Table 3 Elements of cultural adaptation evaluated in fidelity checks

Session 1

 • Leader acknowledged, appreciated use of, and/or incorporated spiritualism, machismo, marianismo, and familismo to enhance rapport.

 • Leader attempted to ensure that cultural values (spiritualism, machismo, marianismo, familismo) did not get in the way of self-management.

 • Leader built on culture and cultural values to help motivate participants.

 • Family was integrated into the session (e.g. in discussion, stories, etc.)

Session 3

 • Content appeared to be at a level that was right for participants.

 • Leader builds on high value of relationships.

 • Leader incorporated spirituality appropriately.

 • Leader used opportunities related to machismo and marianismo to promote the Pisando Fuerte curriculum.

 • Leader incorporated fatalismo to promote self-management.

 • Leader builds on high value placed on familismo.

 • Leader built on culture and values to help motivate participants.

Session 7

 • Leader acknowledged, appreciated use of, and/or incorporated spiritualism, machismo, marianismo, and familismo to enhance rapport.

 • Leader attempted to ensure that cultural values (spiritualism, machismo, marianismo, familismo) did not get in the way of self-management.

 • Leader built on culture and cultural values to help motivate participants.

 • Family was integrated into the session (e.g. in discussion, stories, etc.)