Table 3.

Cultural Tailoring Strategies of Included Studies

Author (publishing date)	Language	People	Metaphors	Content	Concepts	Goals	Methods	Context
Baltaci et al. (2022)	Program offered in English and Spanish	Sessions were led by trained bilingual facilitators, one male and one female, who were parents themselves.	Program was held in a familiar community center setting	Surveys were provided to fathers in Spanish.	Education for parents focused on parenting skills related to parent-child interactions and food- and activity-related parenting practices. Education for youth focused on building strong family communication and connections. Parent and youth joint activities involved explanations of basic nutrition and physical activity concepts and hands-on practice/discussion based on their experiences.		Flyers, announcements, and social media were used to recruit participants at local community service centers and churches. The format, length, session structure, and content of the Padres program was designed based on Latino fathers’ preferences communicated in father advisory board meetings and focus group discussions. Additionally, two bilingual community educators were involved in curriculum development. During the intervention sessions, participants prepared culturally tailored, simple recipes. Mothers were also encouraged to attend sessions and complete data collection.	Group physical activities were those that could be done easily indoors or outdoors regardless of time and resource constraints.
Frediani et al. (2021)	Program offered in English and Spanish.	Coaches were all English and Spanish speaking.	Intervention delivered at local soccer fields in the community.	All participant communication, from recruitment to intervention, was tailored to be culturally and regionally responsive. A closed and encrypted chat (WhatsApp platform) was created for each cohort and for the full group to facilitate peer support, communication, and session attendance.	"Football is Medicine”, the idea that football can be used as therapy and for the prevention and treatment of type 2 diabetes cardiovascular disease, severe obesity, and other pathologies.		Participants were recruited from local Atlanta area Latino organizations using online (social media, websites, email listservs) and print (fliers) advertisement methods. Soccer was used to facilitate physical activity at each practice. Coaches provided attendance encouragement through WhatsApp, and participants also used it to post encouraging messages and provide support (pictures of their dietary choices, activities outside of soccer sessions). Participants were encouraged to bring family and/or friends as spectators for additional social support. Coach assignment and session scheduling was tailored to the group’s preference based on field availability and location convenience.
Garcia et al. (2018)	Program offered in English and Spanish.	English and Spanish-speaking Hispanic male coaches were from the local community and had a broad understanding of the complex sociocultural and socioeconomic barriers to weight management that participants faced.	The intervention was delivered in a space well-recognized and accessible to the study population. The research team ensured that visible décor and any passive information hanging on the walls was culturally and linguistically appropriate.	All participant communication was tailored to be culturally and regionally responsive. Communication was centralized around personalismo, simpatia, and respeto. Participants were reminded of individual appointments and other study activities via their preferred contact method (telephone, email, text messaging).	Risk-based communication was used when providing feedback on cardiometabolic lab values, because fear-appeal communication was identified as a motivator for behavior change. Participants received tailored lesson materials focused on behavioral strategies for adopting and maintaining healthy eating and physical activity behaviors.	Interventionists ensured that dietary changes considered cultural food choice preferences so that behavior changes were attainable. For instance, instead of replacing tortillas with an alternative food or eliminating it all together, portion control was suggested (substitution of corn tortillas for flour tortillas every other meal). Gender- and culturally bound norms related to strenuous work schedules and their impact on health were discussed at counseling sessions to encourage participants to achieve physical activity recommendations.	Recruitment was conducted in outdoor marketplaces (swap meets) frequented by target population. Intervention provided participants and their families with a free 3-month gym membership to facilitate physical activity. Family social support was identified as an important intervention component, thus spouses/significant others were invited to attend specific counseling sessions. Program addressed specific eating behavior issues including: access to healthy food, cost, meal preparation, portion control, and family/social events. Additional issues related to physical activity were addressed including: neighborhood safety, childcare to allow time for physical activity, and acceptance from other family members. Provided strategies to overcome these barriers (a list of neighborhood resources for physical activity).	Held discussions related to gender role strains (the role of the man in the household) during intervention sessions. In addition, issues related to access of healthy foods or safe spaces for physical activity were discussed within the context of socio-economic status.
Gary-Webb et al. (2018)	Program offered in English and Spanish.	Trained male lifestyle coaches who were Black and/or Latino led the program at each site, 1 was a bilingual community health specialist and held the curriculum in Spanish. Coaches modelled weight loss efforts and provided professional expertise in health education or fitness training. 3/4 coaches had personal experience with diabetes or weight issues.	Program was held in a recreational center in a familiar community setting.	Curricular materials and recruitment flyers were all available in English and Spanish. Text and phone were used to send participants reminders. Content featured sports quotes and references. Examples provided of healthy and unhealthy foods were those perceived as more commonly eaten by men, such as chips rather than ice cream.	Coaches explained healthy eating by using familiar food examples. Participants were taught to ask questions and learn to advocate for themselves (for example, asking local stores for healthier food options), given that some men felt that they must already know everything and cannot ask.		Participants and coaches were all male, which participants reported helped them feel that they didn’t have to act as "macho". Participants were provided with paper trackers for diet and exercise, a calorie counter book, pedometers, water bottles, and measuring utensils. After 4 sessions, participants were given a 6-month NYC Parks membership with access to the city’s recreation centers. Additionally, if participants had difficulties attending sessions due to transportation costs, they were given a transit pass. Study worked with the New York City Housing Authority, the administrator of NYC public housing, to mail flyers to residents living near each of the recreation centers. Study hired 2 male outreach workers from the targeted neighborhoods to distribute flyers to barbershops and other local businesses. They also presented at community board meetings, senior centers, schools, libraries, and community-based organizations.	Sites were chosen to be in areas accessible to target population. Sites already had accessible gym equipment, swimming pools (at some locations), fitness classes, and health-related programming. Additionally, the cost of membership to the recreation centers was reasonably affordable. Program included content on male-specific issues such as the connection between diabetes and erectile dysfunction.
Guerrero et al. (2023)	Program offered in English and Spanish	Sessions led by Women, Infant, and Children health educators who were experienced and trusted health educators in their communities		Caregiver surveys were available in English and Spanish. Media educational content was also provided in English and Spanish on the Chorus mobile phone platform. Chorus is a web-based application, allowing users to access content without having to download an application to their phone.	This program was adapted to emphasize the role of collectivism and familism among Latino families.		Recruitment was conducted at Women, Infants, and Children and Early Childhood Education (ECE) Centers using research flyers. Program development was informed by qualitative data collected from Latino mothers, fathers, and grandparents of 2- to 5-year old children to explore the challenges and barriers to support healthy dietary and physical activity behaviors. Caregivers who were fathers were only asked to complete the first 2 weeks of the in-person sessions that were facilitated by a male WIC staff member, instead of all four weeks. Additionally, evening and Saturday sessions were held to provide more flexibility and encourage engagement from fathers, whose participation was limited by work schedules.
Mitchell et al. (2015)	Program offered in English and Spanish.	Intervention and recruitment conducted by English and Spanish-speaking Latina Promotoras.		A native Mexican specialist who is an expert in adapting materials to lower literacy groups developed culturally and linguistically appropriate materials. The content of the sessions was adapted from the “Your Heart, Your Life” program, created to improve heart health and reduce obesity among Latinos. This program was designed to be more accessible to lower literacy groups by not relying on written material.	The concept of "Cinco Pasos para Vivir Mejor" was referenced in this intervention. “Cinco Pasos para Vivir Mejor” is a social media campaign launched by the Mexican Government. The five steps are as follows: (1) drink water; (2) eat fruits and vegetables; (3) measure (what you eat and your waist); (4) move; and (5) share (the message)	Participants set individualized goals for lifestyle change.	Recruitment was conducted in collaboration with the farms where participants worked. During the intervention, high-impact moves were avoided, and music was always included to inspire movement. The actual exercises were kept simple and did not require special equipment, so participants could practice similar sessions at home. Participants were encouraged to make each concept relevant in their daily life by making weekly promises to improve lifestyle and tp collaborate as a group in order to help overcome boundaries to their promises. Participants were encouraged to bring relatives, friends, and children (free childcare provided) to the sessions.	Sessions conducted at easily accessible work-sponsored clinic sites.
O’Connor et al. (2020)	Program offered in English and Spanish.	Program was delivered by three trained facilitators who were Spanish and English speaking.		The reading level of all program material was lowered. Questionnaires were made available in English and Spanish. Social media reminders were sent by Facebook posts. Each family was provided a set of culturally adapted game cards with a bag of sports equipment to encourage practicing sports skills at home.	Curriculum was enhanced with cultural values such as familismo (familism), respeto (respect), and colectivismo (collectivism). Foods, games, and physical activities were modified to those commonly known to Hispanic families (Rough and Tumble play in the context of respeto).	The main goal focused on health promotion for the family, teaching fathers and children how to be healthier and more active and providing an opportunity for fathers to spend time with their children. Encouraged fathers to be healthy role models for their family regarding eating and physical activity and taught fathers authoritative parenting to encourage healthy behaviors in their children. At home health goals/challenges such as trying a new fruit or vegetable with their children and engaging in rough and tumble play were reported by participants to be effective.	“Dad’s Club” all-male participant group met weekly. Mothers were engaged by inviting them to a Facebook Group for the program and sending them weekly videos of that week’s content by Facebook, text, or email. Program included a booster session midway through to reinforce concepts. Resources provided included: Cookbook of Healthy Hispanic Recipes, pedometers for step tracking/family challenges, MyFitnessPal for self-monitoring physical activity and dietary intake. The program was offered on Sunday afternoon, the time preferred by fathers due to busy work schedules, at the child’s primary care pediatric clinic.	Addressed barriers for participation and engagement for Hispanic fathers; discussed difficulties faced raising children in a different culture than your own. Due to concerns about unsafe neighborhoods and lack of public parks, indoor games and exercises were offered as an option.
Rocha-Goldberg et al. (2010)	Program offered in English and Spanish.	Spanish-speaking Hispanic/Latino research assistants conducted participant recruitment and screening interviews. Interventionist was also Latina.		Traditional Hispanic/Latino food names from each country in Latin America were incorporated so that intervention materials could be used with people from different Latino countries of origin. All study materials were translated into Spanish.		Participants developed individually tailored goals for lifestyle change.	Recruitment was conducted during Hispanic/Latino events in the community, such as Hispanic/Latino Health Fairs. Most recruitment was conducted at a federally funded primary care clinic serving a large population of low-income Hispanics/Latinos and a local Hispanic/Latino community organization. To facilitate recruitment and ensure cultural appropriateness of recruitment efforts, investigators worked closely with these organizations. Recipes were adapted to those commonly used by Hispanics/Latinos, and physical activities were included that were traditional within the Hispanic/Latino culture, such as dancing.	Latina interventionist was familiar with the cultural context of the participants (e.g., typical roles of men and women in Hispanic/Latino families).
Rosas et al. (2015)	Program offered in English and Spanish	Interventionists were all English and Spanish-speaking and bicultural. These included case managers, community health workers, and members of the local Fair Oaks community.		Individual steps from "virtual walking groups" were converted to collective miles travelled and used in a multi-media virtual travel adventure “Steps through the Americas” that presents health topics within the context of destinations in North and South America.	CHW approaches integrated with CM activities included building broad skills for navigating an obesogenic environment, fostering family support, enhancing participant success in food negotiations, mapping out neighborhood walking routes, and engaging participants in a modified photovoice activity.	Specific goals were individualized and tailored for each participant.	Individuals were identified for screening through outreach in the clinic and community, which is low-income and majority Latino. Take-home items were provided including pedometers, exercise compact disks, and free weights. Group setting with other community members from similar backgrounds facilitated the development of social support networks. Participants also developed collective efficacy and social support through “virtual walking groups.” Additionally, family and friends were included in session activities. Motivational interviewing, positive feedback, self-reflection, and flexible scheduling techniques were used.	CHW helped participants overcome environmental and social barriers such as acculturation, immigration status, food insecurity, limited opportunities for physical activity, and poverty. To maintain focus on obesity reduction, interventionists followed a protocol to refer patients to other health care services (primary care, mental health, diabetes clinic) and community resources (health insurance programs, immigration assistance) for issues not directly related to weight loss.
Rosas et al. (2022)	Program offered in English and Spanish.	Intervention conducted by English and Spanish-speaking bicultural coaches.		Spanish subtitles were provided for pre-recorded videos.	Each video lesson featured a coach-facilitated group session with actors representing diverse demographic groups, including men and women. The MyPlate Visual was used to communicate food choices.		Participants could choose from three options for engaging with the intervention (online, in-person, or self-guided) using a structured handout that guided them through important decision domains including preferred level of coach and peer support, comfort with technology, and lifestyle factors (e.g., work, family schedule). Encouraged participants to discuss decision with a small group of participants, as well as identify challenges and solutions to intervention adherence. Participants were encouraged to watch pre-recorded videos with family for self-directed option. For the in-person option, they were encouraged to attend specific sessions with family given cultural importance of family support. Study provided digital weight scale, a wearable activity tracker, and the MyFitnessPal application for dietary tracking. This application was chosen because the Latino Patient Advisory Board determined it had high acceptability based on the language, ease of entering cultural foods, social networking, and availability on phone and computer.	Primary care setting for intervention delivery was chosen because a primary motivation for weight loss among men appeared to be reducing chronic disease risk factors and avoiding adverse health outcomes. Implementation in primary care offers the benefit of leveraging primary care provider support for adoption and maintenance of behavior change.
Singh et al. (2020)	Program offered in English and Spanish.	Interventionists were all English and Spanish speaking and Hispanic/Latino. Interactive cooking classes were conducted by expert bilingual staff (three registered dieticians/certified diabetes educators) from the local community.		All the program educational materials were developed for the targeted community with language considerations in mind.	Curriculum draws from theory-driven frameworks built upon cultural awareness, knowledge, skills, encounters, and proficiency. The “Familismo” effect in the Hispanic/Latino cultural context was considered when designing this family-based, culturally tailored intervention.	Program goal was individualized. Each participant was encouraged to transition from one tier of a plant-based food pyramid to the next. No strict vegetarian categories were required.	Recruitment flyers and advertisements in the AH-WMMC system, hospital magazine, and news media were provided in English and Spanish. English and Spanish language television was also used to broadcast recruitment materials. The dietary intervention consisted of cooking instruction and supermarket tours to implement a four-tiered food guide to plant-based eating. All cooking demonstrations were designed with the target population in mind; recipes were carefully aligned with the traditional fare of this community.	The educators took special care to ensure that the recipes taught in the program included only those ingredients that were easily accessible in the local neighborhood markets, making the program recommendations easily attainable.
West et al. (2008)	Program offered in English and Spanish.	Case managers were often chosen from the same ethnic group as participants.		All study materials were translated into Spanish. Reference materials (e.g., fat and calories in commonly eaten foods) and lesson handouts included information about the types of foods and cooking methods used by various ethnic groups.			Individual case managers or “lifestyle coaches” allowed tailoring of intervention activities to the ethnically diverse population and those with low literacy. Individualization was provided through a “toolbox” of adherence strategies. Approximately $100 per participant per year was available for implementing toolbox strategies. For example, participants having trouble achieving or maintaining the activity goal might be loaned or given an aerobic dance tape, enrolled in a community exercise class or a cardiac rehabilitation program, or seen individually by an exercise trainer to begin a tailored exercise regimen. Similarly, participants might be given a cookbook, a scale, grocery store vouchers, or portion-controlled foods.	Lifestyle coaches were encouraged to work with each participant individually to identify their specific barriers to weight loss and possible solutions to these barriers, including addressing financial barriers with a $100 toolbox stipend.

Note. ECE = early childhood education; CHW = community health worker; AH-WMMC = Adventist Health White Memorial Medial Center.