Table 3.

Focus Group Findings: Overview

CATEGORY	THEMES
Cultural considerations related to:
Food	• Food is central to life’s daily activities • Raised to eat unhealthy foods • Used to eating until very full • Something bad must happen before we make changes • Programs/health care provider recommendations “take away culture”
Exercise	• Viewed as a “white person’s luxury” • Women should not exercise; should be at home doing housework
Barriers to:
Healthy eating	• Healthy foods too costly • No time to cook; cheap take-out (“junk”) food more convenient • Family prefers unhealthy foods
Exercise	• No free places to walk (no malls or gyms) • Environment – heat, wild dogs in the neighborhoods, unsafe to walk alone • Daily physical labor associated with job; too tired
Technology use	• Lack “tech savvy”; favor YouTube videos; conflicting opinions re smart phones, computer • No time to learn something new
Health care access	• Inefficient, expensive U.S. health care system (Mexico health care equivalent to U.S. but less expensive, more responsive) • Lack of health insurance; physician visits, medications, and lab tests too expensive • Seeing the doctor takes a whole day out of work (loss of pay) • Lack of transportation • Denial
Healthier lifestyles	• No community support • Poverty levels • Work schedules (multiple jobs) • Child care or other family responsibilities • Fear of deportation
Recommendations for intervention:
Food	• Simple, cheap recipes that require little reading • Live cooking demonstrations; learn “how to cook” • Reading/interpreting labels • Learn portion control and calories • Developing a daily routine, timing of when it is best to eat • Access to a nutritionist • Learn how to make cultural foods healthier • Information about natural remedies, e.g., teas, vitamins • How to eat healthy at restaurants
Exercise	• Group walking • Individually-tailored exercises • Exercises that can be done at home • Interest in dancing as an exercise
Technology	• Willing to learn some technology; most familiar with text messaging • Training family members would be a big help, e.g., Fitbits (or pedometers); give one to family member also
Motivation	• Focus on the family (e.g., family night), family/group counseling • Incorporate competition within/between groups; “gaming” • Desire to live longer, be stronger (men) • Desire to be healthier for the children • Set individualized goals • Invite testimonials from persons who have been successful in dealing with or preventing diabetes • Incorporate accountability, recognition for accomplishments • Financial incentives, small prizes • Calls weekly between classes – reminders, check on progress, provide advice, etc. • Conversations similar to the focus groups about how to eat and exercise helpful • Offer program in community settings throughout the area near where participants live • Monitor weight/weight loss
Diabetes	• Need more knowledge of diabetes – causes, dangers, complications, heredity • Learn what to teach the children about healthy lifestyles and diabetes • Learn how to talk to family members to get their support
General observations	• Offer classes in Spanish; individuals go back-and-forth between Spanish and English but most speak Spanish only • Promotoras can provide logistical support and serve as valuable supporters for general reinforcement