As ethnic diversity in Britain continues to grow, so do the health needs in a society with many different ethnic backgrounds, including the need for personalised healthcare. Studies show that people from ethnic minority groups are at a higher risk of illness and death compared to white people with the same health issues.

For example, ethnic minority individuals have strokes five years earlier than white people and are at greater risk of serious problems, including an increased risk of falling. These differences are made worse because people from ethnic minority communities are less likely to use or engage with healthcare interventions delivered in the community, which increases health inequalities.

Ethnic minorities have a greater susceptibility to falls because they are likely to have underlying health issues, such as high blood pressure and diabetes. We do not have enough evidence on what treatment can stop these falls. Older adults who fall can get hurt and may even die from their falls. Research hasn't found the best ways to prevent falls for ethnic minorities, because often, they are underrepresented in the study. The NHS wants to transform care delivery by providing more care in the community rather than in hospitals, by using more digital tools instead of paper methods and focusing more on keeping people healthy rather than just treating sickness. This means healthcare services need to be designed to meet the specific needs of different ethnic groups when they are provided at home or in community centres. This qualitative study is classified into two phases. The purpose of Phase 1 of the study is to understand how people from ethnic minority backgrounds feel about accessing healthcare delivered to them at home or in community centres, with the view to identifying how to help them participate in these services. Semi-structured interviews, focus groups or informal conversations will be conducted with adults from Asian, Black African, Black Caribbean, or Mixed ethnic backgrounds. The study aims to find out what changes can be made to better meet their needs. Phase 1 will explore broad areas of health due to health inequalities in diagnosis and treatment outcomes for the ethnic minority population. This will help understand the relevant factors to consider when delivering interventions. Phase 2 of the study will focus on falls prevention intervention due to the greater susceptibility to falls among ethnic minorities. A range of people deliver falls prevention in the community, for example, exercise instructors, personal trainers, support workers, nurses, AHPs, falls leads, community groups coordinators, etc. A semi-structured interview will be conducted with people delivering falls prevention interventions in the community to explore their experiences of providing tailored treatment to ethnic minorities.

BACKGROUND AND RATIONALE

As the diversity of Britain continues to grow, so are the health challenges of a multi-diverse society, including the delivery of individualised healthcare (Blake 2024). With the NHS 10-year plan focusing on moving care "from hospital to community, from analogue to digital, and from a focus on sickness to a focus on prevention" (GOV.UK 2025), there is a need for healthcare interventions to be tailored to ethnic minorities needs to mitigate disparities in treatment outcomes (Khunti et al. 2023; Morales and Ali 2021; Tai et al. 2021; Kirby 2020; Gill et al. 2013) and inequity in the safety of healthcare (Wade 2023) as shown in the greater COVID-19 burden experienced by ethnic minorities and the limitation in the effectiveness of interventions for this population (Oskrochi et al. 2023). Despite this knowledge, ethnic minorities are underrepresented in health intervention research (Kayani et al. 2024). They are less likely to engage with healthcare interventions delivered in the community (Smart and Harrison 2016), exacerbating health inequalities that exist (The King's Fund 2024).

Evidence suggests people from ethnic minority backgrounds have a higher risk of morbidity and mortality than white people from cardiovascular diseases such as stroke, heart disease, peripheral arterial disease and aortic disease (Cousins 2024; Razieh et al. 2022). For example, the onset of stroke in ethnic minority individuals is five years earlier than their white counterparts and is twice as common in black populations (Stroke Association 2016) with higher risk of severe adverse outcomes (Fluck et al. 2023), leading to multiple long-term unmet needs (McKevitt et al. 2011), including increased risk of falling (Denissen et al. 2019; NICE 2025). According to Haagsma et al. (2020) report, there is an increased incidence of fall-related injuries requiring healthcare intervention for older adults and increased death rates due to falls. From the existing evidence, there are inconclusive findings to determine the optimum falls prevention interventions (Winter et al. 2013). These studies more often than not fail to report ethnicity data (Nanavati et al. 2024).

Ethnic minorities face higher fall risks (Wehner-Hewson et al. 2022) due to the prevalence of hypertension and diabetes (Freire et al. 2024). Koh et al. (2023) highlighted the interrelationship factors that enable and/or prevent implementation of falls prevention programs in the community. This aligns with World Falls Guidelines, which recommend a tailored multidomain approach to assessing falls risk and implementation of preventative measures (Montero-Odasso et al. 2022). There is an indication that effective implementation of falls prevention intervention requires a multifaceted approach, including collaboration between healthcare professionals, individuals and their support system (Ong et al. 2024), in addition to accessibility of the falls programme (Barmentloo et al. 2020).

This qualitative study is component two of the larger doctoral project exploring ' how falls prevention interventions could be adapted to provide tailored treatment to ethnic minority adults accessing healthcare interventions delivered at home or in community centres. This protocol only refers to this component of the overarching project. The overall doctoral study has three components, which include: a qualitative systematic review (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251003414), a qualitative study and a co-design workshop with iterative and participative action research. Findings from one component will inform the other to help identify whether healthcare interventions delivered at home or in community centres need to be adapted to meet the needs of ethnic minorities.

The aim of the qualitative study (phase 1) is to explore the views and lived experiences from the perspectives of the ethnic minority population accessing healthcare interventions delivered at home or in community centres, and how their participation in healthcare interventions in their own homes or community centres could be supported. Phase 2 of the study aims to explore the experiences of individuals delivering falls prevention interventions in the community.

The data collection methods for phase 1 are semi-structured interviews, focus groups and informal conversational interviews and semi-structured interviews for phase 2. Undertaking semi-structured interviews, focus groups and having informal conversations provides an opportunity for different cultural and religious requirements to be explored, surfacing ways to improve cultural competence. These qualitative methods can help capture differences in opinion and experiences, providing essential deeper insights into real-world situations (Tenny et al. 2022). It will help drill into the multi-faceted and complex nature of healthcare interventions research delivered in the community, its benefits, challenges, and implementation.

Furthermore, a qualitative study is an ideal method for developing partnerships, gaining trust, and building concepts that work for the community. It will provide an understanding of the support required by ethnic minorities to engage in healthcare interventions and assess the inequalities in accessing healthcare interventions delivered in the community. It will help probe into the social, cultural and behavioural nuances. A narrative approach will be used to present the perspectives of the participants (Tenny et al. 2022; Cleland 2017).

The potential risk for this study could be participants sharing sensitive, embarrassing or upsetting information or other disclosures requiring safeguarding action. Another possible risk is that focus group participants may disclose personal information or what has been said in the focus group once the study is over. The researcher(s) will remind participants to respect each other's privacy and maintain confidentiality, and that it is prohibited to repeat anything that has been discussed during the study conversations outside of the study.

It is recognised that findings from this study may not be generalizable to all populations. However, contextual depth will provide rich and valuable insights for healthcare interventions delivered in people's homes or community centres.

The population to be studied in Phase 1 is ethnic minorities. According to the GOV.UK (2024), ethnic minorities refers to all ethnic groups except white British group in the UK. In the context of this study, ethnic minorities include Asian ethnic groups, Black African, Black Caribbean, and people with a Mixed ethnic background. This study will focus on this population because of ethnic inequality in diagnosed illness among this group (The Health Foundation 2025) and increased risk of falling (Wehner-Hewson et al. 2022). The study will seek a diverse group of participants, including individuals from both genders and various ethnic minority groups. In Phase 1, participants information will be provided to all potential participants in an easy-read format to make it accessible to people with language barriers or learning disabilities. The study summary videos are in English and Urdu to facilitate inclusion. A University of Nottingham approved interpreter will be used if required. In Phase 2, the population to be studied is individuals delivering falls prevention interventions in the community, for example, exercise instructors, personal trainers, support workers, nurses, AHPs, falls leads, community groups coordinators, etc. They will be provided with study information using a standardised University of Nottingham template.

Phase 1:

Inclusion Criteria:

• Ethnic minority individuals
• Adults aged 18 and over
• Never accessed or accessed or used or declined health intervention
• Able to provide informed consent
• Lives in their own home or living with family/ friend or supported living facilities
• Lives in the United Kingdom at the time of study participation

Exclusion Criteria:

• Patients in hospital admissions
• Adults living in care homes

Phase 2:

Inclusion criteria:

• Individuals delivering falls prevention interventions in the community, for example, exercise instructors, personal trainers, support workers, nurses, AHPs, falls leads, community groups coordinators, etc.
• From any ethnic background
• Adults aged 18 and over
• Able to provide informed consent

Exclusion criteria:

• Provides falls prevention intervention only to inpatients, or in hospital settings, or in care homes
• Lives outside of the United Kingdom at the time of study participation

In Phase 1, up to 30 individuals from ethnic minority backgrounds (Asian, Black African, Black Caribbean, and people with a Mixed ethnic background) will be recruited into the study. In Phase 2, up to 15 individuals delivering falls prevention intervention in the community, irrespective of ethnic background, will be recruited.

To ensure a diverse sample, the following attributes will be purposively sought:

• Participants from both genders.
• Participants from different ethnic minority groups will be identified through self-identification.
• Adults who receive or deliver healthcare intervention at home or in community settings identified through self-identification.
• Adults who declined healthcare intervention at home or in community settings identified through self-identification.
• Support will be provided to participants who speak little English, have aphasia or a learning disability to take part in the study if they have the capacity to provide informed consent.

All data will be from qualitative interviews, therefore they are not suitable for IPD meta-analysis.