Intersections of identity and multilevel social determinants of health in Hong Kong: a participatory qualitative study of health inequities among Pakistani women

Abstract Background Health inequities among ethnic minority and migrant women remain underexamined in non‑Western contexts. In Hong Kong (HK), South Asian communities are often treated as a homogeneous group in research and policy, obscuring within-group differences. Pakistani women, in particular, experience intersecting social and structural disadvantages and bear disproportionate health burdens yet remain largely invisible in the health literature. This study uses an intersectionality-informed Community‑Based Participatory Action Research (CBPAR) approach to (1) explore how intersecting identities and multilevel social determinants of health (SDOH) shape health inequities among Pakistani women in HK across family, community, institutional, and structural contexts; and (2) document the CBPAR methods for equitable engagement with Pakistani women. Methods Pakistani women were engaged as equal partners across a two-year CBPAR process. This paper reports on the Listening phase — initial focus group discussions (FGDs) designed as safe communicative spaces. FGDs were conducted face-to-face, in English/Urdu, with 72 self-identified Pakistani women (12 groups; 5–8 per group) recruited through multiple channels using maximum variation and snowball sampling. Data was analyzed using an intersectionality-informed thematic analysis approach, with ongoing feedback from community partners throughout the research process. Results Findings revealed that gender, marital status, migration, education, income, language, religion and ethnic minority status intersect with SDOH at individual, community, institutional, and structural levels to produce health inequities in Pakistani women’s healthcare access and well-being. Five interconnected themes illustrate these mechanisms (1) gendered expectations of care in the context of migration; (2) housing, social isolation, and community support; (3) health communication inequities and unmet healthcare needs; (4) inequalities in education and employment opportunities; and (5) the COVID-19 pandemic, racialization, and the deepening of health insecurities. Conclusions Integrating CBPAR with intersectionality helps advance a more just and inclusive framework for health equity research with Pakistani women in HK. Addressing inequities requires direct community engagement, disaggregated data and monitoring, a multilevel approach with tailored community‑driven interventions, and structural policy reforms across education, employment, and the health system. While grounded in Pakistani women’s experiences, this framework offers guidance and can be adapted for equity efforts with other ethnic minority and migrant women in HK and analogous contexts.