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Effective Strategies for Health Education in Immigrant and Refugee Communities

Two women in traditional West African clothing look together at information on a laptop

With over 47 million foreign-born people in the U.S. and more than 20% of the population speaking a language other than English at home, language and cultural barriers significantly impact both comprehension and health-seeking behavior. However, creating health education materials that reach immigrant and refugee communities requires more than translation. 

Traditional public health campaigns often lack the cultural nuance necessary for reaching diverse audiences. The MHI team published a manuscript in the Journal of Health Promotion Practice that describes two complementary approaches used by MHI that show promise for addressing this gap: community-informed design and community codesign.

Use Community-Informed Design for Scale and Efficiency

When responding to health emergencies or addressing widespread health needs, organizations need approaches that balance cultural relevance with rapid development. Community-informed design offers a systematic framework through six key steps:

  1. Listen to communities to understand their preferences and concerns. 
  2. Write content that incorporates community feedback while following plain language principles and medical guidance. 
  3. Design materials using culturally appropriate imagery and formats. 
  4. Translate rigorously using professional translators and multiple layers of review. 
  5. Validate translations and design elements with community members for accuracy and relevance.
  6. Scale by providing customizable templates to trusted messengers.

The advantage of this approach lies in its efficiency. By creating open-source templates, organizations enable community health workers, caseworkers, and other intermediaries to adapt materials for their specific contexts while maintaining medical accuracy. In practice, this approach can result in impressive campaigns that serve communities well:

  • COVID-19: The Get Vaccinated and Get the Facts campaigns advocated for COVID-19 testing and vaccination in more than 40 languages.
  • Mental Health and Stress: MHI and the International Rescue Committee designed this health education collection for Afghan newcomers using cultural references like kite flying and the role of religious leaders.
  • Protect Your Family: MHI’s newest campaign, which promotes hepatitis B vaccination and screening, engaged a cohort of community leaders representing 10 countries and 11 languages to inform campaign strategy.

Community Codesign for In-Depth Local Needs

MHI has partnered with IDEO.org, a nonprofit design firm, in using human-centered design to codesign campaigns and toolkits in partnership with affected communities. Community codesign shifts decision-making authority to communities themselves. Rather than asking for feedback on draft materials, organizations facilitate processes where communities take the lead. This approach involves three phases:

  • Inspiration: Facilitated workshops equip communities to lead discussions without the need to prepare in advance – respecting their expertise as well as their time.
  • Ideation: Equipping communities to test ideas with their peers gives them control over how organizations receive community feedback.
  • Implementation: Community members provide guidance on how to adapt a hyperlocal campaign for use in other geographies, health conditions, or contexts. 

While this approach results in a much more relevant product, it is very resource intensive. Codesign requires more time upfront and the reality that different communities may prefer different formats and messaging. However, the outcome is materials that communities genuinely own and are motivated to disseminate. For example: 

  • Health meetup groups: MHI created Mothers x Mothers with IDEO.org and Refugee Women’s Network using a codesign process, which culminated in a toolkit for organizations to create health-themed meetup groups for immigrant and refugee mothers.
  • Dialogue guide: MHI worked with IDEO.org and several community health workers and healthcare providers to codesign a Hepatitis B Dialogue Guide, designed to support providers in counseling immigrant and refugee patients about hepatitis B vaccination and screening.
  • Youth engagement: MHI worked with IDEO.org, three youth ambassadors from the International Rescue Committee, and five members of a Youth Design Collective to codesign #NoJudgment, a set of tools that engage young people in COVID-19 vaccine promotion

Implementation Considerations

An evaluation commissioned by MHI found that these approaches work effectively when used together. Community-informed design addresses the need for rapid, wide-reaching materials, while community codesign creates culturally specific campaigns with strong community ownership.

Both approaches require genuine investment: compensating community members for their expertise, building relationships proactively, and recognizing that communities understand their needs and preferences better than external organizations. While more resource-intensive than standard translation services, these approaches offer a practical framework for organizations committed to addressing health inequities in immigrant and refugee communities.