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Table 4 Cultural Adaptation of Healthy Dads, Healthy Kids for Hispanic families

From: Cultural adaptation of ‘Healthy Dads, Healthy Kids’ for Hispanic families: applying the ecological validity model

Culturally Centering ElementsComponents retained from original programCultural adaptations to HDHK for Hispanic families
goals• The original goals from HDHK
 o Teach fathers how their attitudes towards eating and physical activity influence the whole family
 o Encourage fathers to be healthy, positive role models for their family
 o Teach fathers effective ways to encourage healthy behaviors in their children
 o Assist to prevent or manage obesity in children
 o Help fathers achieve a healthy weight
 o Improve the relationship(s) between fathers and their child (ren) through physical activity and healthy eating
• Greater emphasis on child health and family health for goals of program
• Greater emphasis on screen reduction and parenting based on desired goals from formative work
• Added new message for reducing screen time for fathers and children in the culturally adapted program: switch off “por mi familia” (for my family)
concepts• The focus on fathers with a gender-tailored program
• Fathers as role models
• Focus on fathers’ attitudes on healthy eating and physical activity influences his whole family
• Promotion of authoritative parenting
• Reciprocal reinforcement was retained, but adapted with the addition of Respeto when teaching children to be their fathers’ health coach
• Add a more explicit discussion with fathers on the importance of letting their kid be their health coach to allow the child to learn healthy lifestyle behaviors.
• Greater focus on the child coaching the whole family toward healthy eating and physical activity
methods• The 90 min structured weekly sessions (welcome/check in, separate practical components for father and children, combined fun PA component for fathers and children)
• The three components of the PA portion; Rough and Tumble Play, Sports Skills (Fundamental Movement Skills) and Fun Fitness.
• Provided adapted handbooks to Fathers, Children and Mothers
• Children were asked to select and complete home tasks every week and have their father sign off
• Fathers were asked to set monthly SMART goals
• Fathers were asked to select and complete weekly home tasks
• Fathers advised to decrease dietary intake by 500 cal/day if they desire healthy weight loss
• Fathers and children were provided with pedometers and asked to track their steps. Encouraged to set challenges for each other to increase steps.
• Fathers were asked to weigh-in every week and track their weight
• Fathers and mothers taught the principle of ‘parent provide, children decide’ to encourage healthful intake at meals.
• Lowered the reading level of all material, including eliminating complex statistics and graphs
• Health statistics were changed to reflect data on Hispanics in the US
• All physical activity, eating and screen media recommendations were changed to reflect the most recent US recommendations.
• The concept of Respto (respect) was introduced to the children when talking about Rough and Tumble Play
• Slides were changed to include more images to depict concepts rather than text
• Changed photos throughout program material to reflect Hispanic families, fathers, and children
• Food and dietary content was changed to reflect common Hispanic foods
• More examples of easy shifts in dietary intake to reduce caloric intake were provided
• Added images of what 500 cal look like (5 flour tortillas, large fries, 2 pieces of pan dulce, etc.)
• Greater discussion on decreasing added sugars to daily intake with examples provided
• Added a booster session at week 6
• Sessions were reordered, so that reducing screen time was moved to earlier in the program to address parents’ desire to make that a more prominent goal of the program
• Encouraged even more group interaction and discussion to minimize didactic portion
• Simplified process for setting SMART goals
• Simplified the process for fathers to calculate their personal energy requirements for weight loss and provided each father with a customized card (rather than having them calculate it themselves)
• Selected dietary intake self-monitoring app available in Spanish and English that had the most complete set of common Hispanic foods listed
• Provided families with a USDA sponsored Cookbook available in Spanish and English on healthy Hispanic recipes: (Flavors of my kitchen; California Department of Public Health. USDA SNAP, 2015)
• Engage mothers in a different way
 o Weekly videos via Facebook or text
 o Secret Facebook group
 o Text reminders
content• Fathers were encouraged to participate with their daughters and sons (gender roles).• Added discussions for fathers about differences between their own attitudes about what it means to be a father compared to that of their own father’s generation (e.g. generational shift).
• Added discussions of raising children in a different culture than their own.
• Promoted importance of health of whole family (familism).
• Fathers were given specific pointers on how to start meaning conversations with their child and how to actively listen to their child to help fathers feel like they can get more involved with their children (gender roles).
• Promoted the group were cohesive and encouraged them that other Hispanic fathers also wanted to get closer to their children and be good role models for their children (collectivism).
persons• Facilitators should be credible, relatable, and likable• Facilitators should be bilingual and preferably from the same or similar culture as the families
• Facilitators to demonstrate simpatia, while being fun and energetic
metaphors• Dad jokes, in Spanish• New program logo
language • Translated into Spanish, focus on content not direct translations
• Revised English to reflect America-English, rather than Australian-English
• Used the term Hispanic when referring to the target population based on their preference
• The games on the play cards were called by the names parents remembered from their childhood or substituted for games they recalled that practiced the same skill.
context• The program will continue to emphasize quality of time, rather than quantity of time fathers are able to spend with their children.• The program will be delivered on the weekend, when Hispanic fathers have more time.
• The benefit of leisure time PA to reduce stress in a way PA from physical demanding jobs cannot has been added.
• Added information on eating on a budget
• Added optional resources on food assistance programs in the local area
• Identified games fathers and children can play indoors on the game cards
• Transportation will be provided to families who report lack of transportation as a barrier to program attendance