.’s access framework was applied after theme development as an interpretive lens rather than as an a priori coding template. Reporting was informed by COREQ. Results Among the 153 eligible community participants, 45 self-reported previous NHS Health Check attendance. Five community-facing themes were developed: limited awareness and knowledge; cultural and language barriers in communication; structural and practical challenges to access; attitudes, fears and trust in healthcare; and community-generated facilitators and suggestions. Participants aged 35–39 mainly described uncertainty about eligibility, information needs and anticipated access; their accounts reinforced the overarching themes rather than forming a separate theme. Healthcare professionals described parallel barriers and additional constraints relating to staffing, consultation time, interpreter capacity, digital systems, outreach and follow-up pathways. Conclusions Participant and professional accounts suggest that access in super-diverse urban communities is shaped by interacting informational, cultural, linguistic, structural and trust-related factors. Stakeholder-proposed adaptations, including clearer multilingual communication, trusted outreach, flexible delivery and stronger follow-up, offer priorities for co-design and prospective evaluation; this qualitative study did not test their effectiveness or their effect on population-level inequalities.