Participants listed several formats and formatting issues that may aid in producing materials and systems more likely to resonate with and be used by a target audience. Some immigrants, as with some American-born people, are not literate in their own first language(s). This does not reflect lack of knowledge or understanding. Many cultures have a strong oral tradition and may not have a writing system, or the written form may be a little-used recent development. Preferably a system or specific materials could be available in multiple formats, such as written and oral or audio, based on community needs and traditions
