Ethnic disparities in awareness, engagement and acceptance of NHS health checks: a community-led participatory study in Birmingham, UK

Introduction
Cardiovascular disease (CVD) remains the leading cause of mortality globally and in the United Kingdom (UK), with disproportionate burdens among Global Majority and migrant populations. Despite the introduction of the National Health Service (NHS) Health Check programme to support early detection and prevention of CVD among adults aged 40–74, uptake remains uneven, particularly among those from the Global Majority heritage. This study aimed to explore how diverse ethnic communities in Birmingham, UK perceive, engage with and access NHS Health Checks.

Methods
Using a community-based participatory action research (PAR) approach, we partnered with ten local community organisations to co-design, co-facilitate and interpret focus groups on NHS Health Checks. Twenty-two focus groups were conducted with 180 participants across ten global majority communities (Arab, Bangladeshi, Black Caribbean, Chinese, Ghanaian, Indian, Nigerian, Pakistani, Somali and White British). Data were analysed inductively using NVivo 12, supported by sensitising concepts related to awareness, access, engagement and cultural relevance.

Results
Five major themes were identified: (1) Awareness and Understanding, characterised by confusion about the purpose of Health Checks and low awareness in several communities; (2) Cultural and Linguistic Barriers, including English-only communication, gender norms and culturally embedded reactive health behaviours; (3) Uptake Variations by Ethnicity, demonstrating substantial intra-ethnic and gender differences; (4) Trust and Previous Experiences, where both negative and respectful encounters shaped willingness to engage; and (5) Structural Access Barriers, including inconvenient appointment times, complex booking systems and limited community-based provision.

Discussion and conclusion
NHS Health Check uptake disparities reflect intersecting cultural, linguistic, experiential and structural influences rather than individual reluctance. Findings highlight the need for culturally tailored communication, gender-sensitive delivery, community-based models and improved ethnicity data granularity.