Table 3.

Feedback from Latino Focus Group Participants and Adaptations in Stage I

Focus Group Theme CategoryFocus Group Feedback1st Round of Adaptations
Family• Family was a key component of culture.• Included family members at 3 key timepoints in the intervention: the orientation session, a midintervention session, and the last session for graduation (Delivery).
• Family support was most commonly reported as positive influence for changing lifestyle behaviors.
• Negative influences from families included family members who were unsupportive of lifestyle changes or weight goals; time pressure/competing priorities from family members.• Developed tips for being a supportive family member (Content).
Community• Community was a key component of Latino culture.• Provided support for participants to connect via the Smartphone applications (Delivery).
• Included potluck meals (Delivery).
Cultural foods• Food was an important element of Latino culture.• Incorporated a healthy meal at every group session (Delivery).
• Cultural foods were the most commonly reported negative influences on healthy eating.• Ensured that meals provided healthy versions of cultural foods; examples included “sopes*,” ceviche, and black bean soup (Delivery).
• Included more Latino food examples in intervention materials, including healthier, not-so-healthy, and traditional foods (Content).
Healthy eating patterns• Traditional Latino eating patterns of a larger lunch and a smaller dinner were thought to promote weight maintenance.• The traditional Latino eating pattern was included as one option for a healthy eating pattern (Content).
• Negative connotation of the term “diet” associated with restriction, deprivation, and limited food variety.• Avoided the term “diet” in favor of terms such as nutrition, eating, and eating plan (Content).
• Challenges to healthy eating included eating breakfast consistently; finding time to cook appealing meals for the whole family.• Designed all session meals to account for budgets, time in preparation, and cultural norms (Delivery).
Physical Activity• Physical activity in groups and children were sources of motivation to make healthy changes.
• Increased time in the US was associated with less occupational physical (more sedentary jobs) activity and exercise.
• Dancing and soccer were commonly mentioned as physical activity options that were culturally congruent. Three types of physical activity were discussed:
  • ○ Exercise: Zumba, walking, hiking, soccer, and gym workout.

  • ○ Occupational: jobs in restaurants, hospitals, housekeeping and childcare.

  • ○ Daily living: housekeeping, gardening, and commuting.

• Provided time for physical activity in groups during the sessions and encouraged physical activity among group participants outside of sessions (Content).
• Highlighted the distinction between leisure-time and occupational physical activity options and that each participants' activity mixture may be made up of different levels of each (Content).
• Emphasized the use of the pedometer to capture all types of physical activity (leisure-time, occupational, and daily living) (Delivery).
• Included more culturally congruent physical activity examples such as dancing and soccer (Content).
Tech use• Heterogeneous familiarity with self-tracking via smartphone or web-based applications.• Allowed for time to introduce and troubleshoot the smartphone applications (Content).
• Most participants were able to easily use the smartphone and web-based MyFitnessPal application to track diet. All but one participant downloaded the application on a smartphone without assistance.• Provided training on skills for self-tracking early in the intervention (Delivery).
• Intervention coach provided online and in-person feedback on self-tracking information (Delivery).
• All are interested in using the FitBit activity monitor as part of the intervention.• Provided all participants with a FitBit (Delivery).
• The MyFitnessPal application was available in both Spanish and English, which was very helpful.• Encouraged participants to use MyFitnessPal application in their preferred language (Delivery).
  • * Sope is a traditional Mexican appetizer that includes vegetable and/or meat toppings on a thick corn meal base.