Applying user-centered design to develop a culturally sensitive, low-calorie meal plan for enhancing dietary behavioral control in MASLD

BACKGROUND: Dietary changes are essential for managing metabolic dysfunction-associated steatotic liver disease (MASLD), yet patients often face barriers related to knowledge, skills, cost, time, and cultural fit. AIMS: The purpose of this paper is to report a process for culturally tailoring a dietary intervention and its application to create a calorie-restricted meal plan for Mexican and Central American patients with MASLD. Guided by the Theory of Planned Behavior and user-centered design, we produced a culturally tailored seven-day structured meal plan aligned with dietary guidelines for MASLD and weight loss. METHODS: We conducted a three-phase, mixed-methods process among Mexican/Central American patients with MASLD from a safety-net healthcare system in Houston, Texas (n = 25). Phase 1 characterized meal patterns and preferences through semi-structured interviews. Phase 2 integrated findings with clinical nutrition guidelines to develop structured meal plan prototypes at 1200-, 1500-, and 1800-calorie levels. Phase 3 tested usability through ecological momentary assessments and daily interviews. RESULTS: Participants typically consumed home-cooked meals centered on animal protein, legumes and simple grains, with lunch and dinner preparation being most challenging. Recipe modifications focused on increasing fiber and reducing fat and refined carbohydrates. Usability testing showed that participants found the plans culturally aligned and practical, improving portion awareness and dietary self-efficacy. CONCLUSIONS: This study offers a patient-centered process for culturally tailoring dietary interventions and its output, a calorie- restricted meal plan that shows preliminary feasibility and acceptability on user testing. Next steps (underway) are to evaluate the meal plan's larger-scale implementation and impact on dietary change and weight loss.