Tailoring nutrition and cancer education materials for breast cancer patients

•Many immigrant breast cancer patients seen at safety net facilities are vulnerable to food insecurity.•An English/Spanish nutrition presentation was developed for breast cancer patients.•Iterative development involved 7 rounds of cognitive interviews per language.•Changes included adapting to regional lexicons and tailoring layout and visuals.•Culturally/linguistically responsive food examples and labeled images were needed. Many breast cancer patients are vulnerable to poor nutritional status and may benefit from nutrition education, but existing materials are not generally tailored to the needs of low-literacy immigrant and minority patients. With nutritionist guidance, we developed a nutrition presentation for breast cancer patients. English- (n = 29) and Spanish-speaking (n = 19) patients were recruited from 5 safety-net hospitals, an academic cancer center, and a Latina cancer support organization. Materials were tested using multiple rounds of cognitive interviewing (with an adapted USDA interview guide), followed by study team reviews and modifications, until saturation. Seven rounds of interviews per language were needed. Approximately 25% of interviewees had less than a high school education. Changes included adapting to regional lexicons and resolving vague/confusing phrasing. Specific food examples needed cultural tailoring. Text color coding (red/bad, green/good) was requested. Labeled images enhanced participants’ understanding of concepts. Spanish speakers expressed a desire to understand nutrition labeling, and this was emphasized in the Spanish slides. Cognitive interviews were an important tool for creating a nutrition curriculum tailored to the needs of low-literacy, mostly immigrant patients. Cultural and linguistic factors should be considered for nutritional education materials in diverse patient populations.