Tackling Inequalities in Preventive Healthcare Access: NHS Health Check Provider Perspectives on Cultural Competence, Capacity and Follow-Up Pathways in a Super-Diverse City

Background/Objectives: Healthcare inequalities remain a persistent challenge for preventive health systems, particularly where culturally diverse and socioeconomically disadvantaged communities experience barriers to timely, acceptable and meaningful care. The NHS Health Check programme in England aims to identify and reduce the risk of cardiovascular disease, type 2 diabetes, stroke, kidney disease and dementia among adults aged 40–74 years. However, uptake remains uneven across population groups, raising questions about how preventive services can be delivered more equitably. While community perspectives are essential, healthcare service providers offer important frontline insights into the organisational, cultural and operational barriers that shape access. This study explored NHS Health Check providers’ perspectives on barriers to equitable engagement and practical solutions for improving access to preventive care in Birmingham, United Kingdom. Methods: This qualitative study drew on two focus group discussions with 13 NHS Health Check professionals, nested within a wider community-based participatory project involving 193 participants across Birmingham. Professionals included general practitioners, nurses and practice managers involved in NHS Health Check delivery. Data, in the form of transcribed audio recordings and facilitator reports of the discussions, were analysed using Framework Analysis with hybrid deductive and inductive coding, informed by pre-specified domains including delivery processes, cultural relevance, communication, access, follow-up and service improvement. Results: Providers identified seven interrelated challenges: limited patient awareness and preventive health literacy; cultural and psychological barriers, including fear, mistrust and stigma; language barriers and limited interpreter availability; inflexible delivery models and appointment systems; variable community engagement; workforce and resource constraints; and weak follow-up pathways after risk assessment. Providers emphasised that improving access requires more than increasing invitations. Practical solutions included culturally tailored communication, community partnerships, use of trusted faith and community leaders, flexible appointment models, stronger language support, provider training in cultural competence, and structured follow-up pathways linking risk assessment to behaviour change support. Conclusions: Provider perspectives show that inequalities in NHS Health Check engagement are produced not only by patient-level factors but also by service design, communication systems, workforce capacity and follow-up infrastructure. Tackling inequalities in preventive healthcare requires culturally responsive, relational and community-embedded models of delivery, supported by sufficient workforce capacity and continuity of care after screening.