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Research and practice show an urgent need for health interventions to be adapted in culturally and linguistically responsive ways for limited English proficient (LEP) communities where cultural and language discordance exacerbate challenges in accessing healthcare. Stop the Bleed (STB), an evidence-based life-saving bleeding control intervention training for lay community members is available in English and Spanish and does not reach members of other culturally and linguistically diverse US communities.


Our aim was to culturally and linguistically adapt STB materials and training to serve six language communities (Arabic, Burmese, Dari, Pashto, Somali, Swahili) in a two-phase project by following health literacy (HL) guidelines and Culturally and Linguistically Appropriate Services (CLAS) standards in materials development and training implementation.


Using a convenience and snowball sample of community residents contacted through face-to-face conversations and a flyer, a semi-structured focus group of eight participants with interpreters and two interviews were held to understand emergency medical services, emergency healthcare in home countries, and interest in STB training. The focus groups and interviews were completed before materials adaptation. Materials were adapted using focus guide/interview data and HL guidelines and shared with members of the targeted language groups to ensure cultural and linguistic responsiveness and understanding of terminology. Community members were recruited for a STB training through face-to-face and in-language flyers. STB training was delivered by certified instructors with interpreters.


A total of 144 community members were trained over a two-year period. In the first phase (n = 46) we assessed knowledge and self-efficacy pre- and post-training; results indicate that there was a statistically significant increase in knowledge about life saving techniques and a significant increase in self-efficacy to use STB. Qualitative survey results indicated that in-language training was critical for skills improvement and appreciated by attendees. In the second phase (n = 98), we trained community and business leaders of a local elementary school and resettlement agency who live among and serve the broad refugee community in Clarkston.


Culturally and linguistically responsive adaptations of health-related materials and training that follow HL and CLAS guidelines must include community members’ perspectives, cultural knowledge, and linguistic expertise. Adapted STB is a low cost feasible way to disseminate life-saving bleeding intervention training to diverse LEP communities.


Originally published in Feinberg, I., Smith, R. N., Zeidan, A., Kogonti, D., Trepanier, K. D., Adrian, S., & O’Connor, M. H. (2024). Cultural and linguistic adaptation of stop the bleed: saving lives in a multi-ethnic refugee resettlement community. Health Literacy and Communication Open, 2(1).


Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.