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Background: Culture on Prescription (CoP) initiatives have been identified as a potentially effective, community-based approach to supporting mental health and wellbeing. Nevertheless, disparities in access and retention persist, particularly among individuals confronted with socioeconomic or geographic disadvantages.

Objectives: The present study investigates the barriers and facilitators that shape equitable participation and retention in the CoP programme implemented in Alentejo Central. The study examines how demographic, contextual, and institutional factors influence continuity.

Methods: The qualitative arm of the mixed-methods design comprised semi-structured interviews with CoP participants and focus groups with healthcare professionals, link workers and cultural facilitators. The transcripts were coded in MAXQDA following a deductive-inductive thematic procedure informed by the RADIANCE framework. The credibility of the research was established through triangulation and member checking.

Results/Insights: Facilitators of equitable engagement included relational trust, culturally relevant artistic offerings, flexible scheduling, and supportive guidance from link workers. The primary barriers identified included transport and mobility constraints in rural areas, socioeconomic vulnerability, administrative fragmentation, stigma surrounding mental health, and unequal visibility of referral pathways. Equity was found to be associated with both the existence of opportunities and the implementation of targeted inclusion strategies, which involved actively reaching underserved populations.

Conclusion/Implications: Achieving fairness in CoP participation necessitates structural attention to organisational design, resource distribution, and governance mechanisms. The findings support the advancement of equity-sensitive cultural prescribing models, the strengthening of cross-sector collaboration, and the informing of policy strategies that embed culture as an accessible, non-stigmatising public health resource.