Barriers and facilitators to accessing preventive services for chronic diseases among people from South Asian backgrounds living in Sydney

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While preventive services are essential, these population groups demonstrated limited access to existing preventive services in Australia. The present study explored the barriers and facilitators to accessing preventive care services among people from Bangladeshi and Nepalese origins living in Sydney, Australia. Methods This qualitative study was conducted following the constructivist paradigm, where realities are constructed on the lived experiences of the participants. Six focus group discussions (FGDs) and 22 in-depth interviews (IDIs) were conducted during August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney. FGDs and IDIs were conducted in participants’ language, transcribed, translated into English, and thematically analysed. The barriers and facilitators at different levels were structured following the socio-ecological framework. Results Several barriers and facilitators were identified across different levels of the socioecological framework. Individual-level barriers included cultural and religious perceptions, limited health literacy, and a lack of awareness of preventive services. Interpersonal barriers included limited English language skills, a lack of translated health education materials and interpreter services and limited cultural understanding among health service providers. Community-level barriers involved chronic disease-related stigma and lack of community engagement. Institutional and policy barriers included limited culturally tailored support and infrequent public transport to health facilities. Conversely, facilitators included self-awareness and ownership of health, knowledge about available preventive services, peer support, cultural and linguistic competency of health care providers, use of digital and social media for health information sharing, and the role of community organisations. Conclusion These findings suggest implementing multi-level, culturally tailored, community-led interventions leveraging community and social engagement platforms to ensure adequate access to available preventive services for chronic diseases among these disadvantaged population groups in Australia. Preventive Medicine Barriers facilitators chronic diseases preventive care services people from Bangladeshi and Nepalese origin Australia Figures Figure 1 1 Introduction Chronic diseases, such as arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and mental health conditions are the leading cause of illness, disability, and deaths in Australia 1 . According to the Australian Institute of Health and Welfare, 38% of Australians had two or more chronic diseases, and 90% deaths were attributed to chronic conditions in 2022 1 . Particularly, one quarter of the Australian population, who speak a language other than English at home, also known as people from culturally and linguistically diverse (CALD) backgrounds, experience a disproportionate burden to chronic diseases 2 . Individuals of South Asian origin are one of the fastest-growing CALD population groups comprising around 14.2% of the total overseas migrants in Australia 3 . Alike people from other CALD communities, individuals from South Asian backgrounds have a disproportionate burden to several chronic diseases 2 . For example, a recent study reported a high prevalence of diabetes (21%), heart disease (12%), and depression (22%) among people from South Asian backgrounds living in Australia 4 . Among the broader South Asian migrants, Bangladeshi and Nepalese are two rapidly growing communities in Australia 2 , who are experiencing a higher burden of chronic diseases 2 . Recent research reported a high prevalence of diabetes and heart disease in the Bangladesh-born (12% and 4.6% respectively) and Nepalese origin (6.2% and 1.8% respectively) Australians 2 . In these realities, prevention is crucial to reduce incidence and chronic disease-related death, ill health, and disability 5 . The prevention of chronic diseases includes regular health check-ups, screening programs for early detection of chronic diseases e.g. cancer, diabetes, health promotion activities e.g. health education sessions, promotion of a healthy diet, and physical activity 5 . In Australia, to reduce the burden of chronic disease, the ‘National Strategic Framework for Chronic Disease’ for prevention, management, and treatment of chronic disease has been undertaken 6 . Other initiatives to support the prevention of chronic disease at the national level include the Medicare Benefits Schedule (MBS), the National Diabetes Services Scheme, support program for Aboriginal and Torres Strait Islander peoples with chronic conditions, including the Indigenous Australians’ Health Program 6 . A range of robust programs targeting prevention and management of chronic diseases are available, e.g. early detection program for cancer and diabetes screening, lifestyle modification program 6 – 8 . There is also a dedicated information and support system to manage chronic disease e.g. health-direct helpline, Cancer Learning, Better Health Channel and condition-specific support groups 7 , 8 . Despite the high prevalence of chronic diseases and availability of preventive care services, multiple studies reported a low health care utilisation in South Asian migrants due to several social, cultural, and institutional factors 3 , 9 . Language barriers and communication challenges, difficulties in adapting to a new culture, limited health literacy, and the complexity of navigating healthcare system all impact their access to healthcare services 2 , 3 , 9 – 12 . Moreover, socio-cultural practices, traditions and beliefs of health and well-being also shape the healthcare utilisation of South Asian migrants 13 . Previous research conducted on South Asian migrants in Australia has focused on exploring broader health care access and utilisation 3 , 4 , 9 , 10 , 14 . However, there is a paucity of evidence that particularly focuses on the barriers and facilitators to access preventive care services for chronic diseases among the people of Bangladeshi and Nepalese origin living in Australia, highlighting a significant knowledge gap. Moreover, the existing studies reported limited information on the theoretical grounding of factors associated with healthcare access. The socio-ecological framework is widely used in public health research that enables exploring factors at the health system, organizational, community, and individual levels 15 . The individual level of socio ecological framework focuses on individual knowledge, attitude, self-concept, behaviour and skills. Formal and informal social networks and their information sharing, emotional support and social norms are covered under the interpersonal level of the socio-ecological framework. Organizational (both formal and informal) characteristics and their rules and regulations and their influence on delivery and uptake of health service are discussed in the organizational level. Broader community networks, their relationship, values, norms, and structures and their impact on perceptions and accessibility of services are covered in community level. Finally, impact of policy development, public awareness, advocacy and implementation on accessibility and availability of healthcare services are discussed at policy level 15 . Therefore, the present study aims to identify the barriers and facilitators to accessing preventive care services for chronic disease using the socio-ecological framework 15 among Bangladeshi and Nepalese people living in Sydney, Australia. The study focuses on these two population groups because of their increased migration rate, high chronic disease burden, and their distinct, understudied social-cultural and migration contexts. By investigating both the barriers and facilitators across multiple socioecological levels, this study aims to inform the design of culturally sensitive, accessible, and equitable preventive care interventions and enhance the uptake of preventive care services in these populations. 2 Method 2.1 Study design The study followed a cross-sectional, qualitative research design adopting the constructivist paradigm 16 , 17 , and the information was collected through in-depth interviews (IDIs) and focus group discussions (FGD). The use of qualitative design allowed to capture human phenomena, e.g. experiences, attitudes and behaviours related to accessing preventive care services among the study participants. It further facilitated articulating participants’ thoughts, emotions, and experiences in accessing preventive care services 17 . The utilisation of the constructivist paradigm enabled exploration of the barriers and facilitators to accessing preventive care services, delving into the lived experience of the participants 16 . A phenomenological approach was utilised to understand, describe, and interpret the perceptions of barriers and facilitators to accessing preventive, generated through the individual and collective experiences of the participants 18 . Both IDIs and FGDs were conducted to collect complementary information and to examine complex, context-specific issues, allowing participants to express their experiences freely and flexibly, generating a detailed, nuanced understanding 19 . 2.2 Study setting and participants This study was carried out in the South-Western suburbs of Sydney where majority of the population are from South Asian backgrounds. The study participants were adult people aged 18 years and above from Bangladeshi and Nepalese origin residing in Australia for more than one year. The inclusion criteria also included that the participants are currently living in Sydney. 2.3 Sampling and recruitment The research team maintains an ongoing connection with the community members from various CALD communities, including those of Bangladeshi and Nepalese communities in Sydney, through the Multicultural Health Care Support Group (MHCSG) in Sydney. This support group was established by the research team in early 2025 including community advisors from different CALD population groups of Sydney (i.e., Bangladeshi, Nepalese, Indian) to have an ongoing conversation about their health attributes. Recruitment flyers were disseminated by the community advisors of MHCSG to the broader Bangladeshi and Nepalese communities in Sydney through community gatherings, social media and personal networks. MHCSG advisors shared the contact details of the potential study participants who verbally agreed to participate in the study and gave their consent to share contact details with the research team. Members of the research team (AA, GP), contacted the potential participants and checked their eligibility and sent through the participant information statement and consent form via post or email. A total of 6 FGDs (3 from each population groups) and 22 IDIs (11 from each population groups) to achieve data saturation, which is aligned with similar qualitative research 20 , 21 . Selection of participants also encountered the diversity in terms of age, sex, locality, occupation, and type of residency (temporary/permanent) among the Bangladeshi and Nepalese communities living in Sydney 22 . 2.4 Data collection Data were collected through FGDs and IDIs during August 2024 and January 2025, using relevant guides, developed in English language through an extensive literature review and informal community consultations 14 , 20 , 23 . These underwent multiple revisions based on the feedback of the research team before finalization. The final FGD and IDI guides (Supplementary file 1) covered different aspects on barriers and facilitators to accessing preventive services for chronic diseases. These included participants’ understanding of chronic disease and available preventive services, what participant or their families experienced, and what they observed in communities while accessing preventive services. The final FGD and IDI guides were then translated into Bengali and Nepalese language for data collection. FGDs were conducted before IDIs to identify more broader perspective before capturing specific nuances and FGD participants were excluded from IDIs. All FGDs, each comprising 5–8 participants from the same community, were conducted face-to-face within the locality of the participants such as library premises or community park. The FGDs were facilitated in native language of the participants by two research team members (AA, GP), PhD candidates, experienced in qualitative research and being from Bangladeshi (AA) and Nepalese (GP) origin. Meanwhile, in-language IDIs were conducted by AA and GP over the telephone based on participants’ availability and convenience. Participants received gift vouchers worth $ 40 as a token of appreciation for their time and involvement in the study. 2.5 Data analysis All the FGDs and IDIs were transcribed, translated into English, and thematically analysed using Braun and Clarke’s six-step thematic analysis and allowing for a data-driven identification of themes 24 . We employed a deductive thematic analysis using socio-ecological framework 15 to identify the barriers facilitators to accessing preventive care services for people of Bangladeshi and Nepalese origin living in Sydney and used NVivo (version 14) for management of qualitative data. As a first analytical step, two FGD and three IDI transcripts were thoroughly read by two researchers (AA and GP) to familiarise themselves with the data and to develop an initial coding framework independently. The initial coding frameworks were discussed with the research team for finalization. Contradictions and inconsistencies were resolved through in-depth discussion and mutual agreement amongst the research team members. After the emerging codes and categories were finalised, a coding template was developed for the rest of the transcripts. Two researchers independently coded the data using the coding template and 20% of the transcripts were cross-checked to ensure coding consistency. In the next few steps, codes are collated and grouped them into themes and refined the themes through discussion with team members for better presentations. In the final phase of analysis, all identified themes were systematically organized within the socioecological framework 15 . Notably, no themes were found that extended beyond the boundaries of this framework. 3 Results 3.1 Characteristics of the participants Most of the participants were female (n = 42/63, 66.67%). The average age of participants was 38.8 years, and the average length of time residing in Australia was 10 years. Most of the participants reported being permanent residents and citizens (n = 42, 66.67%), while the rest of the participants reported being on temporary residency status (n = 21, 33.33%). Table 1 outlines a detailed characteristic of the participants. Table 1 Characteristics of the study participants by community Community Variables Interviews FGD Bangladeshi Total number of participants 11 (M-5, F-6) 23 (M-2, F-21) Average age of the participants 39.5 years 43.8 years Average no of years of living in Australia: 9.14 years 8.91 years Residency status: Permanent residency- 7 Temporary residency-4 Permanent residency- 16 Temporary residency-7 Nepalese Total number of participants in interviews: 11 (M-8, F-3) 18 (M-5, F-13) Average age of the participants: 36 years 34 years Average no of years of living in Australia: 11.34 years 11 years Residency status: Permanent residency-6 Temporary residency-5 Permanent residency-13 Temporary residency-5 We summarised the barriers and facilitators in five broad levels: 1) individual, 2) interpersonal, 3) institutional, 4) community, and 5) policy. The broad levels, respective themes and relevant quotes are comprehensively presented in supplementary file 2 and 3, while representative quotes relevant to specific themes are presented within the text for better understanding. Barriers to accessing preventive services for chronic disease 3.2 Individual-level barriers 3.2.1 Cultural and religious perceptions related to chronic disease Participants reported that cultural and religious perceptions of chronic disease impeded their access to preventive care services. Participants expressed cultural and religious beliefs such as that chronic disease is God-given, culture-driven health beliefs and taboos impeded their access to preventive care services. “Especially many of us think that diabetes is God given. I have nothing to do here. But many people don't think that it is a modifiable matter, within a person's control. So, according to religious faith, it is considered pre-destination by all.” (BD-FGD2-P3). 3.2.2 Limited health literacy about chronic disease Limited health literacy about chronic disease was identified as another barrier. Many participants reported being unaware of the definition and types of common chronic diseases. “I googled the chronic disease today at the time of interviewing you. I thought chronic disease meant cancer or something big like that. But I did not know that diabetes or hypertension are chronic diseases.” ( BD-IDI-3). It was noticed by participants that their community people have a little knowledge about their chronic conditions even after they are diagnosed with a chronic disease. “I believe poor health literacy is one of the barriers. Even when people are diagnosed with chronic conditions, they know little about their health problems.” (Nepalese-IDI-2). 3.2.3 Lack of awareness about preventive services Participants reported a lack of awareness about available preventive services as a hindrance to accessing them. Participants mentioned a lack of information about what preventive care services cover and what services are offered by the health system. “No, we have not accessed…. We don’t know what services are available here in Australia or what the government offers.” (Nepalese-IDI-9). 3.2.4 Limited focus to self-care Many participants reported limited focus to self-care as a barrier to accessing preventive services. Prioritizing work, financial instability, pressure of balancing work and personal life, and responsibilities often deters them from prioritizing their health, leading to low engagement in accessing preventive services. “Often, their priorities are focused more on work and financial stability than on health, which leads to low engagement in preventive healthcare.” (Nepalese-FGD2-P1). Many participants pointed that women tend to neglect their health because of their daily caregiving responsibilities for their families. This negligence complemented with their lack of self-confidence and self-care, which deteriorates their physical and mental health, delaying accessing preventive care. “They neglect their health. Women are special. They completely ignore their health. They come here and become so busy with their husband's career, job, and their children's school..…..They do not exist on their own. As a result, various diseases occur. Diabetes is there, along with many other complex chronic diseases. Many also develop mental health-related problems.” (BD-IDI-5). 3.2.5 Fear of impact on visa status Qualitative findings revealed that fear of a negative impact on visa status, including the potential for obtaining permanent residency, appeared to be an important barrier to accessing preventive health care services. “I have seen closely, one of my friends, who didn't have permanent residency at the time, may have felt restricted in accessing healthcare services here.” (Nepalese-FGD2-P3). 3.3 Interpersonal level barriers 3.3.1 Language barrier Limited English language proficiency emerged as one of the significant barriers to accessing preventive care services. Participants reported that language difficulties not only hindered their verbal communication but also access to free-of-cost services. “Even the free-of-cost services that the government offers through community services often go untapped within the Nepali community. Whether knowingly or unknowingly, the language barrier prevents people from fully accessing these services .” (Nepalese-FGD2-P1). Participants also reported that different unfamiliar dialects and accents of health service providers can also hinder people’s ability to undertake preventive care services. “I didn't even understand their accent. Canterbury Hospital had an Indian Bengali-speaking interpreter in the antenatal sector; she explained everything to me. But unfortunately, I could not catch the classes on diabetes for even one day .” (BD-IDI-5). 3.3.2 Limited availability of multilingual health education material and interpreter support Lack of health-related education materials translated into the Bengali and Nepalese languages limit access to health information and concomitant services. “There is an interpreter, but there is no Bengali version for various documents. Many leaflets, but if they are in Bengali, people can read and understand. A lot of information can be found.” (BD-FGD2-P1). Moreover, limited availability of interpreters also hinders people’s access to preventive services. “Sometimes we go to Bankstown, interpreters are available. Again, when I went to Canterbury, no interpreter was available.” (BD-FGD3-P4). 3.3.3 Inadequate cultural understanding among health care service providers Although many of the participants described their positive interaction with health service providers, some of the participants described healthcare providers’ lack of understanding in their health beliefs, culture, and tradition. “I also feel that GPs do not want to understand or assess our health beliefs, culture, and traditions.” (Neplese-IDI-3). 3.4 Institutional-level barriers 3.4.1 Limited culturally and linguistically tailored navigation support and information access Participants reported that limited culturally and linguistically tailored navigation support and information about the health care system and available preventive care services impacts people’s ability to timely seek preventive care services. “There's a lack of information and navigating the healthcare system can be overwhelming without proper guidance or awareness. This leads to many people missing out on preventive care and timely treatment.” (Nepalese-FGD3-P5). 3.4.2 Indirect and/or infrequent public transport to health facilities Absence of direct and/or infrequent public transport service to health care facilities acts as a barrier to accessing preventive health care facilities, especially for people who are dependent on public transport facilities or lack private vehicles. “Like Canterbury Hospital, it is near, not too far. But leaving Lakemba, I think, becomes difficult. Because I must come to the station from my house, from here again go to Canterbury by train, then go again by bus.” ( BD-FGD1-P6). 3.4.3 Lack of after-hours preventive program/services Lack of after-hours preventive services was a barrier to accessing preventive care services for many people, especially those who are working and their nature of work does not allow attending preventive services during working hours. “Various awareness sessions are held for diabetes. I do participate in those awareness sessions. But he doesn't have time as he has work at that time and the sessions are in working hours.” (BD-IDI-9). 3.5 Community-level barriers 3.5.1 Community attitude towards health Community negative attitude towards health appeared to be a significant barrier to accessing preventive health care services both in Bangladeshi and Nepalese communities. Delayed health-seeking behaviour, reluctancy to visit health professional, and seeking help from health providers only in emergency hinder people’s access to preventive services. “Overall, Nepalese-origin individuals tend to neglect their health, skipping routine checkups and only seeking care during emergencies or severe illnesses .” (Nepalese-IDI-5). 3.5.2 Distance to health care facilities Long distance health care facilities appeared to be an important barrier for accessing preventive care services. “Distance to healthcare facilities also plays a role in seeking care. In the past, I had to travel a long distance for counselling, which was difficult for me.” (Nepalese-IDI-2). 3.5.3 Limited connection and engagement within the community Participants reported limited social connection and engagement within the community as a barrier to accessing preventive care services. “Here's what I see, you just be yourself, no one tells you anything. Everyone is busy with themselves.” (BD-IDI-1). “Additionally, social interactions and community involvement tend to be minimal…. Participation in community and volunteering activities is quite low, further limiting opportunities for social connection and engagement.” (Nepalese-FGD2-P1). 3.5.4 Stigma associated with chronic disease Chronic disease related stigma emerged as a significant community-level barrier to accessing preventive health care services both in Bangladeshi and Nepalese communities. Participants reported that community-wide stigma to share health-related information, fear of judgment, and shame hindering people’s seeking timely support and accessing preventive care services. One participant from the Bangladeshi community reported how stigma can delay people’s sharing of health-related concerns and information in community settings, creating a barrier to access preventive services for chronic disease. “It's a big barrier to going to the doctor plus a barrier to sharing information....It may take them a long time to think about sharing this topic. This attitude is strong among Bangladeshis.” (BD-IDI-5) . Participants from the Nepalese community expressed how the fear of judgment or being isolated by family or community hinders people’s timely seeking of support. “……. but social stigma plays a significant role in the Nepalese community. Many individuals with mental health conditions prefer to remain unidentified and isolate themselves due to fear of being judged by their families, relatives, or community. This hesitation prevents them from seeking timely medical support.” (Nepalese-IDI-6) . Moreover, participants from the Nepalese communities further expressed people’s perceptions towards chronic diseases and perceptions of being weak when people seek assistance, act as barrier to accessing preventive services for chronic disease. “The social factors play a big role in creating barriers within the Nepali community…..This stigma can prevent many from accessing the care they need, and it’s something that could be addressed by fostering a more open and supportive environment where seeking help is seen as a sign of strength, not weakness.” (Nepalese-FGD3-P6). 3.6 Policy-level barriers 3.6.1 Inadequate coverage of preventive services Participants reported limited accessibility, visibility, and cultural relevance of the available preventive services as a barrier to accessing preventive care services. “These programs are not visible. Not particularly visible in community settings, and they lack accessibility. The main reason for the lack of accessibility is that they are not exposed. and not culturally acceptable at the community level.” (BD-FGD2-P3). Moreover, participants reported that the inconsistency of the available preventive services across geographical locations in Sydney was also identified as a barrier for people. “Yes, there are free health education programs for diabetes management. However, the availability of these services can vary depending on the local council, authority, or GP.” (Nepalese-IDI-11). 3.6.2 Lack of patient-centric preventive care Participants raised their concerns about the services being focused on advocacy and a top-down approach, rather than targeting and engaging community people who are in need. This highlights the disconnection between the present advocacy framework, existing service delivery and tangible community benefits. “These programs are not just patient-centred services in New South Wales; they are more advocates. They do more advocacy, but they don't do much for the common people.” (BD-FGD2-P3). Facilitators for accessing preventive services for chronic disease 3.7 Individual-level facilitators 3.7.1 Self-awareness and ownership of health Self-awareness and ownership of health were identified as facilitators for assessing preventive care. Some participants shared how self-awareness about chronic disease motivated them to engage in preventive activities. “If my diabetes goes above 9, I feel very sick. I see many going on 12/13, but I can't. My body tells me that my diabetes has increased, so I am forced to do so much. That’s why I am so aware.” (BD-IDI-6). 3.7.2 Knowledge about available preventive services Knowledge about available preventive services appeared to be another important facilitator for accessing preventive services. A few participants shared their knowledge about available preventive services promoting their intention to access them. “As far as I know Metro Assist or the library sometimes conducts some sessions of yoga exercise, chair sitting type of activities for the elderly, long-term spine problems, diabetes problems……Chair sitting activity, morning walk activity, these I have seen on behalf of Metro Assist plus the initiatives taken by Lakemba Library in the community.” (BD-FGD3-P4). 3.8 Interpersonal level facilitators 3.8.1 Cultural and linguistic competency of the healthcare service providers Sharing a similar cultural and linguistic background with the healthcare service providers was identified as a facilitator as cultural and linguistic similarity eased the communication between them. “I find it easier to communicate with Nepalese GPs as we share the same language and cultural background.” (Nepalese-IDI-1). 3.8.2 Community-based peer-support and informal information navigation Informal peer support group and sharing of information was another facilitator at the interpersonal level. Participants described that casual social gatherings and group activities facilitate people’s experience and information sharing. “Social gatherings where people talk openly about chronic disease. There is a group of people who are diabetic. They will walk or do some activity together…..then communication will be fine.” (BD-IDI-7). Participants further reported utilising informal peer groups, including family, friends, and peers, as a primary source to get preventive service-related information. “When someone in my family has a chronic condition, I usually seek advice from other senior Nepalese people or contact the hospital for information. This is what my family and I typically do.” (Nepalese-FGD-P4). 3.9 Institutional-level facilitators 3.9.1 Availability of multilingual health education resources and interpreter services Participants reported that translated chronic disease-related education materials and the availability of interpreter services could ease access to the preventive services and recommended extending these services to the primary care for better communication. “There is an interpreter, but there is no Bengali for various documents. Many leaflets, but if they are in Bengali, people can read and understand. A lot of information can be found.” (BD-FGD2-P1). 3.9.2 Digital and social media as source of information Participants reported the utilisation of existing digital and social media to share information and raise awareness about chronic disease related preventive services, due to their ability to reach a larger number of people. “ I believe social media is the most practical solution for spreading information…….. By creating dedicated health-focused pages, we can share valuable information, tips, and resources directly with the community.” (Nepalese-FGD-P3). Participants further reported that sending mobile SMS, which is already in use for informing different services, can be a useful way to reach people who have limited access or knowledge about internet use. “ I think because everyone uses mobile phones. ...……. ….For them mobile SMS can be given in different languages, it can be helpful to pass information like we get for different things.” (BD-FGD3-P4). The radio program was further identified as an effective way to raise awareness about preventive health services and available healthcare programs. “Radio ads could be an effective way to raise awareness about preventive health services and available healthcare programs…….who may not actively seek out information online or through pamphlets.” (Nepalese-FGD-P6). 3.10 Community-level facilitators 3.10.1 Community-led psychosocial support Community-led psychosocial support appeared to be a facilitator for coping with stigma, isolation, and psychological stress, and thus facilitating access to the preventive care services. “…….. Bangladeshis can give each other mental support. They can help in different ways. The help that I get. Many Bangladeshi brothers whom I don't even know visit me.” (BD-IDI-11). 3.10.2 Reorientation and utilisation of existing community organisations for preventive care Many participants reported that some community organisations mainly focus on fundraising for treatment as health-related support system. They emphasized reorientation of community organizations to facilitate preventive care service accessibility through awareness sessions, and navigation support. “However, I believe these organizations tend to be more reactive than proactive. There is a need for them to focus more on raising awareness and actively advocating for health issues at the community level, rather than only responding to situations as they arise.” (Nepalese-FGD2-P3). 3.10.3 Utilisation of existing community gatherings as a point of preventive care outreach Some participants pointed out different community festivals, gatherings, and community places e.g. schools, parks as a touchpoint for promoting preventive care services and facilitate access. “The Bangladeshi community has many festivals. There are various health promotion programs in these festivals, those who work with the community can provide booths. They can do community consultation within the booth. If you go to these places, you will get this service.” (BD-FGD2-P3). 3.11 Policy-level facilitators 3.11.1 Integrated service provision for immigrants Some participants mentioned about the importance of integrating available preventive services with existing social support services e.g. Centrelink, MediCare to promote better access. “Immigrants face multiple challenges as they move from one country to another…..So, here, comprehensive patient-centred needs for immigrants need to be understood by the government. And these should be tagged with support services like Centrelink, MediCare.” (BD-FGD1-P3). 4 Discussion This study comprehensively examined barriers and facilitators to accessing preventive care services at different levels among people of Bangladeshi and Nepalese origin living in Sydney, Australia which have significant implications for policy and practice. 4.1 Barriers to accessing preventive care services for chronic diseases Cultural and religious perceptions of chronic disease, limited health literacy and awareness about chronic diseases, and limited focus on self-care emerged as individual level barriers to accessing preventive services, which is supported by prior literature. Studies conducted on South Asian and other CALD communities living in the UK, Canada, the US, and Australia reported challenges in navigating healthcare system due to limited health literacy 25 , 26 . A previous study employed the socio-ecological framework to understand the uptake of cervical cancer screening services among Pakistani and Somali immigrant women and found that limited health literacy hindering the access 27 . Similarly, lack of awareness about the available preventive services also limits access to those services among South Asian migrants 9 . Moreover, aligned with prior studies conducted among South Asian migrants in Australia 11 , 28 , present study also reported that work pressure, financial instability, and caregiving responsibilities often results in undermining self-care among the participants, limiting engagement with preventive care. These findings are consistent with the previous studies on South Asian communities in Australia 11 , 28 . Another critical barrier reported by both the Bangladeshi and Nepalese communities is the perception that accessing preventive care services may negatively impact their visa status, i.e., may not receive permanent residency if they are diagnosed with chronic conditions. These findings suggest promotion of culturally appropriate health education initiatives to improve health literacy and awareness on available health services 29 . At the interpersonal level, language barrier with limited availability of multilingual health education materials and interpreter services were the key barriers to accessing preventive care services. Limited English language skills hinder communication, understanding materials written in English, and navigate complex health system, especially for those whose first language is not English 30 . This finding aligns with previous research on South Asian migrants and CALD communities in Australia and other countries 2 , 9 , 11 , 27 , 28 . Although interpreter services and translated health education materials are available in various languages 31 , this is limited for Bengali and Nepalese people in Australia. Community outreach activities and educational programs that include bilingual community health navigators, availability of onsite interpreter services and translated education materials in native languages 28 , 29 , 32 for Bangladeshi and Nepalese communities can effectively address these challenges. Moreover, lack of cultural understanding among health care service providers was identified as a barrier to accessing preventive care services, aligned with previous studies 3 , 14 , 32 . The development of a culturally competent, empathetic framework 33 placing importance on providing care in a culturally appropriate manner is required. Training on culturally responsive training 14 , 30 can also result in improved cultural responsiveness amongst health service providers. Participants expressed challenges in accessing preventive services due to inadequate culturally tailored health information and navigation services. This finding is consistent with previous research findings among CALD communities in Australia 14 , 34 . Utilisation of bilingual community health navigators, and education materials available in the native languages, can be effective in alleviating these barriers. Inequitable public transport infrastructure and unavailability of after-hours services was also identified as institutional-level barriers to accessing preventive services. Unavailability of adequate public transports has often been cited as a major barrier impacting access to healthcare 35 . These urges reorganizing the public transport infrastructure in collaboration with health policy makers, urban planners, and transport experts 35 . Unavailability of after-hours preventive service limits people’s ability to access the preventive services, especially those who have long working hours and are burdened with different household and care responsibilities. Although there are some available after-hours supports for primary and emergency care 36 , preventive care services for chronic diseases are scarce in the Australian health system. The after-hours preventive service delivery model 37 can be considered for improving access to preventive services. Community negligent attitude towards health appears to be a significant barrier at the community level to promote access to preventive services. Delayed health-seeking behaviour, views that occasional visit to health professionals are sufficient for managing chronic diseases and only accessing health care service during an emergency hinder accessing preventive care services. This behaviour aligns with South Asians’ chronic health-related attitude of relying on a curative approach rather than a preventive approach 38 . Alongside this, a sense of limited social connection and engagement within the community has been identified as a barrier to accessing preventive care services. Strong community support and social network results in better participation to preventive services 39 . Individualistic lifestyle and work pressure lead to limited community participation and interpersonal communication, and social isolation, which can contribute to reduced flow of information and underutilisation of preventive services 28 , 34 . Community-wide stigma related to chronic disease is reported to be a critical barrier for accessing preventive services by majority of the participants. Fear of judgment, shame, and hesitancy to share health-related information is found in the South Asian communities. This may lead to delayed seeking and accessing preventive services 40 . Moreover, engagement with preventive services might be considered as a ‘sign of weakness’, hindering people’s access to preventive services in CALD communities 41 . Community-based and culturally appropriate health education programs may help to improve community attitudes towards and reduce stigma 29 . The formation of peer support groups can also be effective in improving community engagement and support, thereby improving access to preventive services 42 . Moreover, distance to health care facilities was also identified as a community-level barrier to access preventive services. Long distance to health care facilities, inadequate public transport system, and reliance on private vehicles influence people’s health care access behaviour 43 . Limited English language proficiency and poor communication skills add a layer of complexity in finding existing facilities and arranging transport, and the cost of transport acts as a barrier for CALD communities, especially for those who rely on public transport 14 . Transportation incentives, including bus passes, taxi vouchers, and free or reimbursed transportation costs, can help improving access to preventive services 44 . Participants criticized the current preventive care services because of inadequate coverage and a lack of a patient-centric approach. Although CALD communities are a priority population for chronic disease prevention in Australia, the health system has not been able to serve the needs of the South Asian communities, especially Bangladeshi and Nepalese communities, completely. This highlights the need to develop a preventive care service model for chronic disease that will be culturally tailored, addressing the needs and voice of South Asian migrants, including the population from Bangladeshi and Nepalese origin. Facilitators for accessing preventive care services for chronic disease Participants also noted several facilitators to accessing preventive services across all levels of the socioecological framework. Some participants pointed about individual self-awareness, ownership of health, and adequate knowledge about available preventive services as facilitators to accessing preventive care services. Prior research also document that providing importance to own health and having information on available services improve access to care 30 , 45 . Cultural and linguistic competency of healthcare providers was identified as a facilitator at the interpersonal level. This finding aligns with studies conducted in South and Southeast Asian immigrants in Japan 46 and Pakistani and Somali immigrant women in Oslo 27 . Both studies utilising socio-ecological framework showed that cultural and linguistic competency of health service providers help address language barrier and improve communication to facilitate uptake of preventive services 28 . Peer support and informal navigation can serve as a trusted way of sharing information share and promoting behaviour change 42 . At institutional level, availability of multilingual education resources and utilisation of digital and use of social media as a source of information were identified as facilitators for accessing preventive services. These findings are aligned with previous studies conducted on in South and Southeast Asian migrants 46 and Pakistani and Somali immigrants 27 . Availability of multilingual education resources facilitates the dissemination of information through trusted source and organisations 46 and can facilitate better access to care. Availability of community-led psychological support was identified as a facilitator for accessing preventive services. Psychological distress can hinder the utilisation of preventive care services 47 , and psychological support offered by community members is beneficial for improving access to preventive care. Participants from the Nepalese community critiqued the community organisation of not being focused on chronic disease prevention and suggested reorientation of community organisations to promote access to preventive care among community members. This is aligned with the findings of a qualitative study exploring the role of community organisations in improving access to community resources for chronic disease prevention and management 48 . Most of the participants emphasised utilisation of social gatherings to promote importance of accessing preventive services. Participants urged for integrated services for chronic disease prevention with other social support services, e.g. Centrelink services or Medicare. A comparable model in Canada, Accessing Canadian Healthcare for Immigrants: Empowerment, Voice & Enablement (ACHIEVE) program, has been proven successful for improved health care utilisation among immigrants 45 . Adaptation of this kind of immigrant-focused program in the Australian context may be beneficial for underexplored communities, e.g. Bangladeshi and Nepalese communities. 4.2 Strengths and limitations of the study Our study is one of the first studies providing insights into the barriers and facilitators to accessing chronic disease preventive services faced by the South Asian migrants in Australia. Utilisation of FGD and IDIs provided opportunities to explore both communities' perspectives on the barriers to accessing preventive care. The established relationship between the research team and community representatives is a strength of the study, ensuring trust among the participants. This established relationship was also helpful in recruitment of diverse participants for FGD and IDIs. The FGDs and IDIs were conducted in the native languages of participants which ensured active participation of the study participants. However, this study only explores the perspective of Bangladeshi and Nepalese communities living in Sydney, therefore, the study findings may not be generalizable to the whole population from South Asian backgrounds and those from other parts of Australia. We could not conduct the IDIs face-to-face, which might limit richness in data that would be achieved by in-person interviews, despite all efforts to ensure participants’ comfort in sharing their experiences. Moreover, Bangladeshi and Nepalese communities itself are very diverse, and we could not capture the intra-subgroup variations. This also highlights the importance of considering the heterogeneity of communities in preventive care design, rather than placing them under ‘South Asian Migrants’. 5 Conclusion This qualitative study sheds light on the barriers and facilitators to accessing preventive care services at different levels among Bangladeshi and Nepalese communities in Sydney. Several barriers identified at different levels such as cultural and religious perceptions, limited health literacy and awareness to language barriers, limited culturally and linguistically tailored support, community stigma and gaps in available preventive programs. Self-focus on health, peer support, cultural and linguistic competency of the service providers and use of digital and social media were some of the facilitators identified. The study highlights the importance of implementing multilevel, culturally appropriate, and community-based interventions to improve access to preventive care services among these disadvantaged population groups. Finally, policymakers and public health practitioners should focus on reframing the existing policy framework and practices to ensure equitable access to preventive care services among Bangladeshi and Nepalese communities in Australia. 6. Declarations 6.1 Data availability statement The data will not be shared publicly considering the privacy and anonymity of the participants. 6.2 Conflict of interest disclosure The authors declare that they have no conflict of interest to disclose. 6.3 Ethics approval statement The study protocol was approved by University of New South Wales Human Research Ethics Committee (iRECS6554) in June 2024. 6.4 Patient consent statement Written informed consent was sought from the participants before data collection. 6.5 Permission to reproduce material from other sources Not applicable 6.6 Clinical trial registration Not applicable 6.7 Acknowledgements We would like to acknowledge the support of community advisors of the Multicultural Healthcare Support Group, Sydney in recruitment of the study participants. We would also like to acknowledge Jasmine Mguizra, Team leader, Metro Assist for her help with organizing the venue for the FGD in Lakemba library premise and helping with recruitment of study participants. 6.8 Funding This study was supported by a seed grant from the School of Population Health, UNSW Sydney, Australia. Patient or Public Contribution Study participants were not involved in the study design or conduct of study, analysis or interpretation of the data or in preparation of the manuscript. References Australian Institute of Health and Welfare. Chronic Disease (2024) ; https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview Australian Institute of Health and Welfare (2023) Chronic health conditions among culturally and linguistically diverse Australians. AIHW, Canberra Adhikari M, Kaphle S, Dhakal Y et al (2021) Too long to wait: South Asian migrants’ experiences of accessing health care in Australia. BMC Public Health 21(1):1–11 Nisar M, Kolbe-Alexander T, Khan A (2024) Chronic diseases and their behavioural risk factors among South Asian immigrants in Australia. Aust Health Rev 49(1):1–8 AbdulRaheem Y (2023) Unveiling the Significance and Challenges of Integrating Prevention Levels in Healthcare Practice. J Prim Care Community Health 14:1–6 Department of Health Disability and Ageing (2022) What we’re doing about chronic conditions. ; https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions#consultation-and-engagement Department of Health Disability and Ageing. Managing chronic conditions (2020) ; https://www.health.gov.au/topics/chronic-conditions/managing-chronic-conditions#populationbased-health-screening . Accessed 15 September 2025 Department of Health Disability and Ageing. Our work related to chronic conditions (2023) ; https://www.health.gov.au/topics/chronic-conditions/related-work . Accessed 15 September 2025 Nisar M, Costa N, Kolbe-Alexander T, Khan A (2025) Exploring Healthcare Access Challenges Among South Asian Migrants in Australia: A Mixed‐Method Study. Health Promotion J Australia 36(2):1–14 Alam Z, Deol H, Dean JA, Janda M (2022) Reasons behind low cervical screening uptake among South Asian immigrant women: a qualitative exploration. Int J Environ Res Public Health 19(3):1–15 Nisar M, Khan A, Kolbe-Alexander TL (2022) Cost, culture and circumstances’: Barriers and enablers of health behaviours in South Asian immigrants of Australia. Health Soc Care Commun 30(5):e3138–e3149 Australian Institute of Health and Welfare (2025) Culturally and linguistically diverse Australians, vol 11. Australian Institute of Health and Welfare, aihw.gov.au, /2/2025 Subedi R, Kaphle S, Adhikari M et al (2022) First call, home: perception and practice around health among South Asian migrants in Melbourne, Australia. Aust J Prim Health 28(1):40–48 Javanparast S, Naqvi SKA, Mwanri L (2020) Health service access and utilisation amongst culturally and linguistically diverse populations in regional South Australia: a qualitative study. Rural Remote Health 20(4):1–15 McLeroy KR, Bibeau D, Steckler A, Glanz K (1988) An ecological perspective on health promotion programs. Health Educ Q 15(4):351–377 Ayton D, Tsindos T (2023) Foundations of qualitative research–paradigms, philosophical underpinnings. In: Berkovic DATTD (ed) Qualitative Research–a practical guide for health and social care researchers and practitioners. Monash University Tenny S, Brannan JM, Brannan GD (2025) Qualitative Study. StatPearls. Treasure Island (FL). StatPearls Publishing LLC. Tsindos T (2023) Theory in qualitative research. In: Berkovic DATTaD, ed. Qualitative Research–a practical guide for health and social care researchers and practitioners. Monash University Creswell JW, Creswell JD (2017) Research design: Qualitative, quantitative, and mixed methods approaches. Sage Mistry SK, Harris E, Harris MF (2022) Scoping the needs, roles and implementation of bilingual community navigators in general practice settings. Health Soc Care Commun 30(6):e5495–e5505 Booth BJ, Zwar N, Harris MF (2013) Healthcare improvement as planned system change or complex responsive processes? A longitudinal case study in general practice. BMC Fam Pract 14:1–12 Australian Bureau of Statistics (2021) Search Census data by country of birth. Canbera Australian Bureau of Statistics Mistry SK, Harris E, Li X, Harris MF (2023) Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Serv Res 23(1):476 Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77–101 Smith GD, Chaturvedi N, Harding S, Nazroo J, Williams R (2000) Ethnic inequalities in health: a review of UK epidemiological evidence. Crit public health 10(4):375–408 Scheppers E, Van Dongen E, Dekker J, Geertzen J, Dekker J (2006) Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract 23(3):325–348 Gele AA, Qureshi SA, Kour P, Kumar B, Diaz E (2017) Barriers and facilitators to cervical cancer screening among Pakistani and Somali immigrant women in Oslo: a qualitative study. Int J women's health :487–496 Khatri RB, Assefa Y (2022) Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 22(1):1–14 Henderson S, Kendall E, See L (2011) The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health Soc Care Commun 19(3):225–249 Henderson S, Kendall E (2011) Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Aust J Prim Health 17(2):195–201 NSW Health. NSW Health Care Interpreting Services (2024) ; https://www.health.nsw.gov.au/multicultural/Pages/health-care-interpreting-and-translating-services.aspx Roberts DA, Abera S, Basualdo G et al (2021) Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants. PLoS ONE 16(5):1–13 Hannawa AF, Wu AW, Kolyada A, Potemkina A, Donaldson LJ (2022) The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Educ Couns 105(6):1561–1570 Khatri RB, Assefa Y (2023) Drivers of the Australian health system towards health care for all: a scoping review and qualitative synthesis. Biomed Res Int 2023(1):1–19 Syed ST, Gerber BS, Sharp LK (2013) Traveling towards disease: transportation barriers to health care access. J Community Health 38(5):976–993 Department of Health and Aged Care (2024) A better after-hours system. Department of Health and Aged Care, Canberra Flarup L, Moth G, Christensen MB, Vestergaard M, Olesen F, Vedsted P (2014) Daytime use of general practice and use of the Out-of-Hours Primary Care Service for patients with chronic disease: a cohort study. BMC Fam Pract 15(1):1–9 Siddiqui F, Hewitt C, Jennings H et al (2024) Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review. PLOS Global Public Health 4(1):e0001668 Fufaa GD (2024) The Role of Preventive Health Care in Preventing Chronic Diseases. In: Ozminkowski RJ (ed) International Perspectives and Experiences Enhancing Access to Healthcare. IntechOpen, Rijeka Sinnathurai R (2025) Addressing mental health within the South Asian community. ; https://www.scientianews.org/articles/psychology/addressing-mental-health-within-the-south-asian-community . Accessed 29 July, 2025 Kara BH, Khawaja NG (2024) Wellbeing programs for culturally and linguistically diverse population in Australia: barriers and improvements. Australian Psychol 59(3):200–211 Panaite AC, Desroches OA, Warren É, Rouly G, Castonguay G, Boivin A (2024) Engaging with peers to integrate community care: Knowledge synthesis and conceptual map. Health Expect 27(2):e14034 Mseke EP, Jessup B, Barnett T (2024) Impact of distance and/or travel time on healthcare service access in rural and remote areas: A scoping review. J Transp Health 37:101819 Starbird LE, DiMaina C, Sun CA, Han HR (2019) A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases. J Community Health 44(2):400–411 Ghahari S, Burnett S, Alexander L (2020) Development and pilot testing of a health education program to improve immigrants’ access to Canadian health services. BMC Health Serv Res 20(1):1–12 Matsuoka S, Kharel M, Koto-Shimada K et al (2022) Access to Health-Related Information, Health Services, and Welfare Services among South and Southeast Asian Immigrants in Japan: A Qualitative Study. Int J Environ Res Public Health ;19(19) Thorpe JM, Kalinowski CT, Patterson ME, Sleath BL (2006) Psychological Distress as a Barrier to Preventive Care in Community-Dwelling Elderly in the United States. Med Care 44(2):187–191 Nguyen KH, Fields JD, Cemballi AG et al (2021) The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Family Med 34(4):1–11 Additional Declarations The authors declare no competing interests. Supplementary Files Supplementaryfile1.docx Supplementary file 1: Topic guides for participants Supplementaryfile2.docx Supplementary file 2: Barriers to access preventive care services with representative quotes Supplementaryfile3.docx Supplementary file 3: Facilitators to access preventive care services with representative quotes Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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10:19:53","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":26871,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary file 2: Barriers to access preventive care services with representative quotes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Supplementaryfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8384471/v1/6b30f58890175320954a3ed0.docx"},{"id":98780359,"identity":"014ae5c7-5b2d-42e2-9391-1b9102db3bc8","added_by":"auto","created_at":"2025-12-22 12:31:14","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23981,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary file 3: Facilitators to access preventive care services with representative quotes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Supplementaryfile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8384471/v1/22b1a5b77d33aefd472007b3.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBarriers and facilitators to accessing preventive services for chronic diseases among people from South Asian backgrounds living in Sydney\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eChronic diseases, such as arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and mental health conditions are the leading cause of illness, disability, and deaths in Australia \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. According to the Australian Institute of Health and Welfare, 38% of Australians had two or more chronic diseases, and 90% deaths were attributed to chronic conditions in 2022 \u003csup\u003e1\u003c/sup\u003e. Particularly, one quarter of the Australian population, who speak a language other than English at home, also known as people from culturally and linguistically diverse (CALD) backgrounds, experience a disproportionate burden to chronic diseases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIndividuals of South Asian origin are one of the fastest-growing CALD population groups comprising around 14.2% of the total overseas migrants in Australia \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Alike people from other CALD communities, individuals from South Asian backgrounds have a disproportionate burden to several chronic diseases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. For example, a recent study reported a high prevalence of diabetes (21%), heart disease (12%), and depression (22%) among people from South Asian backgrounds living in Australia \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Among the broader South Asian migrants, Bangladeshi and Nepalese are two rapidly growing communities in Australia \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, who are experiencing a higher burden of chronic diseases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Recent research reported a high prevalence of diabetes and heart disease in the Bangladesh-born (12% and 4.6% respectively) and Nepalese origin (6.2% and 1.8% respectively) Australians \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn these realities, prevention is crucial to reduce incidence and chronic disease-related death, ill health, and disability \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The prevention of chronic diseases includes regular health check-ups, screening programs for early detection of chronic diseases e.g. cancer, diabetes, health promotion activities e.g. health education sessions, promotion of a healthy diet, and physical activity \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In Australia, to reduce the burden of chronic disease, the \u0026lsquo;National Strategic Framework for Chronic Disease\u0026rsquo; for prevention, management, and treatment of chronic disease has been undertaken \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Other initiatives to support the prevention of chronic disease at the national level include the Medicare Benefits Schedule (MBS), the National Diabetes Services Scheme, support program for Aboriginal and Torres Strait Islander peoples with chronic conditions, including the Indigenous Australians\u0026rsquo; Health Program \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. A range of robust programs targeting prevention and management of chronic diseases are available, e.g. early detection program for cancer and diabetes screening, lifestyle modification program \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. There is also a dedicated information and support system to manage chronic disease e.g. health-direct helpline, Cancer Learning, Better Health Channel and condition-specific support groups \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Despite the high prevalence of chronic diseases and availability of preventive care services, multiple studies reported a low health care utilisation in South Asian migrants due to several social, cultural, and institutional factors \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Language barriers and communication challenges, difficulties in adapting to a new culture, limited health literacy, and the complexity of navigating healthcare system all impact their access to healthcare services \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Moreover, socio-cultural practices, traditions and beliefs of health and well-being also shape the healthcare utilisation of South Asian migrants \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Previous research conducted on South Asian migrants in Australia has focused on exploring broader health care access and utilisation \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, there is a paucity of evidence that particularly focuses on the barriers and facilitators to access preventive care services for chronic diseases among the people of Bangladeshi and Nepalese origin living in Australia, highlighting a significant knowledge gap. Moreover, the existing studies reported limited information on the theoretical grounding of factors associated with healthcare access.\u003c/p\u003e \u003cp\u003eThe socio-ecological framework is widely used in public health research that enables exploring factors at the health system, organizational, community, and individual levels \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The individual level of socio ecological framework focuses on individual knowledge, attitude, self-concept, behaviour and skills. Formal and informal social networks and their information sharing, emotional support and social norms are covered under the interpersonal level of the socio-ecological framework. Organizational (both formal and informal) characteristics and their rules and regulations and their influence on delivery and uptake of health service are discussed in the organizational level. Broader community networks, their relationship, values, norms, and structures and their impact on perceptions and accessibility of services are covered in community level. Finally, impact of policy development, public awareness, advocacy and implementation on accessibility and availability of healthcare services are discussed at policy level \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, the present study aims to identify the barriers and facilitators to accessing preventive care services for chronic disease using the socio-ecological framework \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e among Bangladeshi and Nepalese people living in Sydney, Australia. The study focuses on these two population groups because of their increased migration rate, high chronic disease burden, and their distinct, understudied social-cultural and migration contexts. By investigating both the barriers and facilitators across multiple socioecological levels, this study aims to inform the design of culturally sensitive, accessible, and equitable preventive care interventions and enhance the uptake of preventive care services in these populations.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThe study followed a cross-sectional, qualitative research design adopting the constructivist paradigm \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, and the information was collected through in-depth interviews (IDIs) and focus group discussions (FGD). The use of qualitative design allowed to capture human phenomena, e.g. experiences, attitudes and behaviours related to accessing preventive care services among the study participants. It further facilitated articulating participants\u0026rsquo; thoughts, emotions, and experiences in accessing preventive care services \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The utilisation of the constructivist paradigm enabled exploration of the barriers and facilitators to accessing preventive care services, delving into the lived experience of the participants \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. A phenomenological approach was utilised to understand, describe, and interpret the perceptions of barriers and facilitators to accessing preventive, generated through the individual and collective experiences of the participants \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Both IDIs and FGDs were conducted to collect complementary information and to examine complex, context-specific issues, allowing participants to express their experiences freely and flexibly, generating a detailed, nuanced understanding \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study setting and participants\u003c/h2\u003e \u003cp\u003eThis study was carried out in the South-Western suburbs of Sydney where majority of the population are from South Asian backgrounds. The study participants were adult people aged 18 years and above from Bangladeshi and Nepalese origin residing in Australia for more than one year. The inclusion criteria also included that the participants are currently living in Sydney.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sampling and recruitment\u003c/h2\u003e \u003cp\u003eThe research team maintains an ongoing connection with the community members from various CALD communities, including those of Bangladeshi and Nepalese communities in Sydney, through the Multicultural Health Care Support Group (MHCSG) in Sydney. This support group was established by the research team in early 2025 including community advisors from different CALD population groups of Sydney (i.e., Bangladeshi, Nepalese, Indian) to have an ongoing conversation about their health attributes. Recruitment flyers were disseminated by the community advisors of MHCSG to the broader Bangladeshi and Nepalese communities in Sydney through community gatherings, social media and personal networks. MHCSG advisors shared the contact details of the potential study participants who verbally agreed to participate in the study and gave their consent to share contact details with the research team. Members of the research team (AA, GP), contacted the potential participants and checked their eligibility and sent through the participant information statement and consent form via post or email. A total of 6 FGDs (3 from each population groups) and 22 IDIs (11 from each population groups) to achieve data saturation, which is aligned with similar qualitative research \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Selection of participants also encountered the diversity in terms of age, sex, locality, occupation, and type of residency (temporary/permanent) among the Bangladeshi and Nepalese communities living in Sydney \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data collection\u003c/h2\u003e \u003cp\u003eData were collected through FGDs and IDIs during August 2024 and January 2025, using relevant guides, developed in English language through an extensive literature review and informal community consultations \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These underwent multiple revisions based on the feedback of the research team before finalization. The final FGD and IDI guides (Supplementary file 1) covered different aspects on barriers and facilitators to accessing preventive services for chronic diseases. These included participants\u0026rsquo; understanding of chronic disease and available preventive services, what participant or their families experienced, and what they observed in communities while accessing preventive services. The final FGD and IDI guides were then translated into Bengali and Nepalese language for data collection. FGDs were conducted before IDIs to identify more broader perspective before capturing specific nuances and FGD participants were excluded from IDIs.\u003c/p\u003e \u003cp\u003eAll FGDs, each comprising 5\u0026ndash;8 participants from the same community, were conducted face-to-face within the locality of the participants such as library premises or community park. The FGDs were facilitated in native language of the participants by two research team members (AA, GP), PhD candidates, experienced in qualitative research and being from Bangladeshi (AA) and Nepalese (GP) origin. Meanwhile, in-language IDIs were conducted by AA and GP over the telephone based on participants\u0026rsquo; availability and convenience. Participants received gift vouchers worth \u003cspan\u003e$\u003c/span\u003e40 as a token of appreciation for their time and involvement in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data analysis\u003c/h2\u003e \u003cp\u003eAll the FGDs and IDIs were transcribed, translated into English, and thematically analysed using Braun and Clarke\u0026rsquo;s six-step thematic analysis and allowing for a data-driven identification of themes \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. We employed a deductive thematic analysis using socio-ecological framework \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e to identify the barriers facilitators to accessing preventive care services for people of Bangladeshi and Nepalese origin living in Sydney and used NVivo (version 14) for management of qualitative data.\u003c/p\u003e \u003cp\u003eAs a first analytical step, two FGD and three IDI transcripts were thoroughly read by two researchers (AA and GP) to familiarise themselves with the data and to develop an initial coding framework independently. The initial coding frameworks were discussed with the research team for finalization. Contradictions and inconsistencies were resolved through in-depth discussion and mutual agreement amongst the research team members. After the emerging codes and categories were finalised, a coding template was developed for the rest of the transcripts. Two researchers independently coded the data using the coding template and 20% of the transcripts were cross-checked to ensure coding consistency. In the next few steps, codes are collated and grouped them into themes and refined the themes through discussion with team members for better presentations. In the final phase of analysis, all identified themes were systematically organized within the socioecological framework \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Notably, no themes were found that extended beyond the boundaries of this framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Characteristics of the participants\u003c/h2\u003e \u003cp\u003eMost of the participants were female (n\u0026thinsp;=\u0026thinsp;42/63, 66.67%). The average age of participants was 38.8 years, and the average length of time residing in Australia was 10 years. Most of the participants reported being permanent residents and citizens (n\u0026thinsp;=\u0026thinsp;42, 66.67%), while the rest of the participants reported being on temporary residency status (n\u0026thinsp;=\u0026thinsp;21, 33.33%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines a detailed characteristic of the participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study participants by community\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterviews\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFGD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBangladeshi\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (M-5, F-6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (M-2, F-21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage age of the participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage no of years of living in Australia:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.91 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResidency status:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePermanent residency- 7\u003c/p\u003e \u003cp\u003eTemporary residency-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent residency- 16\u003c/p\u003e \u003cp\u003eTemporary residency-7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNepalese\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of participants in interviews:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (M-8, F-3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (M-5, F-13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage age of the participants:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage no of years of living in Australia:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResidency status:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePermanent residency-6\u003c/p\u003e \u003cp\u003eTemporary residency-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePermanent residency-13\u003c/p\u003e \u003cp\u003eTemporary residency-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe summarised the barriers and facilitators in five broad levels: 1) individual, 2) interpersonal, 3) institutional, 4) community, and 5) policy. The broad levels, respective themes and relevant quotes are comprehensively presented in supplementary file 2 and 3, while representative quotes relevant to specific themes are presented within the text for better understanding.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eBarriers to accessing preventive services for chronic disease\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Individual-level barriers\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Cultural and religious perceptions related to chronic disease\u003c/h2\u003e \u003cp\u003eParticipants reported that cultural and religious perceptions of chronic disease impeded their access to preventive care services. Participants expressed cultural and religious beliefs such as that chronic disease is God-given, culture-driven health beliefs and taboos impeded their access to preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Especially many of us think that diabetes is God given. I have nothing to do here. But many people don't think that it is a modifiable matter, within a person's control. So, according to religious faith, it is considered pre-destination by all.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Limited health literacy about chronic disease\u003c/h2\u003e \u003cp\u003eLimited health literacy about chronic disease was identified as another barrier. Many participants reported being unaware of the definition and types of common chronic diseases.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I googled the chronic disease today at the time of interviewing you. I thought chronic disease meant cancer or something big like that. But I did not know that diabetes or hypertension are chronic diseases.\u0026rdquo;\u003c/em\u003e (\u003cb\u003eBD-IDI-3).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIt was noticed by participants that their community people have a little knowledge about their chronic conditions even after they are diagnosed with a chronic disease.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I believe poor health literacy is one of the barriers. Even when people are diagnosed with chronic conditions, they know little about their health problems.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-2).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Lack of awareness about preventive services\u003c/h2\u003e \u003cp\u003eParticipants reported a lack of awareness about available preventive services as a hindrance to accessing them. Participants mentioned a lack of information about what preventive care services cover and what services are offered by the health system.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;No, we have not accessed\u0026hellip;. We don\u0026rsquo;t know what services are available here in Australia or what the government offers.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-9).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 Limited focus to self-care\u003c/h2\u003e \u003cp\u003eMany participants reported limited focus to self-care as a barrier to accessing preventive services. Prioritizing work, financial instability, pressure of balancing work and personal life, and responsibilities often deters them from prioritizing their health, leading to low engagement in accessing preventive services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Often, their priorities are focused more on work and financial stability than on health, which leads to low engagement in preventive healthcare.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD2-P1).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMany participants pointed that women tend to neglect their health because of their daily caregiving responsibilities for their families. This negligence complemented with their lack of self-confidence and self-care, which deteriorates their physical and mental health, delaying accessing preventive care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They neglect their health. Women are special. They completely ignore their health. They come here and become so busy with their husband's career, job, and their children's school..\u0026hellip;..They do not exist on their own. As a result, various diseases occur. Diabetes is there, along with many other complex chronic diseases. Many also develop mental health-related problems.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-5).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.5 Fear of impact on visa status\u003c/h2\u003e \u003cp\u003eQualitative findings revealed that fear of a negative impact on visa status, including the potential for obtaining permanent residency, appeared to be an important barrier to accessing preventive health care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have seen closely, one of my friends, who didn't have permanent residency at the time, may have felt restricted in accessing healthcare services here.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Interpersonal level barriers\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Language barrier\u003c/h2\u003e \u003cp\u003eLimited English language proficiency emerged as one of the significant barriers to accessing preventive care services. Participants reported that language difficulties not only hindered their verbal communication but also access to free-of-cost services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even the free-of-cost services that the government offers through community services often go untapped within the Nepali community. Whether knowingly or unknowingly, the language barrier prevents people from fully accessing these services\u003c/em\u003e.\u0026rdquo; \u003cb\u003e(Nepalese-FGD2-P1).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eParticipants also reported that different unfamiliar dialects and accents of health service providers can also hinder people\u0026rsquo;s ability to undertake preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I didn't even understand their accent. Canterbury Hospital had an Indian Bengali-speaking interpreter in the antenatal sector; she explained everything to me. But unfortunately, I could not catch the classes on diabetes for even one day\u003c/em\u003e.\u0026rdquo; \u003cb\u003e(BD-IDI-5).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Limited availability of multilingual health education material and interpreter support\u003c/h2\u003e \u003cp\u003eLack of health-related education materials translated into the Bengali and Nepalese languages limit access to health information and concomitant services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is an interpreter, but there is no Bengali version for various documents. Many leaflets, but if they are in Bengali, people can read and understand. A lot of information can be found.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P1).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMoreover, limited availability of interpreters also hinders people\u0026rsquo;s access to preventive services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes we go to Bankstown, interpreters are available. Again, when I went to Canterbury, no interpreter was available.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD3-P4).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e\u003cem\u003e3.3.3 Inadequate cultural understanding among health care service providers\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eAlthough many of the participants described their positive interaction with health service providers, some of the participants described healthcare providers\u0026rsquo; lack of understanding in their health beliefs, culture, and tradition.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I also feel that GPs do not want to understand or assess our health beliefs, culture, and traditions.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Neplese-IDI-3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Institutional-level barriers\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Limited culturally and linguistically tailored navigation support and information access\u003c/h2\u003e \u003cp\u003eParticipants reported that limited culturally and linguistically tailored navigation support and information about the health care system and available preventive care services impacts people\u0026rsquo;s ability to timely seek preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There's a lack of information and navigating the healthcare system can be overwhelming without proper guidance or awareness. This leads to many people missing out on preventive care and timely treatment.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD3-P5).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Indirect and/or infrequent public transport to health facilities\u003c/h2\u003e \u003cp\u003eAbsence of direct and/or infrequent public transport service to health care facilities acts as a barrier to accessing preventive health care facilities, especially for people who are dependent on public transport facilities or lack private vehicles.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Like Canterbury Hospital, it is near, not too far. But leaving Lakemba, I think, becomes difficult. Because I must come to the station from my house, from here again go to Canterbury by train, then go again by bus.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eBD-FGD1-P6).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3 Lack of after-hours preventive program/services\u003c/h2\u003e \u003cp\u003eLack of after-hours preventive services was a barrier to accessing preventive care services for many people, especially those who are working and their nature of work does not allow attending preventive services during working hours.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Various awareness sessions are held for diabetes. I do participate in those awareness sessions. But he doesn't have time as he has work at that time and the sessions are in working hours.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-9).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Community-level barriers\u003c/h2\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1 Community attitude towards health\u003c/h2\u003e \u003cp\u003eCommunity negative attitude towards health appeared to be a significant barrier to accessing preventive health care services both in Bangladeshi and Nepalese communities. Delayed health-seeking behaviour, reluctancy to visit health professional, and seeking help from health providers only in emergency hinder people\u0026rsquo;s access to preventive services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Overall, Nepalese-origin individuals tend to neglect their health, skipping routine checkups and only seeking care during emergencies or severe illnesses\u003c/em\u003e.\u0026rdquo; \u003cb\u003e(Nepalese-IDI-5).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2 Distance to health care facilities\u003c/h2\u003e \u003cp\u003eLong distance health care facilities appeared to be an important barrier for accessing preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Distance to healthcare facilities also plays a role in seeking care. In the past, I had to travel a long distance for counselling, which was difficult for me.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-2).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e3.5.3 Limited connection and engagement within the community\u003c/h2\u003e \u003cp\u003eParticipants reported limited social connection and engagement within the community as a barrier to accessing preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Here's what I see, you just be yourself, no one tells you anything. Everyone is busy with themselves.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-1).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Additionally, social interactions and community involvement tend to be minimal\u0026hellip;. Participation in community and volunteering activities is quite low, further limiting opportunities for social connection and engagement.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD2-P1).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section3\"\u003e \u003ch2\u003e3.5.4 Stigma associated with chronic disease\u003c/h2\u003e \u003cp\u003eChronic disease related stigma emerged as a significant community-level barrier to accessing preventive health care services both in Bangladeshi and Nepalese communities. Participants reported that community-wide stigma to share health-related information, fear of judgment, and shame hindering people\u0026rsquo;s seeking timely support and accessing preventive care services.\u003c/p\u003e \u003cp\u003eOne participant from the Bangladeshi community reported how stigma can delay people\u0026rsquo;s sharing of health-related concerns and information in community settings, creating a barrier to access preventive services for chronic disease.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It's a big barrier to going to the doctor plus a barrier to sharing information....It may take them a long time to think about sharing this topic. This attitude is strong among Bangladeshis.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-5)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eParticipants from the Nepalese community expressed how the fear of judgment or being isolated by family or community hinders people\u0026rsquo;s timely seeking of support.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;. but social stigma plays a significant role in the Nepalese community. Many individuals with mental health conditions prefer to remain unidentified and isolate themselves due to fear of being judged by their families, relatives, or community. This hesitation prevents them from seeking timely medical support.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-6)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eMoreover, participants from the Nepalese communities further expressed people\u0026rsquo;s perceptions towards chronic diseases and perceptions of being weak when people seek assistance, act as barrier to accessing preventive services for chronic disease.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The social factors play a big role in creating barriers within the Nepali community\u0026hellip;..This stigma can prevent many from accessing the care they need, and it\u0026rsquo;s something that could be addressed by fostering a more open and supportive environment where seeking help is seen as a sign of strength, not weakness.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD3-P6).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Policy-level barriers\u003c/h2\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003ch2\u003e3.6.1 Inadequate coverage of preventive services\u003c/h2\u003e \u003cp\u003eParticipants reported limited accessibility, visibility, and cultural relevance of the available preventive services as a barrier to accessing preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;These programs are not visible. Not particularly visible in community settings, and they lack accessibility. The main reason for the lack of accessibility is that they are not exposed. and not culturally acceptable at the community level.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMoreover, participants reported that the inconsistency of the available preventive services across geographical locations in Sydney was also identified as a barrier for people.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, there are free health education programs for diabetes management. However, the availability of these services can vary depending on the local council, authority, or GP.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-11).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section3\"\u003e \u003ch2\u003e3.6.2 Lack of patient-centric preventive care\u003c/h2\u003e \u003cp\u003eParticipants raised their concerns about the services being focused on advocacy and a top-down approach, rather than targeting and engaging community people who are in need. This highlights the disconnection between the present advocacy framework, existing service delivery and tangible community benefits.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;These programs are not just patient-centred services in New South Wales; they are more advocates. They do more advocacy, but they don't do much for the common people.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eFacilitators for accessing preventive services for chronic disease\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Individual-level facilitators\u003c/h2\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003e3.7.1 Self-awareness and ownership of health\u003c/h2\u003e \u003cp\u003eSelf-awareness and ownership of health were identified as facilitators for assessing preventive care. Some participants shared how self-awareness about chronic disease motivated them to engage in preventive activities.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If my diabetes goes above 9, I feel very sick. I see many going on 12/13, but I can't. My body tells me that my diabetes has increased, so I am forced to do so much. That\u0026rsquo;s why I am so aware.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-6).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003e3.7.2 Knowledge about available preventive services\u003c/h2\u003e \u003cp\u003eKnowledge about available preventive services appeared to be another important facilitator for accessing preventive services. A few participants shared their knowledge about available preventive services promoting their intention to access them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;As far as I know Metro Assist or the library sometimes conducts some sessions of yoga exercise, chair sitting type of activities for the elderly, long-term spine problems, diabetes problems\u0026hellip;\u0026hellip;Chair sitting activity, morning walk activity, these I have seen on behalf of Metro Assist plus the initiatives taken by Lakemba Library in the community.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD3-P4).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec35\" class=\"Section2\"\u003e \u003ch2\u003e3.8 Interpersonal level facilitators\u003c/h2\u003e \u003cdiv id=\"Sec36\" class=\"Section3\"\u003e \u003ch2\u003e3.8.1 Cultural and linguistic competency of the healthcare service providers\u003c/h2\u003e \u003cp\u003eSharing a similar cultural and linguistic background with the healthcare service providers was identified as a facilitator as cultural and linguistic similarity eased the communication between them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I find it easier to communicate with Nepalese GPs as we share the same language and cultural background.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-IDI-1).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section3\"\u003e \u003ch2\u003e3.8.2 Community-based peer-support and informal information navigation\u003c/h2\u003e \u003cp\u003eInformal peer support group and sharing of information was another facilitator at the interpersonal level. Participants described that casual social gatherings and group activities facilitate people\u0026rsquo;s experience and information sharing.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Social gatherings where people talk openly about chronic disease. There is a group of people who are diabetic. They will walk or do some activity together\u0026hellip;..then communication will be fine.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-7).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eParticipants further reported utilising informal peer groups, including family, friends, and peers, as a primary source to get preventive service-related information.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When someone in my family has a chronic condition, I usually seek advice from other senior Nepalese people or contact the hospital for information. This is what my family and I typically do.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD-P4).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec38\" class=\"Section2\"\u003e \u003ch2\u003e3.9 Institutional-level facilitators\u003c/h2\u003e \u003cdiv id=\"Sec39\" class=\"Section3\"\u003e \u003ch2\u003e3.9.1 Availability of multilingual health education resources and interpreter services\u003c/h2\u003e \u003cp\u003eParticipants reported that translated chronic disease-related education materials and the availability of interpreter services could ease access to the preventive services and recommended extending these services to the primary care for better communication.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is an interpreter, but there is no Bengali for various documents. Many leaflets, but if they are in Bengali, people can read and understand. A lot of information can be found.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P1).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec40\" class=\"Section3\"\u003e \u003ch2\u003e3.9.2 Digital and social media as source of information\u003c/h2\u003e \u003cp\u003eParticipants reported the utilisation of existing digital and social media to share information and raise awareness about chronic disease related preventive services, due to their ability to reach a larger number of people.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo; I believe social media is the most practical solution for spreading information\u0026hellip;\u0026hellip;.. By creating dedicated health-focused pages, we can share valuable information, tips, and resources directly with the community.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD-P3).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e Participants further reported that sending mobile SMS, which is already in use for informing different services, can be a useful way to reach people who have limited access or knowledge about internet use.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo; I think because everyone uses mobile phones. ...\u0026hellip;\u0026hellip;. \u0026hellip;.For them mobile SMS can be given in different languages, it can be helpful to pass information like we get for different things.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD3-P4).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe radio program was further identified as an effective way to raise awareness about preventive health services and available healthcare programs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Radio ads could be an effective way to raise awareness about preventive health services and available healthcare programs\u0026hellip;\u0026hellip;.who may not actively seek out information online or through pamphlets.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD-P6).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec41\" class=\"Section2\"\u003e \u003ch2\u003e3.10 Community-level facilitators\u003c/h2\u003e \u003cdiv id=\"Sec42\" class=\"Section3\"\u003e \u003ch2\u003e3.10.1 Community-led psychosocial support\u003c/h2\u003e \u003cp\u003eCommunity-led psychosocial support appeared to be a facilitator for coping with stigma, isolation, and psychological stress, and thus facilitating access to the preventive care services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.. Bangladeshis can give each other mental support. They can help in different ways. The help that I get. Many Bangladeshi brothers whom I don't even know visit me.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-IDI-11).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec43\" class=\"Section3\"\u003e \u003ch2\u003e3.10.2 Reorientation and utilisation of existing community organisations for preventive care\u003c/h2\u003e \u003cp\u003eMany participants reported that some community organisations mainly focus on fundraising for treatment as health-related support system. They emphasized reorientation of community organizations to facilitate preventive care service accessibility through awareness sessions, and navigation support.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;However, I believe these organizations tend to be more reactive than proactive. There is a need for them to focus more on raising awareness and actively advocating for health issues at the community level, rather than only responding to situations as they arise.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(Nepalese-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec44\" class=\"Section3\"\u003e \u003ch2\u003e3.10.3 Utilisation of existing community gatherings as a point of preventive care outreach\u003c/h2\u003e \u003cp\u003eSome participants pointed out different community festivals, gatherings, and community places e.g. schools, parks as a touchpoint for promoting preventive care services and facilitate access.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The Bangladeshi community has many festivals. There are various health promotion programs in these festivals, those who work with the community can provide booths. They can do community consultation within the booth. If you go to these places, you will get this service.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD2-P3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec45\" class=\"Section2\"\u003e \u003ch2\u003e3.11 Policy-level facilitators\u003c/h2\u003e \u003c/div\u003e \u003cdiv id=\"Sec46\" class=\"Section2\"\u003e \u003ch2\u003e3.11.1 Integrated service provision for immigrants\u003c/h2\u003e \u003cp\u003eSome participants mentioned about the importance of integrating available preventive services with existing social support services e.g. Centrelink, MediCare to promote better access.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Immigrants face multiple challenges as they move from one country to another\u0026hellip;..So, here, comprehensive patient-centred needs for immigrants need to be understood by the government. And these should be tagged with support services like Centrelink, MediCare.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(BD-FGD1-P3).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study comprehensively examined barriers and facilitators to accessing preventive care services at different levels among people of Bangladeshi and Nepalese origin living in Sydney, Australia which have significant implications for policy and practice.\u003c/p\u003e \u003cdiv id=\"Sec48\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Barriers to accessing preventive care services for chronic diseases\u003c/h2\u003e \u003cp\u003eCultural and religious perceptions of chronic disease, limited health literacy and awareness about chronic diseases, and limited focus on self-care emerged as individual level barriers to accessing preventive services, which is supported by prior literature. Studies conducted on South Asian and other CALD communities living in the UK, Canada, the US, and Australia reported challenges in navigating healthcare system due to limited health literacy \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. A previous study employed the socio-ecological framework to understand the uptake of cervical cancer screening services among Pakistani and Somali immigrant women and found that limited health literacy hindering the access \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Similarly, lack of awareness about the available preventive services also limits access to those services among South Asian migrants \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Moreover, aligned with prior studies conducted among South Asian migrants in Australia \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, present study also reported that work pressure, financial instability, and caregiving responsibilities often results in undermining self-care among the participants, limiting engagement with preventive care. These findings are consistent with the previous studies on South Asian communities in Australia \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Another critical barrier reported by both the Bangladeshi and Nepalese communities is the perception that accessing preventive care services may negatively impact their visa status, i.e., may not receive permanent residency if they are diagnosed with chronic conditions. These findings suggest promotion of culturally appropriate health education initiatives to improve health literacy and awareness on available health services \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAt the interpersonal level, language barrier with limited availability of multilingual health education materials and interpreter services were the key barriers to accessing preventive care services. Limited English language skills hinder communication, understanding materials written in English, and navigate complex health system, especially for those whose first language is not English \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. This finding aligns with previous research on South Asian migrants and CALD communities in Australia and other countries \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Although interpreter services and translated health education materials are available in various languages \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, this is limited for Bengali and Nepalese people in Australia. Community outreach activities and educational programs that include bilingual community health navigators, availability of onsite interpreter services and translated education materials in native languages \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e for Bangladeshi and Nepalese communities can effectively address these challenges. Moreover, lack of cultural understanding among health care service providers was identified as a barrier to accessing preventive care services, aligned with previous studies \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. The development of a culturally competent, empathetic framework \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e placing importance on providing care in a culturally appropriate manner is required. Training on culturally responsive training \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e can also result in improved cultural responsiveness amongst health service providers.\u003c/p\u003e \u003cp\u003eParticipants expressed challenges in accessing preventive services due to inadequate culturally tailored health information and navigation services. This finding is consistent with previous research findings among CALD communities in Australia \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Utilisation of bilingual community health navigators, and education materials available in the native languages, can be effective in alleviating these barriers. Inequitable public transport infrastructure and unavailability of after-hours services was also identified as institutional-level barriers to accessing preventive services. Unavailability of adequate public transports has often been cited as a major barrier impacting access to healthcare \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. These urges reorganizing the public transport infrastructure in collaboration with health policy makers, urban planners, and transport experts \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Unavailability of after-hours preventive service limits people\u0026rsquo;s ability to access the preventive services, especially those who have long working hours and are burdened with different household and care responsibilities. Although there are some available after-hours supports for primary and emergency care \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, preventive care services for chronic diseases are scarce in the Australian health system. The after-hours preventive service delivery model \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e can be considered for improving access to preventive services.\u003c/p\u003e \u003cp\u003eCommunity negligent attitude towards health appears to be a significant barrier at the community level to promote access to preventive services. Delayed health-seeking behaviour, views that occasional visit to health professionals are sufficient for managing chronic diseases and only accessing health care service during an emergency hinder accessing preventive care services. This behaviour aligns with South Asians\u0026rsquo; chronic health-related attitude of relying on a curative approach rather than a preventive approach \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Alongside this, a sense of limited social connection and engagement within the community has been identified as a barrier to accessing preventive care services. Strong community support and social network results in better participation to preventive services \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Individualistic lifestyle and work pressure lead to limited community participation and interpersonal communication, and social isolation, which can contribute to reduced flow of information and underutilisation of preventive services \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Community-wide stigma related to chronic disease is reported to be a critical barrier for accessing preventive services by majority of the participants. Fear of judgment, shame, and hesitancy to share health-related information is found in the South Asian communities. This may lead to delayed seeking and accessing preventive services \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Moreover, engagement with preventive services might be considered as a \u0026lsquo;sign of weakness\u0026rsquo;, hindering people\u0026rsquo;s access to preventive services in CALD communities \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Community-based and culturally appropriate health education programs may help to improve community attitudes towards and reduce stigma \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The formation of peer support groups can also be effective in improving community engagement and support, thereby improving access to preventive services \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Moreover, distance to health care facilities was also identified as a community-level barrier to access preventive services. Long distance to health care facilities, inadequate public transport system, and reliance on private vehicles influence people\u0026rsquo;s health care access behaviour \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Limited English language proficiency and poor communication skills add a layer of complexity in finding existing facilities and arranging transport, and the cost of transport acts as a barrier for CALD communities, especially for those who rely on public transport \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Transportation incentives, including bus passes, taxi vouchers, and free or reimbursed transportation costs, can help improving access to preventive services \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParticipants criticized the current preventive care services because of inadequate coverage and a lack of a patient-centric approach. Although CALD communities are a priority population for chronic disease prevention in Australia, the health system has not been able to serve the needs of the South Asian communities, especially Bangladeshi and Nepalese communities, completely. This highlights the need to develop a preventive care service model for chronic disease that will be culturally tailored, addressing the needs and voice of South Asian migrants, including the population from Bangladeshi and Nepalese origin.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFacilitators for accessing preventive care services for chronic disease\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants also noted several facilitators to accessing preventive services across all levels of the socioecological framework. Some participants pointed about individual self-awareness, ownership of health, and adequate knowledge about available preventive services as facilitators to accessing preventive care services. Prior research also document that providing importance to own health and having information on available services improve access to care \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCultural and linguistic competency of healthcare providers was identified as a facilitator at the interpersonal level. This finding aligns with studies conducted in South and Southeast Asian immigrants in Japan \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e and Pakistani and Somali immigrant women in Oslo \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Both studies utilising socio-ecological framework showed that cultural and linguistic competency of health service providers help address language barrier and improve communication to facilitate uptake of preventive services \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Peer support and informal navigation can serve as a trusted way of sharing information share and promoting behaviour change \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAt institutional level, availability of multilingual education resources and utilisation of digital and use of social media as a source of information were identified as facilitators for accessing preventive services. These findings are aligned with previous studies conducted on in South and Southeast Asian migrants \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e and Pakistani and Somali immigrants \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Availability of multilingual education resources facilitates the dissemination of information through trusted source and organisations \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e and can facilitate better access to care.\u003c/p\u003e \u003cp\u003eAvailability of community-led psychological support was identified as a facilitator for accessing preventive services. Psychological distress can hinder the utilisation of preventive care services \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e, and psychological support offered by community members is beneficial for improving access to preventive care. Participants from the Nepalese community critiqued the community organisation of not being focused on chronic disease prevention and suggested reorientation of community organisations to promote access to preventive care among community members. This is aligned with the findings of a qualitative study exploring the role of community organisations in improving access to community resources for chronic disease prevention and management \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Most of the participants emphasised utilisation of social gatherings to promote importance of accessing preventive services. Participants urged for integrated services for chronic disease prevention with other social support services, e.g. Centrelink services or Medicare. A comparable model in Canada, Accessing Canadian Healthcare for Immigrants: Empowerment, Voice \u0026amp; Enablement (ACHIEVE) program, has been proven successful for improved health care utilisation among immigrants \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Adaptation of this kind of immigrant-focused program in the Australian context may be beneficial for underexplored communities, e.g. Bangladeshi and Nepalese communities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec49\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Strengths and limitations of the study\u003c/h2\u003e \u003cp\u003eOur study is one of the first studies providing insights into the barriers and facilitators to accessing chronic disease preventive services faced by the South Asian migrants in Australia. Utilisation of FGD and IDIs provided opportunities to explore both communities' perspectives on the barriers to accessing preventive care. The established relationship between the research team and community representatives is a strength of the study, ensuring trust among the participants. This established relationship was also helpful in recruitment of diverse participants for FGD and IDIs. The FGDs and IDIs were conducted in the native languages of participants which ensured active participation of the study participants. However, this study only explores the perspective of Bangladeshi and Nepalese communities living in Sydney, therefore, the study findings may not be generalizable to the whole population from South Asian backgrounds and those from other parts of Australia. We could not conduct the IDIs face-to-face, which might limit richness in data that would be achieved by in-person interviews, despite all efforts to ensure participants\u0026rsquo; comfort in sharing their experiences. Moreover, Bangladeshi and Nepalese communities itself are very diverse, and we could not capture the intra-subgroup variations. This also highlights the importance of considering the heterogeneity of communities in preventive care design, rather than placing them under \u0026lsquo;South Asian Migrants\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis qualitative study sheds light on the barriers and facilitators to accessing preventive care services at different levels among Bangladeshi and Nepalese communities in Sydney. Several barriers identified at different levels such as cultural and religious perceptions, limited health literacy and awareness to language barriers, limited culturally and linguistically tailored support, community stigma and gaps in available preventive programs. Self-focus on health, peer support, cultural and linguistic competency of the service providers and use of digital and social media were some of the facilitators identified. The study highlights the importance of implementing multilevel, culturally appropriate, and community-based interventions to improve access to preventive care services among these disadvantaged population groups. Finally, policymakers and public health practitioners should focus on reframing the existing policy framework and practices to ensure equitable access to preventive care services among Bangladeshi and Nepalese communities in Australia.\u003c/p\u003e"},{"header":"6. Declarations","content":"\u003ch2\u003e6.1 Data availability statement\u003c/h2\u003e\n\u003cp\u003eThe data will not be shared publicly considering the privacy and anonymity of the participants.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e6.2 Conflict of interest disclosure\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest to disclose.\u003c/p\u003e\n\u003ch2\u003e6.3 Ethics approval statement\u003c/h2\u003e\n\u003cp\u003eThe study protocol was approved by University of New South Wales Human Research Ethics Committee (iRECS6554) in June 2024.\u003c/p\u003e\n\u003ch2\u003e6.4 Patient consent statement\u003c/h2\u003e\n\u003cp\u003eWritten informed consent was sought from the participants before data collection.\u003c/p\u003e\n\u003ch2\u003e6.5 Permission to reproduce material from other sources\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003e6.6 Clinical trial registration\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003e6.7 Acknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to acknowledge the support of community advisors of the Multicultural Healthcare Support Group, Sydney in recruitment of the study participants. We would also like to acknowledge Jasmine Mguizra, Team leader, Metro Assist for her help with organizing the venue for the FGD in Lakemba library premise and helping with recruitment of study participants.\u003c/p\u003e\n\u003ch2\u003e6.8 Funding\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis study was supported by a seed grant from the School of Population Health, UNSW Sydney, Australia.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003ePatient or Public Contribution\u003c/h2\u003e\n\u003cp\u003eStudy participants were not involved in the study design or conduct of study, analysis or interpretation of the data or in preparation of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare. Chronic Disease (2024) ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare (2023) Chronic health conditions among culturally and linguistically diverse Australians. AIHW, Canberra\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdhikari M, Kaphle S, Dhakal Y et al (2021) Too long to wait: South Asian migrants\u0026rsquo; experiences of accessing health care in Australia. BMC Public Health 21(1):1\u0026ndash;11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNisar M, Kolbe-Alexander T, Khan A (2024) Chronic diseases and their behavioural risk factors among South Asian immigrants in Australia. Aust Health Rev 49(1):1\u0026ndash;8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdulRaheem Y (2023) Unveiling the Significance and Challenges of Integrating Prevention Levels in Healthcare Practice. J Prim Care Community Health 14:1\u0026ndash;6\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health Disability and Ageing (2022) What we\u0026rsquo;re doing about chronic conditions. ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions#consultation-and-engagement\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions#consultation-and-engagement\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health Disability and Ageing. Managing chronic conditions (2020) ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/topics/chronic-conditions/managing-chronic-conditions#populationbased-health-screening\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/topics/chronic-conditions/managing-chronic-conditions#populationbased-health-screening\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 September 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health Disability and Ageing. Our work related to chronic conditions (2023) ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/topics/chronic-conditions/related-work\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/topics/chronic-conditions/related-work\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 September 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNisar M, Costa N, Kolbe-Alexander T, Khan A (2025) Exploring Healthcare Access Challenges Among South Asian Migrants in Australia: A Mixed‐Method Study. Health Promotion J Australia 36(2):1\u0026ndash;14\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlam Z, Deol H, Dean JA, Janda M (2022) Reasons behind low cervical screening uptake among South Asian immigrant women: a qualitative exploration. Int J Environ Res Public Health 19(3):1\u0026ndash;15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNisar M, Khan A, Kolbe-Alexander TL (2022) Cost, culture and circumstances\u0026rsquo;: Barriers and enablers of health behaviours in South Asian immigrants of Australia. Health Soc Care Commun 30(5):e3138\u0026ndash;e3149\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare (2025) Culturally and linguistically diverse Australians, vol 11. Australian Institute of Health and Welfare, aihw.gov.au, /2/2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubedi R, Kaphle S, Adhikari M et al (2022) First call, home: perception and practice around health among South Asian migrants in Melbourne, Australia. Aust J Prim Health 28(1):40\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJavanparast S, Naqvi SKA, Mwanri L (2020) Health service access and utilisation amongst culturally and linguistically diverse populations in regional South Australia: a qualitative study. Rural Remote Health 20(4):1\u0026ndash;15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLeroy KR, Bibeau D, Steckler A, Glanz K (1988) An ecological perspective on health promotion programs. Health Educ Q 15(4):351\u0026ndash;377\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyton D, Tsindos T (2023) Foundations of qualitative research\u0026ndash;paradigms, philosophical underpinnings. In: Berkovic DATTD (ed) Qualitative Research\u0026ndash;a practical guide for health and social care researchers and practitioners. Monash University\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTenny S, Brannan JM, Brannan GD (2025) Qualitative Study. \u003cem\u003eStatPearls.\u003c/em\u003e Treasure Island (FL). StatPearls Publishing LLC.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsindos T (2023) Theory in qualitative research. In: Berkovic DATTaD, ed. \u003cem\u003eQualitative Research\u0026ndash;a practical guide for health and social care researchers and practitioners.\u003c/em\u003e Monash University\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Creswell JD (2017) Research design: Qualitative, quantitative, and mixed methods approaches. Sage\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMistry SK, Harris E, Harris MF (2022) Scoping the needs, roles and implementation of bilingual community navigators in general practice settings. Health Soc Care Commun 30(6):e5495\u0026ndash;e5505\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBooth BJ, Zwar N, Harris MF (2013) Healthcare improvement as planned system change or complex responsive processes? A longitudinal case study in general practice. BMC Fam Pract 14:1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics (2021) Search Census data by country of birth. Canbera Australian Bureau of Statistics\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMistry SK, Harris E, Li X, Harris MF (2023) Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Serv Res 23(1):476\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77\u0026ndash;101\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith GD, Chaturvedi N, Harding S, Nazroo J, Williams R (2000) Ethnic inequalities in health: a review of UK epidemiological evidence. Crit public health 10(4):375\u0026ndash;408\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScheppers E, Van Dongen E, Dekker J, Geertzen J, Dekker J (2006) Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract 23(3):325\u0026ndash;348\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGele AA, Qureshi SA, Kour P, Kumar B, Diaz E (2017) Barriers and facilitators to cervical cancer screening among Pakistani and Somali immigrant women in Oslo: a qualitative study. Int J women's health :487\u0026ndash;496\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatri RB, Assefa Y (2022) Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 22(1):1\u0026ndash;14\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenderson S, Kendall E, See L (2011) The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health Soc Care Commun 19(3):225\u0026ndash;249\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenderson S, Kendall E (2011) Culturally and linguistically diverse peoples\u0026rsquo; knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Aust J Prim Health 17(2):195\u0026ndash;201\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNSW Health. NSW Health Care Interpreting Services (2024) ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.nsw.gov.au/multicultural/Pages/health-care-interpreting-and-translating-services.aspx\u003c/span\u003e\u003cspan address=\"https://www.health.nsw.gov.au/multicultural/Pages/health-care-interpreting-and-translating-services.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoberts DA, Abera S, Basualdo G et al (2021) Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants. PLoS ONE 16(5):1\u0026ndash;13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHannawa AF, Wu AW, Kolyada A, Potemkina A, Donaldson LJ (2022) The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. Patient Educ Couns 105(6):1561\u0026ndash;1570\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatri RB, Assefa Y (2023) Drivers of the Australian health system towards health care for all: a scoping review and qualitative synthesis. Biomed Res Int 2023(1):1\u0026ndash;19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSyed ST, Gerber BS, Sharp LK (2013) Traveling towards disease: transportation barriers to health care access. J Community Health 38(5):976\u0026ndash;993\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health and Aged Care (2024) A better after-hours system. Department of Health and Aged Care, Canberra\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlarup L, Moth G, Christensen MB, Vestergaard M, Olesen F, Vedsted P (2014) Daytime use of general practice and use of the Out-of-Hours Primary Care Service for patients with chronic disease: a cohort study. BMC Fam Pract 15(1):1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqui F, Hewitt C, Jennings H et al (2024) Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review. PLOS Global Public Health 4(1):e0001668\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFufaa GD (2024) The Role of Preventive Health Care in Preventing Chronic Diseases. In: Ozminkowski RJ (ed) International Perspectives and Experiences Enhancing Access to Healthcare. IntechOpen, Rijeka\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinnathurai R (2025) Addressing mental health within the South Asian community. ; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scientianews.org/articles/psychology/addressing-mental-health-within-the-south-asian-community\u003c/span\u003e\u003cspan address=\"https://www.scientianews.org/articles/psychology/addressing-mental-health-within-the-south-asian-community\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 29 July, 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKara BH, Khawaja NG (2024) Wellbeing programs for culturally and linguistically diverse population in Australia: barriers and improvements. Australian Psychol 59(3):200\u0026ndash;211\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanaite AC, Desroches OA, Warren \u0026Eacute;, Rouly G, Castonguay G, Boivin A (2024) Engaging with peers to integrate community care: Knowledge synthesis and conceptual map. Health Expect 27(2):e14034\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMseke EP, Jessup B, Barnett T (2024) Impact of distance and/or travel time on healthcare service access in rural and remote areas: A scoping review. J Transp Health 37:101819\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarbird LE, DiMaina C, Sun CA, Han HR (2019) A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases. J Community Health 44(2):400\u0026ndash;411\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhahari S, Burnett S, Alexander L (2020) Development and pilot testing of a health education program to improve immigrants\u0026rsquo; access to Canadian health services. BMC Health Serv Res 20(1):1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuoka S, Kharel M, Koto-Shimada K et al (2022) Access to Health-Related Information, Health Services, and Welfare Services among South and Southeast Asian Immigrants in Japan: A Qualitative Study. Int J Environ Res Public Health ;19(19)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThorpe JM, Kalinowski CT, Patterson ME, Sleath BL (2006) Psychological Distress as a Barrier to Preventive Care in Community-Dwelling Elderly in the United States. Med Care 44(2):187\u0026ndash;191\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen KH, Fields JD, Cemballi AG et al (2021) The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Family Med 34(4):1\u0026ndash;11\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"cbc9bb94-fad4-4d92-b196-35bd00e1dd33","identifier":"10.13039/501100001773","name":"University of New South Wales","awardNumber":"Not Applicable","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of New South Wales","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Barriers, facilitators, chronic diseases, preventive care services, people from Bangladeshi and Nepalese origin, Australia","lastPublishedDoi":"10.21203/rs.3.rs-8384471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8384471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeople from South Asian backgrounds, including those of Bangladeshi and Nepalese origin, have a disproportionate burden of chronic diseases, i.e., diabetes and cardiovascular diseases. While preventive services are essential, these population groups demonstrated limited access to existing preventive services in Australia. The present study explored the barriers and facilitators to accessing preventive care services among people from Bangladeshi and Nepalese origins living in Sydney, Australia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative study was conducted following the constructivist paradigm, where realities are constructed on the lived experiences of the participants. Six focus group discussions (FGDs) and 22 in-depth interviews (IDIs) were conducted during August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney. FGDs and IDIs were conducted in participants\u0026rsquo; language, transcribed, translated into English, and thematically analysed. The barriers and facilitators at different levels were structured following the socio-ecological framework.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeveral barriers and facilitators were identified across different levels of the socioecological framework. Individual-level barriers included cultural and religious perceptions, limited health literacy, and a lack of awareness of preventive services. Interpersonal barriers included limited English language skills, a lack of translated health education materials and interpreter services and limited cultural understanding among health service providers. Community-level barriers involved chronic disease-related stigma and lack of community engagement. Institutional and policy barriers included limited culturally tailored support and infrequent public transport to health facilities. Conversely, facilitators included self-awareness and ownership of health, knowledge about available preventive services, peer support, cultural and linguistic competency of health care providers, use of digital and social media for health information sharing, and the role of community organisations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings suggest implementing multi-level, culturally tailored, community-led interventions leveraging community and social engagement platforms to ensure adequate access to available preventive services for chronic diseases among these disadvantaged population groups in Australia.\u003c/p\u003e","manuscriptTitle":"Barriers and facilitators to accessing preventive services for chronic diseases among people from South Asian backgrounds living in Sydney","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 10:19:48","doi":"10.21203/rs.3.rs-8384471/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bac37c19-043a-45b5-b750-77ff64bea23b","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59851070,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-12-22T10:19:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 10:19:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8384471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8384471","identity":"rs-8384471","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}