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

Background: People from Bangladeshi and Nepalese origin living in Australia experience a disproportionate burden of chronic diseases, such as diabetes and cardiovascular diseases. Although preventive services are essential to reduce the burden of chronic diseases, existing evidence indicates that these communities encounter unique migration, socioeconomic and health system-level challenges that impede their access to existing preventive services in Australia. The present study therefore explored the barriers and facilitators to accessing preventive care services among people of Bangladeshi and Nepalese origin living in Sydney, Australia. Methods: This qualitative study was conducted within a constructivist paradigm, which recognizes that realities are constructed through participants' lived experiences. Six focus group discussions (FGDs) and 22 in-depth interviews (IDIs) were conducted between August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney, Australia. FGDs and IDIs were conducted in participants' native language, transcribed verbatim, translated into English and thematically analysed. The identifed barriers and facilitators to accessing preventive services were organized across multiple levels using the socio-ecological framework. Results: Several barriers and facilitators relevant to the contextual experience of people from Bangladeshi and Nepalese backgrounds were identified across multiple levels of the socioecological framework. At the individual level, key barriers included cultural and religious perceptions, limited health literacy and low awareness of available preventive care services. Interpersonal barriers included limited English language proficiency, inadequate availabilty of translated health education materials and interpreter services, and limited cultural understanding among health care providers. Community-level barriers comprised chronic disease-related stigma and low level of community engagement. At the institutional and policy levels, barriers included limited culturally tailored support services and infrequent public transport to health care facilities. Conversely, facilitators across these levels included self-awareness and personal ownership of health, knowledge of available preventive services, peer support network, cultural and linguistic competence of health care providers, the use of digital and social media for health information dissemination, and the supportive role of community organisations. Conclusion: These findings suggest the need for implementing multi-level, culturally tailored, community-led interventions that leverage existing community and social engagement platforms to ensure equitable access to available preventive services for chronic diseases among these disadvantaged population groups in Australia. Patient or Public Contribution: Study participants contributed to research by sharing their lived experiences of accessing preventive services for chronic diseases. The shared linguistic and cultural backgrounds between the researchers and participants helped rapport-building and supported in-depth exploration of the complex factors influencing access to preventive care. Participants provided valuable insights through participating in IDIs or FGDs, which formed the basis of the study findings. However, participants were not directly involved in the study design or conduct of the study, data analysis or interpretation or manuscript preparation.