Table A2.

Findings from stakeholder meetings and expert review meetings regarding facilitators and barriers of the guideline, and revisions made based on these findings.

Findings	Stakeholder Meetings	Global Expert Review	Quotes
Facilitators	Providing insight into the culture and context of end-users: especially helpful when implementing an intervention in another area or with other end-users. Guideline helps to adapt a medical message to the appropriate context.	Guideline should become routine when developing, implementing, or revising interventions. A tool that helps to deliver information in a culturally adapted way.	Participant from Indonesia: “Some medical words were used in the materials that health practitioners use. However, not all community members know these words. Based on the checklist, we found this and revised this.”
	Contextual aspects covered in the checklist are broader than merely health-related. Thus, the guideline can be applied beyond health-related CBHIs. Conceptual framework provides a broad perspective on health, including social and environmental aspects.	Guideline covers interventions beyond health, such as interventions to reduce natural disasters.	Participant from The Philippines: “The guideline can be used more broadly, not only for health focus or topics. For example, for disaster reduction. It should also be culturally and contextually sensitive. Often we use or refer to materials from other countries, and we forget that we have a different context and a different culture.”
Barriers	Several contextual aspects vary within a country, an area, and different groups. Implication: guideline needs to be customized: different contextual aspects can be important in different contexts.	To overcome this barrier, involve stakeholders in the early stage of development or revision. People from the community itself know what fits their culture best.	Participant from Indonesia: “The aspects of religion and beliefs are not applicable in our country because this is a private or a sensitive issue. Therefore in every context, different contextual aspects are more or less important. This should be more clear.”
	Language can be a barrier for global use; translation is a difficult process, and meanings can be lost.	For translation, deploy stakeholders, expert translators, or a combination. A combination is preferred: a higher quality of professional translation combined with community stakeholder translation.	Participant from Vietnam: “It would be ideal to involve people from other stakeholders or the communities where the training will be implemented. We often write proposals to international NGOs and include material development and communication materials. When representatives from different groups are involved, we could have really powerful input from communities about what would be important for them for developing this training. I think it even goes back to proposal development, because this takes budget to do it well.”
	Time-allocation: applying the guideline takes time; this could limit use of the guideline.	Allocate the budget for applying the guideline when writing a proposal for the development of interventions. Moreover, involvement of stakeholders will save time.	Participant from Vietnam: “The guideline is developed in English. So we are faced with the language barrier when using it in different countries with different languages.”
		Revise model of healthy lifestyle. Implementers are not always role models; this should be carefully considered.	Participant from Cambodia: “It is too sensitive that an implementer or a trainer should be a role model for a healthy lifestyle. Someone can still deliver this message of healthy lifestyle and be overweight.”
Revisions made based on barriers	Application of the guideline should be a continuous process; if changes to an intervention take place, e.g., different target group or other area, the guideline should be used as a tool for monitoring. The guideline should be seen as an aid and not mandatory.	Make clear that it is a tool, and not every aspect is applicable. If an aspect is not applicable, it can be ignored. In addition, make it clear that if topics or aspects are needed, they can be added to the checklist.	Participant from Vietnam: “When implementing a training in a rural area and then in an urban area, there are differences between the target groups. With the guideline, we revised the training to make it more suitable for the local context. This can also be helpful when a training is adopted in another country.”
	In contexts where social desirability and respect are highly valued, the implementer could feel restraint in writing down outcomes of the checklist. It could feel safer to discuss outcomes informally.	Open feedback questions can be added to the guideline. These questions can be put to the end-users to create discussion. Moreover, adding these questions involves stakeholders.
	Add a textbox for lessons learned to contribute to transparency and suggest tips and tricks where needed.	Add suggestions as to who could be an observer. If no independent person is available, give options.	Participant from Vietnam: “From past experience, I know how difficult it is to find observers. So maybe the suggestion could include options for the observers. If there are two or three trainers, that is not ideal, but they could take turns being the observer, and then give feedback together.”
	Gender differences should be included in the checklist.	Ageism, disability discrimination, digital in-/exclusion and teaching methodology should be in the checklist. Cultural aspects of the visuals, such as posters, should also be in included.
	Add hints and tricks on how to to develop trust and a feeling of safety among participants; this is important for cultural and contextual adaptation.	Explain that there are different levels of awareness of context in the process of adapting: organisational level, community level, and individual level.	Participant from The Philippines: “There are different levels of awareness, at the organisational level, the individual staff level, the program level, or the organisational level. I think it is important to be aware of that and make it explicit.”