Context: Low health literacy (HL) is closely associated with poor health outcomes. It was estimated that more than one-third of the US adult population have below basic HL. Inadequate HL has been postulated to be one of the major barriers to healthcare in the refugee population, and this is exacerbated by the stress of resetting in a new country, language and cultural gap, and the difficulty in navigating a new healthcare system. To date, there were no published studies on the general HL in the refugee population in Texas. Objective: To determine the HL status in refugees and ultimately to advance HL and meet the healthcare needs of refugees. Setting/Participants: Adult refugees who were seeking services at the Center for Refugee Services (CRS) and the San Antonio Refugee Health Clinic (SARHC) between 7/1/2019 and 8/31/2020. Study Design: Cross-sectional quantitative study using a convenience sample on assessing HL in adult refugees (goal sample size = 220). Two HL assessment tools were used for the study: the brief health literacy screening tool (BRIEF) and the Short-Test of Functional Health Literacy in Adults (STOFHLA). Additionally, the HL tools were translated into Arabic, Pashto, and Burmese besides English and French. Results: Preliminary analysis from 91 surveys shows that 92.3% of the participants who completed the STOFHLA and 86.8% of the participants who completed the BRIEF had low HL. There is a positive and linear correlation between BRIEF and STOFHLA scores in the samples (p<0.01). Crosstabulation between different variables and HL suggests education and proficiency in reading and writing English significantly impact HL (p<0.05) assessed by either STOFHLA or BRIEF, while age, gender, family size, income, health insurance status, employment status, length of time in the US do not. Conclusions: Preliminary results demonstrated an overwhelming prevalence of inadequate HL levels among refugees in San Antonio, TX. A positive and linear association between BRIEF and STOFHLA HL assessment tools, suggests perhaps a short 4Q BRIEF is a valuable and practical tool to assess HL in fast-paced clinical settings. The current study and subsequent follow-up studies will facilitate patient-centered care in the refugee community, and to promote patient engagement in healthcare decisions and reduce health disparities in this vulnerable population.