Background <p>The challenges in managing and treating the growing numbers with chronic ill health are often exacerbated in minoritized, isolated, and economically marginalized communities (“underserved populations”). One approach that has the potential to address persistent health inequalities in these populations is health and wellbeing coaching. Its ability to offer flexibility of timing and location, equitable communication, tailored content, and cultural congruency mean it is well-suited to engage with populations that mainstream care fails to adequately engage. To help understand the extent to which this is the case, this review will systematically explore the perspectives and experiences of health and wellbeing coaching amongst underserved populations, with the intention of identifying and exploring barriers and facilitators to its success and where possible suggesting practical strategies for improving its effectiveness and impact.</p> Methods <p>Electronic databases including Medline/PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, PsycINFO, Cochrane Library and EMBASE were consulted. Included studies were qualitative, conducted in underserved populations with adults &gt; 18yrs (i.e. rural areas, ethnic minorities, lower socioeconomic backgrounds, and other disadvantaged groups); where the interventions were categorised as health and wellbeing coaching delivered by trained coaches. The results are presented in an amended version of the Theoretical Framework of Acceptability.</p> Results <p>A total of 483 studies were identified with nine included in the review from four different countries. In summary, participants were satisfied with health and wellbeing coaching noting the strength and value of their equitable relationship with the coach, how external responsibilities and economic pressures limited engagement; the benefits of demographically similar coaches that met linguistic and cultural preferences. The flexibility afforded by hybrid mHealth interventions was broadly welcomed, with the interventions tending to be successful in delivering notable change to mutually agreed goals.</p> Conclusions <p>The techniques used in the identified studies reflect the strategies recommended in overcoming inequalities in access and utilisation of health and social care in a range of settings and the use of health and wellbeing coaching appears to offer viable and practical means of supporting lifestyle change and improving self-management.</p> Trial registration <p>The review was registered on PROSPERO registration CRD42023472159.</p>