Table 3.

Feedback from Latino Focus Group Participants and Adaptations in Stage I

Focus Group Theme Category	Focus Group Feedback	1st 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).
Community		• 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.