**Background:** The COVID-19 pandemic exposed a critical health literacy gap for refugee, immigrant, and migrant (RIM) populations, who faced barriers including limited English proficiency, low health literacy, mistrust of authorities, and lack of culturally and linguistically responsive messaging. Clarkston, Georgia—a refugee resettlement community where approximately half of 17,000 residents are foreign-born and more than 60 languages are spoken—exemplified these challenges. Residents faced substandard social determinants of health including high unemployment, low income, limited health insurance, densely populated housing, and poor digital access. Almost 70% of Clarkston’s residents did not know where to go or how to access social support benefits. The authors aimed to use a systematic approach grounded in community-based participatory research (CBPR) principles, CLAS standards, and plain language health literacy guidelines to improve understandability and usability of COVID-19 messaging.
**Methods:** The work was conducted through the Clarkston Community COVID-19 Task Force, a volunteer group meeting weekly that included representatives from health clinics, resettlement agencies, the CDC-funded Prevention Research Center (PRC), local government, the board of health, community residents, and academic partners from Georgia State University. Three frameworks guided the work: CBPR principles (engaging community as equal partners), the 15 national CLAS standards for cultural and linguistic responsiveness, and health literacy universal precaution guidelines (using plain language for every message). The materials development team included faculty from the Adult Literacy Research Center and PRC, plus undergraduate and graduate students with lived experience of forced migration. Following CDC's 'Simply Put' guidelines, draft messages prioritized the most important information first, limited the number of messages, described actionable steps, and avoided jargon. Materials used 12–14 point font, dark ink on light background, adequate white space, and culturally relevant visuals. Each document was assessed using the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability in English. Prior to translation, messages were reviewed with student assistants who were members of the intended audience. Translations were performed by community members or professional translators, and reviewed again by students and community members for accuracy.
**Key Results:** Multiple products were developed: (1) 'Answers to Coronavirus' booklets in English and seven other languages (Arabic, Amharic, Burmese, Nepali, Spanish, Swahili, Tigrinya), framing myth-dispelling as 'This is what I heard' followed by the dispelling statement; hundreds were distributed at clinics, testing sites, childcare centers, and van-share locations. (2) Plain-language information cards distributed with more than 20,000 PPE kits door-to-door in high-density apartment complexes. (3) 'Protect Clarkston' and 'Vaccinate Clarkston' lawn signs—250 signs in six languages placed on highly trafficked routes. (4) 60-second 'You should get a COVID-19 vaccine' animated videos translated into 20 languages. (5) Vaccine Ambassador flyers targeting five ethnic/linguistic communities (Arabic, Swahili, Dari/Pashto, Somali, Burmese); 12 unique flyers were created. (6) 'Get Your Vaccine Today' bus stop posters on MARTA shelters featuring seven trusted community sources; the QR code was accessed 26 times in four weeks, with over 530,000 views of the posters during the same period. The authors note that vaccine rates in Clarkston outpaced other similar areas of the county and state due to this broad community-wide effort.
**Clinical Implications:** This case study demonstrates that a rigorous, systematic approach integrating health literacy universal precautions, CLAS standards, and CBPR principles can produce accessible, trusted health information for RIM communities even during a rapidly evolving crisis. Key lessons include: (1) taking time to develop health-literate materials despite urgency; (2) ensuring community collaboration for scientific accuracy, cultural sensitivity, and linguistic responsiveness; (3) using flexible, multi-channel dissemination (print, social media, WhatsApp, listservs, bus stop posters); (4) recognizing that translation alone does not ensure understandability—community input is critical; (5) prioritizing print materials over digital for populations with limited digital access and literacy; and (6) building on established relationships of trust. The authors emphasize that this approach, while expensive and time-consuming, is critical for reaching community members least able to access trusted information, and should be applied to other health inequities and social determinants of health.