Abstract Background Reducing health inequalities among population groups is imperative, however, health communication strategies tailored to ethnic minorities remain under-researched. To address this issue, various health communication strategies were developed and tested within the 3 year Saste Roma project, focused on improving health literacy and disease prevention in the excluded Czech Roma population. Methods A planning group comprising of doctors, sociologists, psychologists, NGOs and community health workers was established to create tailored health communication tools. The tools were developed with consideration of the sociocultural specifics of the Roma community, using focus groups, in-depth interviews, and the Delphi method. A PR agency was hired to implement the tools. Reach, engagement and Price Per Click = PPC were measured for online tools; feedback on offline tools was collected via surveys and interviews. Results From April 2021 to March 2024, 12 online and offline tools addressing 10 diseases were developed for various age groups and implemented. These tools, such as health literacy brochures and leaflets (78,500 pcs distributed), music videoclips (viewed 150,000 times), a mobile application (with over 500 users), social media profiles dedicated to health (with 140 followers), preventative events, school-based e-learning modules (implemented in 86 elementary schools in excluded areas), online campaigns (reaching 556,337 people; PPC of 0.85 EUR in case of in-house campaign Vs. PPC of 3.21 EUR by PR agency) or poster campaigns (engaging 3,046 individuals) focusing on excluded areas. Lessons This project represents the first extensive use of diverse communication tools targeting the Roma population. The involvement of community representatives (patients, artists, actors, and residents) in tool development is crucial. Training and support for health community workers are essential to achieve effective engagement with the community. Key messages • Tools must be delivered in a culturally sensitive and comprehensible manner by members of the communities. • Commercial PR agencies failed with this specific campaign. Cooperation with Roma artists and influencers is essential.