Table 2.

Cultural adaptations for the Hombres Saludables physical activity intervention.

Theme		Intervention modification
Surface structure
	Activity preferences	Focus intervention on gender-neutral and male-associated activities (eg, soccer and hiking)
	Language	Translate intervention into appropriate Spanish for the diverse Latino audience
	Literacy	Use qualitative methods (eg, focus groups with Latino men to review intervention materials) and low-literacy strategies (eg, Flesch Kincaid grade level less than eighth grade) to modify measures and materials to better match educational experience of participants
	Role models	Provide videos, photos, and stories of diverse Latino men and families from the target population on a website
Deep structure
	Gender role expectations	Emphasize the need for the head of family to set a good example by being active and protect family members by exercising with them; highlight benefits of aerobic activities for men’s health
	Not wanting to spend money on fitness when that money should be used for family needs	Reframe PAa to include behaviors that do not require gym membership or special equipment, distribute information on low- or no-cost PA resources in the community (eg, hiking and walking trails, recreation centers, and pickup soccer games), offer a list of free Spanish or bilingual smartphone apps that provide access to exercise resources, and provide a 6-month gym membership
	Perceived lack of access to culturally appropriate PA	Provide tailored community guides identifying places to do PA, including information and schedules for free and low-cost team sports at local recreation centers and community or social sports leagues; include Spanish exercise videos that are appropriate for Latino men; offer a list of free Spanish or bilingual smartphone apps that provide access to exercise resources; and provide a 6-month gym membership
Barriers to PA
	Stress reduction	Provide information on PA and stress reduction for stressors commonly experienced by Latino men
	PA conflicts with work schedule	Provide tips for exercising at work or for transportation and on finding time with a hectic schedule; highlight low-cost local sports and activities that occur on nights and weekends
	Lack of time and conflicts with family time	Augment existing content on this topic with examples that are familiar to Latino men (planning PA around family and work commitments); share Spanish exercise videos that are appropriate for Latino men; and provide membership to a gym that is open for extended hours, which helps men find time to exercise around work schedules. Provide tips and texts for getting children and family involved in PA and include specific suggestions regarding family-friendly activities (eg, easy hiking trails)
	Partner support	Provide tips on eliciting social support from friends and family
	Need for accountability	Provide pedometer, emphasize monthly personal reporting and feedback based on participant’s reported PA (steps or minutes), provide normative feedback comparing their progress with others, send regular text messages asking about recent activity and reminding participants to log activity and answer monthly surveys, and offer private Facebook group to post progress and request support

^aPA: physical activity.