"We built the ship as we sailed it": exploring public health outreach targeting communities shaped by migration in Stockholm, Sweden during the COVID-19 pandemic.

BACKGROUND: Effective health crisis communication requires culturally sensitive, community-engaged approaches, particularly for reaching vulnerable populations. The COVID-19 pandemic exposed significant gaps in public health preparedness for communities shaped by migration. This study explores how public health staff in Stockholm, Sweden designed and delivered crisis communication targeting migrant populations during the pandemic. METHODS: A qualitative study was conducted using eight individual in-depth interviews and three focus group discussions with 21 participants involved in planning, producing, and disseminating COVID-19 public health messages in Stockholm. Participants included public health strategists, communications officers, and frontline healthcare staff. Interview data were analyzed using thematic analysis. RESULTS: Four main themes emerged from the data, revealing a temporal evolution in outreach strategies. Initially, efforts focused heavily on language translation of standardized health messages. However, participants recognized this approach as insufficient and gradually shifted toward more dialogue-based engagement. Key developments included: (a) establishing trust through active involvement of community stakeholders such as religious leaders, neighborhood organizers, and social media influencers; (b) addressing structural barriers including overcrowded housing, precarious employment, and digital exclusion rather than assuming non-adherence reflected poor understanding; (c) counteracting stigma related to infection and vaccination; and (d) fostering creative problem-solving despite organizational rigidity and unclear coordination. Participants emphasized the importance of listening to the concerns in the community and co-developing solutions rather than simply disseminating information. However, many expressed concern that networks established during the pandemic and insights gained about structural inequalities were already being lost as systems "returned to normal". CONCLUSION: Public health authorities must move beyond one-way messaging toward sustained community partnership and dialogue-based engagement. Effective crisis preparedness requires addressing social determinants of health and building community networks during non-crisis periods, rather than relying on ad-hoc solutions during emergencies. Without institutional commitment to translating crisis experiences into lasting structural changes, authorities risk repeating past mistakes and eroding public trust-a critical concern given the likelihood of future health crises. TRIAL REGISTRATION: The study protocol was preregistered on the Open Science Framework (osf.io/rt47j) on March 22, 2022.