Laying the groundwork for a culturally sensitive pediatric primary care eating disorders intervention for the Latino community: insights from focus groups.

BACKGROUND: Adolescents and caregivers from the Latino community face significant barriers to accessing treatment for eating disorders (ED) and disordered eating (DE) including cultural stigma, language barriers, and limited availability of culturally congruent care. Most existing ED/DE interventions were developed for non-Hispanic White populations, often limiting their application to families from the Latino community. To address this disparity, we are developing First Approach Skills Training- Trastornos de la Conducta Alimentaria (FAST-TCA), a culturally adapted version of FAST-DE, a brief workbook-based intervention for ED/DE designed for implementation in pediatric primary care. METHODS: This study used a community-engaged iterative process to inform the first steps of the cultural adaptation of FAST-DE into FAST-TCA. Two rounds of semi-structured focus groups were conducted with each of two stakeholder groups: Latino caregivers of adolescents with ED/DE histories and Latino adolescents with lived experience of ED/DE. Focus groups were recorded, transcribed, and analyzed using a codebook thematic analysis informed by a phenomenological perspective. RESULTS: Seven themes emerged from caregiver focus groups: psychological and social influences on ED/DE development, treatment experiences, family context, barriers to care, treatment priorities, caregiver empowerment, and workbook design and accessibility. Four themes were extracted from adolescent focus groups: navigating cultural identity and ED/DE, family dynamics and support, the need for sensitive and thoughtful content delivery, and ED/DE recovery experience reflections. Across both groups, participants emphasized the importance of accessible, culturally congruent, family-centered care and offered specific feedback that informed the revisions to the FAST-TCA workbook, including the incorporation of culturally relevant foods and expanded caregiver psychoeducation. CONCLUSIONS: Focus group insights guided the development of the first draft of FAST-TCA, an initial cultural adaptation of FAST-DE. This study demonstrates the utility of community-engaged methods in enhancing the cultural relevance of ED/DE interventions. The next phase of the cultural adaptation will occur following the pilot implementation of FAST-TCA, where additional feedback from adolescents and caregivers will inform further refinement of the intervention.