Assessing and managing risk are central to participation in preventive health checks, as the purpose is to identify adverse health behaviours and risk factors. Drawing on the cultural theory of risk, we explore why people without formal education participate in preventive health checks and discuss how this is related to their understandings of risk and health. With this aim, we conducted semi-structured qualitative interviews with people without formal education who participated in the intervention study Check-in. Check-in evaluated the effect of an invitation of people aged 45–64 without formal education beyond lower secondary school (grades 7–9) to a prescheduled preventive health check in general practice. In this way, Check-in provided the empirical context of this study. Within our analysis we identified four participation styles representing different ways of participating in preventive health checks: 1) selective participation, 2) participation to control uncertainty, 3) feeling an obligation to participate and 4) participation to change the healthcare system. Across the participation styles, we found that participants attended the preventive health check for reasons other than getting help to change their health behaviour and that the accounts of participation were socially embedded. Participants ascribed and assessed risk and health in relation to their immediate network and everyday lives and thereby presented risk perceptions differently from the general preventive messages. From these findings we suggest that preventive health checks should be based on participants’ context-dependent needs.