Lessons Learned From TranslateCovid,a Multilingual Online Resource Hub for Asian American and Pacific Islander Communities and Beyond

Abstract

The COVID-19 pandemic exacerbated health disparities among immigrant communities. Delivering accurate information and addressing misinformation on protective measures and vaccination to linguistically disadvantaged groups was critical for mitigating the effects of the pandemic. One group that was especially vulnerable to miscommunication about COVID-19 was non–native English-speaking immigrants. To address these disparities, the Asian American Studies Center and the Fielding School of Public Health at the University of California, Los Angeles, partnered to create a multilingual resource hub, TranslateCovid.org, to disseminate credible and reliable information about COVID-19 safety measures, the science behind the vaccines, and vaccine safety. We identified >1300 verified resources in 60 languages from government, academic, and nonprofit organizations and reposted them on the TranslateCovid website. We also developed public service announcement videos on handwashing, use of face masks, and social distancing in 10 languages and a fact sheet for frequently asked questions in 20 languages. We used a participatory approach to develop strategies for disseminating these resources. We discuss lessons learned, including strategies for forming government, community, and academic partnerships to support the timely development and dissemination of information. We conclude with a discussion on the unique role of universities in promoting equitable access to public health resources among immigrant communities in times of crisis.

Racial and ethnic minority groups and immigrant communities have borne a disproportionate burden of COVID-19 cases, hospitalizations, and deaths.^1-3 Crowded living conditions, poor health status (prepandemic), and the lack of access to health care are some of the reasons for these racial and ethnic disparities.^4,5 Linguistic barriers to timely and accurate information about protective measures and vaccines also contribute to health disparities.^6,7 This case study describes a collaborative effort initiated by 2 academic departments in response to a need for linguistically appropriate COVID-19 information for non–English-speaking immigrant communities.

Early in the COVID-19 pandemic, misinformation about the novel coronavirus spread at an unprecedented rate.^8-10 Non–native English speakers in the United States who had access to the internet also encountered inaccurate and misleading information in their native languages. ¹¹ A statement issued by the World Health Organization and other international partners noted that “the technology we rely on to keep connected and informed is enabling and amplifying an infodemic that continues to undermine the global response and jeopardizes measures to control the pandemic.” ¹² To counter the effects of misinformation, government and academic organizations attempted to disseminate accurate information about the virus and protective measures in multiple languages through the internet. Despite these efforts, at least 3 major barriers prevented timely access to COVID-19 information for non–native English-speaking communities. First, the lack of a pandemic communications infrastructure hampered the timely development and dissemination of culturally and linguistically appropriate materials for non–native English speakers and the coordination of any attempted efforts. ¹³ Second, groups such as adults aged ≥65 years and people with disabilities faced technology barriers to accessing information on the internet.^14,15 Third, trust in government was often lacking, allowing for inaccurate information to spread quickly. ¹⁶

Our case study took place in Los Angeles County, one of the most diverse regions in the United States. With a population of nearly 10 million, of whom about 34% are non–US- born and 27% “speak English less than very well,” ¹⁷ the county found it especially challenging to disseminate timely and accurate COVID-19–related information to residents with limited English proficiency (LEP). LEP is defined as individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, and understand English. LEP affects >2.2 million people residing in Los Angeles County, with the largest LEP groups speaking Spanish, Chinese, Korean, Armenian, Vietnamese, and Filipino/Tagalog. ¹⁷

The objective of this project was to gather and share reliable COVID-19 information for multilingual communities.

Methods

In March 2020, alumni from the University of California, Los Angeles (UCLA), reached out to UCLA faculty asking if they knew of reliable COVID-19 informational materials available for non–English-speaking populations. The Los Angeles County Department of Public Health (LACDPH) and other government agencies, such as the Centers for Disease and Control and Prevention, had some capacity to translate COVID-19 materials into Spanish but less capacity for the variety of Asian languages spoken in Los Angeles County. Given the urgency of these requests, a group of faculty and staff from the Asian American Studies Center (AASC) and the Fielding School of Public Health at UCLA convened in April 2020 and identified the following needs for increasing access to COVID-19 information among non–native English-speaking populations:

• • Credible, accurate, culturally resonant, easy-to-understand, and updated COVID-19 information in the languages of the largest linguistically isolated groups in Los Angeles County. ¹⁷

• • Timely dissemination of accurate information to the sociodemographic groups with the greatest need for such information, including older adults, people with disabilities, and people with no or poor access to the internet, by organizations trusted by the specified communities.

Representatives from community-based organizations (CBOs) and local public health departments identified 2 strategies to address these needs: (1) an online multilingual resource hub and (2) regular social media postings of messages in the languages of the most linguistically isolated groups in Los Angeles County. The multilingual resource hub would provide a single place where accurate language-appropriate COVID-19–related information could be easily accessed by CBOs and the non–native English-speaking groups that they served (hereinafter, end users), including those who were technologically challenged. The regular social media postings would allow for public health recommendations to be communicated quickly.

This project did not involve human data or participants; hence, review by the UCLA Office of Human Research Protection Program was deemed not necessary. TranslateCovid.org launched on May 10, 2020.

Intervention Activities

We leveraged the knowledge, expertise, and networks of Fielding School of Public Health faculty and staff of AASC’s Center for Ethno-Communications; the website development expertise of AASC staff; and the relationships of AASC with a wide network of CBOs and funders. Meeting weekly to make decisions about design and hub content, the team quickly built a website, sought feedback from partners (including CBOs and end users), and modified it to the extent possible with limited financial resources.

A key objective was to provide reliable, easy-to-understand, and accurate science-based information. Although some translated materials were available on the internet, we had concerns that these materials were not necessarily accurate or up-to-date. We developed a protocol for finding, vetting, and reviewing relevant materials, which included a list of search engines and keywords and a decision tree (Figure 1), and we used the protocol to train students and community volunteers to identify materials that were factual, reliable, and relevant. We obtained informational materials mostly from government and established nonprofit and professional organizations. Because of resource constraints, we used 3 criteria to prioritize resources for vetting translated material: California threshold languages, ¹⁸ other common languages in California, and languages for groups that had high incidence and rates of death relative to their population size. Our production team developed a relational database to manage the data and workflow.

Figure 1.

Decision tree for reviewing COVID-19 educational materials for populations that were limited English proficient, United States, 2020. The decision tree was used to gather credible and reliable informational materials mostly from government, academic, established nonprofit, and professional organizations, including the Centers for Disease Control and Prevention, the World Health Organization, the Los Angeles County Department of Public Health, California’s Vaccinate All 58 Campaign, The California Endowment, and other state and county departments of public health.

In-house informational materials, developed to fill gaps in in-language resource materials, included short videos on protective measures (handwashing, wearing face masks, and social distancing) and fact sheets presented in an FAQs (frequently asked questions) format to dispel potentially harmful myths. The videos and FAQs were scripted in English and translated into the prioritized languages through contracted translation services. We required that 2 professional translators review each translated script. FAQs were created in English, Chinese (traditional and simplified), Spanish, Russian, Korean, Vietnamese, Tagalog, Farsi, Japanese, French, Hmong, Armenian, Marshallese, Chuukese, Khmer, Thai, Tongan, Laotian, Hindi, and Bengali.

The content for the videos and FAQs was decided by faculty and staff, and the scripts for the videos were collaboratively written by a filmmaker, faculty, and staff. We reviewed the FAQs to ensure that each question was free of technical jargon and easy to comprehend, and we sought feedback from relatives and friends of the production team. Professional translators and community partners translated the videos and FAQs into multiple languages; these were updated when possible and made available on the resource hub.

The online resource hub was launched through email notification of organizations that provide services to immigrant communities (directly or indirectly), media releases, and social media.

Social Media Postings

To inform our social media messaging about COVID-19–protective behaviors, we adopted ideas that arose during LACDPH’s COVID-19 Listening Session, which took place on January 22, 2021, in Los Angeles. LACDPH brought together a panel of CBOs and health care organizations that serve Asian American, Native Hawaiian, and Pacific Islander communities to provide feedback on messaging issues. Messages that focused on the well-being of individuals or the ending of the pandemic generally did not resonate well, while messages that focused on the well-being of family and community members were rated favorably, such as “I’m protecting myself, my family, and my community.” Panel members also commented on the need for graphics to include images that immigrants can quickly relate to, such as images of people who look like them.

Social media campaigns began with a team of public health students and faculty who developed COVID-19 information in Spanish, Chinese, Korean, Vietnamese, and Tagalog for linguistically isolated groups in Los Angeles County. ¹⁹ The team disseminated weekly messages through Facebook, TikTok, KakaoTalk, Instagram, and X (formerly Twitter); translated infographics and videos; and created graphics to share on social media. Campaigns were limited because of a lack of adequate staffing, but a program manager was later hired with extramural funding to coordinate campaigns and recruit, train, and supervise bilingual students and community volunteers. The team relied primarily on direct messaging and partnerships with organizations and Los Angeles County for campaigns to amplify the social media messaging as new materials were created. A social media toolkit was included on the hub that included infographics with messages such as “Spread the Word, Not the Virus” and “Protect Your Grandma”; translated graphics were also provided in newsletters and included information on booster eligibility, tips for wearing face masks, and in-home vaccination programs.

Outreach

Initially, we reached out to CBOs and health care networks through newsletters and an email campaign geared toward zip codes with high levels of vaccine hesitancy and low rates of vaccination that were heavily populated with non–native English speakers. Specifically, we overlaid vaccine hesitancy survey data from the Institute of Health Metrics and Evaluation and the California Department of Public Health’s statewide vaccination data to help prioritize zip codes with lower vaccination rates and higher infection rates.^20,21 We also reached out to end users through Facebook, Instagram, and X by posting messages to promote protective behaviors. We based these messages on the content of our multilingual hub resources and wrote them in English and, whenever possible, languages spoken by our student assistants. We also organized webinars in partnership with LACDPH to inform CBOs and health and social service agencies about our resources, and we disseminated press releases and conducted interviews with news outlets.

As the pandemic continued into the second year, we focused our efforts on reaching people aged ≥65 years and other populations who faced technology barriers by working with CBOs. For example, we learned from CBOs that serve these groups that they needed material in formats that could be easily printed on standard 8.5 × 11–inch sheets so that they could quickly share the information through venues such as food distribution events and vaccination clinics. In addition to translated materials that English-speaking young adults could take to their parents and grandparents, CBOs wanted accompanying English materials that they could use as talking points, because children of immigrants can often speak their native language but may not be able to read or write in it. We also helped provide translation of fact sheets using our professional translators or students when possible.

A crucial partner was LACDPH’s Asian American and Pacific Islander (AAPI) COVID-19 Community Engagement and Communications Subcommittee, which included more than a dozen CBOs and health and professional organizations. Together, we worked to increase the use of TranslateCovid.org, ²² including COVID-19 materials in multiple languages produced by LACDPH, through sharing of materials and joint webinars held in 2020 and 2021.

Evaluation

Because of financial constraints, we were unable to conduct a comprehensive evaluation of outcomes. We used Google Analytics to assess the use of the multilingual resource hub, and we used Facebook business insights data to determine the number of views, likes, and comments on social media.

Outcomes

Most resources obtained were from the Centers for Disease Control and Prevention, the World Health Organization, LACDPH, California’s Vaccinate All 58 Campaign, The California Endowment, CDPH, and other state and county departments of public health. In addition, our team developed public service announcement videos on handwashing, wearing face masks, and social distancing in 10 languages and created FAQs in 20 languages. Among the FAQs created in-house, English was accessed the most frequently (28.1%), followed by Tagalog (21.2%), Spanish (5.1%), Armenian (4.4%), Vietnamese (4.2%), and Chinese (4.2%).

We restructured the website several times to address users’ comments. In particular, we focused on improving the search function. The final version of the website allowed users to search by language. In addition, links to the various in-language pages were provided on the landing page so that users who knew very little (or no) English could easily find them (Figure 2).

Figure 2.

TranslateCovid.org in-language resource pages for limited English proficient residents, United States, 2020. The resource hub was developed by the Asian American Studies Center and the Fielding School of Public Health at the University of California, Los Angeles, to disseminate timely and accurate COVID-19–related information to residents who were limited English proficient. TranslateCovid provided >1300 vetted resources in 60 languages from May 2020 through June 2022.

The number of resources grew from 800 in May 2020 to >1300 by June 2022. The hub contained 60 in-language pages; most simply provided links to reliable content sourced from other sites. The number of resources found for each language ranged from 1 to 243. The languages that had the most resources were English (n = 243), Chinese (n = 119), Spanish (n = 73), Russian (n = 55), Arabic (n = 51), Korean (n = 43), and Vietnamese (n = 39). In addition, the team gathered 83 resources in Pacific Islander languages (eg, Chuukese, Marshallese). Vetted materials about how to be safe accounted for most resources maintained by the hub (57%), followed by fact sheets, information on symptoms and health, and materials for children.

As of June 24, 2022, the site had 24 498 users and 75 612 nonduplicated page views. The reach of our website users spanned California, with a high concentration in Southern California. Given our location, hub resources skewed toward local services such as vaccination clinics in Los Angeles. Among US users, 42.8% came from California; visitors from other US regions generally came from states with high concentrations of AAPI residents, including Washington State (5.8%), New York (3.5%), Texas (3.5%), and Hawaii (2.2%).

Across Facebook, X, and Instagram, we had 69 000 views of social media postings from June 2020 through June 2022. Among the 3 platforms, the UCLACOVID19 Instagram channel had the most followers and infographics, with as many as 1110 followers and nearly 400 infographics during the 2-year span. Nine newsletters were published digitally, beginning with 595 recipients for the first issue (September 2021) and 975 recipients for the last issue (June 2022), spanning 225 organizations that included health, mental health, education, and community centers.

Lessons Learned

Multisectoral relationships across academia, government, and CBOs created the infrastructure for disseminating information to non–native English-speaking groups. These relationships, with human resource capabilities and timely access to funding, are necessary for an effective and adaptive response. Having students and volunteers with bilingual skills and staff with skills in website development, software engineering, and database management, all of whom volunteered countless hours, allowed for the rapid development of the website portal. Not having timely access to funding limited our ability to increase reach and share materials. Grants totaling $145 000 helped to fund outreach activities, professional translation services, an outreach manager, and a project coordinator. We obtained these grants through existing relationships of the AASC director with philanthropic organizations that could provide immediate funding. For the languages for which we did not have translators, the ability to contract translation services was critical. For smaller language groups, such as Marshallese and Chuukese, ties with bilingual community members provided the sole avenue for translation. Thus, formal and informal relationships are often necessary in serving AAPI-language populations.

Workforce Capacity

While we were able to mobilize bilingual students and community volunteers to assist with social media postings, we were limited by the languages in which they were fluent, their capacity to work consistently, and their lack of training in the creation of educational materials. Academic institutions of higher learning could play an important role in developing the needed workforce. Training professionals who are adept at developing culturally appropriate informational materials for non–native English-speaking groups is an area of needed investment. A need exists for more attention to the development of a multilingual communications infrastructure in public workforce development policies and programs, particularly for the vast number of AAPI languages.

Disaggregated Data

AAPI subgroups differ considerably in sociodemographic characteristics and health outcomes; yet, disaggregated data for identifying the needs and monitoring the conditions of these subgroups are often unavailable. ²³ For example, early anecdotal information from community partners indicated that Pacific Islander residents were heavily affected by COVID-19. This finding was consistent with data that emerged showing that Native Hawaiian and Pacific Islander communities had some of the highest COVID-19 mortality rates in relation to other groups. ²⁴ To help address rising infection and mortality rates in 2021, the team responded by focusing additional attention on finding resources in Pacific Islander languages. However, a lack of disaggregated data, such as vaccination rates by ethnic subgroups, made dissemination to subgroups challenging. Leveraging existing surveys to gather data from adequate samples of smaller ethnic subgroups (non–English speaking) will contribute toward achieving health equity in ethnically diverse regions such as Los Angeles County.

Trisector Partnership

Partnerships among CBOs, academic institutions, and government agencies form the trifecta necessary to reach and serve multicultural and multilingual populations (Figure 3). CBOs are generally well positioned to know how to best deliver information to people who are underserved by mainstream health care providers, including those with technological barriers, and to understand their informational needs. ²⁵ Academic institutions are positioned to develop new solutions to emerging problems and train the needed workforce. Government agencies usually have oversight over policies that mandate the provision of public health information in the languages of linguistically isolated groups, and they have greater access than CBOs to resources for infrastructure support and funding for programs and policies. However, because of the diversity of AAPI populations, their vast spatial distribution across jurisdictions, and often small population concentrations, sustained support from government agencies is necessary for true pandemic preparedness.

Figure 3.

Trisector partnership model for disseminating public health information to immigrants with limited English proficiency through TranslateCovid.org, United States, 2020. Partnerships among community-based organizations, academic institutions, and government agencies form the trifecta that was necessary to reach and serve multicultural and multilingual populations. Given their knowledge and organizational capacity, partners each helped to address critical linguistic and health equity challenges of pandemic preparedness.