Gendered Patterns of Engagement With NHS Health Checks in a Super-Diverse City: Community Perspectives and Implications for Equity.

Background: NHS Health Checks are a national preventive programme in England designed to reduce cardiovascular disease and related long-term conditions, yet uptake remains uneven. Gender differences persist, with men, particularly from racially marginalised and socioeconomically deprived communities, engaging less with preventive services, potentially reinforcing health inequalities. Methods: A qualitative community-based participatory study was conducted in Birmingham using focus groups across 10 community organisations, alongside discussions with NHS Health Check professionals. Data were analysed using framework analysis, with attention to gendered and intersectional influences on engagement. Results: Women generally reported higher participation than men, although patterns varied across communities. Men's lower engagement was commonly attributed to inflexible employment, perceived low relevance of preventive care and limited trust in services. Women's engagement was shaped by childcare responsibilities, gender concordance of staff and cultural acceptability. Across genders, participants highlighted communication gaps, limited follow-up and structural barriers within service delivery. Conclusion: Gendered inequalities in NHS Health Check engagement reflect intersecting social, cultural and systemic factors. Addressing these requires gender-responsive, culturally competent delivery models, flexible access arrangements and strengthened community partnerships to promote equitable uptake of preventive care. These findings inform policy, commissioning and practice aimed at reducing gendered inequalities in prevention services.