Table 4.

Summary of Themes from Coach Interviews Drawing from PRISM

Theme	Sub-Theme	Proportion of Coaches Endorsing	Example Quotations
Characteristics of multilevel recipients of the intervention
Player and coach: Knowledge about skin cancer	Existing and new awareness of risk and sun protective behaviors	2/14 14%	“I guess just the how simple it is to get it. Like the meloma, Melanoma or how you say it. Um, like I said, it runs in my family, so I’m aware of it, but I didn’t know. And I, and I can’t think of the numbers off the top of my head, but you just like 15–20 minutes in the sun is enough to start forming those, those Melanoma pockets. And I mean that was new info for me and kind of an eye opener that even walking out to do yard work or whatever that I need, to be more careful.” (Fall Sport Coach) I think they’re aware. I think they’re aware now well, and they probably were before too. I have, there were a couple kids that would always come with sunscreen, so I know that they’re aware and if not before they are now. (Summer Sport Coach)
	Change in awareness of skin cancer risk and sun protective behaviors	8/14 57%	“But I liked the information that came from it because it, it made me more aware and want to take more of an active role. I know meaning the players on my team’s, I know their lives. Four or five of them come from farms farming communities. So they’re there and as soon as they get home from school they are outside moving water or they’re outside doing, doing stuff for their dads.” (Fall Sport Coach) “So it made me think, cause I coach, I coach a lot of sports. And I coach baseball in the spring um, and ya know we’re outside eight hours some days and I wear sunscreen and I make my, my kid wear sunscreen. But, I was always uncomfortable about offering it to other kids but um…I think I’ll start to offer it if kids want it. And parents are okay with it.” (Fall Sport Coach)
External Environment
External Environment and Impact on RAYS	Physical layout and structure of sports fields	6/14 43%	“I don’t think it’s the greatest, I think it could be better. Um. Like I said, there’s not a lot of shady areas to take precautions to be out of the sun here. Like I mean our dugouts for softball and stuff they are covered. But, when the Suns beating right into the dugout, the cover dugout doesn’t serve its purpose. You know what I mean? Like when the kids are playing soccer or flag football, there’s just. There’s no means for shade.” (Summer Sport Coach)
	RAYS is best implemented in the spring and summer league seasons	7/14 50%	“Yeah, I think that’s, that’s …I don’t know the other challenge, well I don’t want to say challenge…given it was a fall sport, um it cooled off incredibly, I think 3 of our games were like rainy like we played on days that were super rainy so like the sun was never out, so the sun was never out. So I just think that given the time frame of, of this sport uh, the the sun by the time like, for the first couple of times like it was super-hot but after that, I uh ya know, these kids were in long-sleeve shirts and hoodies.” (Fall Sport Coach)
Implementation and Sustainability Infrastructure
Barriers to Implementation of RAYS	Challenges with league & community support and involvement with RAYS	4/14 29%	“Uhhh, maybe [avoiding] a middle party like the rec center and just come in and run it yourself [laughs]…Yeah I bet you’re fully capable, people to do that. When I, when we got all this information about two weeks into practices if this information would have come to us sooner. We were practicing at 5:00 o’clock in the middle of August and it’s pretty dang hot. I, I would have taken a more proactive stance. We were always in shade when we got done. We always took water breaks but there was never, I never encourage some sunscreen until you made me aware of that. So, maybe when the season starts when we get our teams, when we get everything, send us the expectations. But again I don’t think that comes from you it probably comes from the rec center.” (Fall Sport Coach)
Future Strategies to Improve the RAYS Intervention and its Reach	Social media and community events as a recruitment strategies	8/14 57%	“I don’t know, maybe, maybe I know a lot of them do like Facebook and. Things like that around here. But you could do like surveys. You know online surveys reach out kind of that way. Just kind of get a feel for what parents think.” (Fall Sport Coach) “Uh, probably just events. We have events at the lake and events every Tuesday night downtown at a farmers market. If there was information there it would reach more people. We don’t have a TV station so a lot of stuff, local geared things, is all radio and maybe Facebook I guess.” (Fall Sport Coach)
	Timing of recruitment	5/14 36%	“The only suggestion that I would have is to front-load some of the stuff. Um, so when parents sign up their kids for a sporting event then at that point the rec center or whoever, notifies the parent and says “hey this is sponsored by such and such study, that they’ll being doing this throughout the year. The coaches will be talking about skin care awareness.” (Fall Sport Coach)
	Parent support key for RAYS’ success	7/14 50%	“Trying to think of a way that’s like maybe to get good parents to be more involved in it, if that makes sense. I, I just don’t know how. You guys could incorporate, incorporate into that. I guess maybe that’s something else that like us as coaches would need to do, but it’s just, I mean, it’s kind of hard to go in and track down all the parents and be like hey listen, so I don’t know if there was like maybe that slide show like… But I don’t know, or maybe if you offer the parents on the team some type of incentive to watch this video on how important it is and to you know actually do it or even host like a one night class for 30 minutes or something. I don’t know. Yeah, I mean coaches can do it while they’re there, but as far as like informing them when they’re outside of there, I feel like that would be the parents that should do that.” (Summer Sport Coach) “I think primarily the parents buying in would be huge. And then having, having I mean it pushed through the rec center for coaches to help. I think those would be the two. So uh, buy in from parents and that comes from communicating up front with the parents what’s going on. And then getting the rec center to help. Um, and sending that message to each of them.” (Fall Sport Coach)
	Strategies to improve reach	12/14 86%	“I don’t know it of how to do it down here, but like an online, like a technology thing for parents to take their teenagers to. You know about Internet safety and things like that and they just did a class here one night and I think they offered some type of incentive, which I think made a lot more parents go than they would have. And they just, they just went over all the information and it was really beneficial and so something like that I feel could really get the community like more on board. And like I said with like one night a month, a one-time thing or something you could even do more than that I guess. But just as far as like our little community, I feel something like that might be beneficial.” (Summer Sport Coach) “If there’s some way to get that training to all the parents. Even if there’s like a 5 or 10 minute video. Or like you sent it to the coaches and they sent it to the parents and they parents can watch it you know?” (Fall Sport Coach)
Intervention Design/Characteristics
Acceptability of RAYS Intervention	RAYS was a turn-key intervention, simple and efficient	14/14 100%	“It was easy. It wasn’t hard at all. Um, just being able to have the resources available like you guys providing the sunscreen and the shirts and like the sunglasses. So like we didn’t have to, you know. Getting things out of our own. Use our money out of our own pocket. It was very helpful.” (Summer Sport Coach) “I thought it’s actually really easy to deliver […] put it all in a package and we were able to kind of just really easily, you know, send the information out and then hang up and supplies at one of our games. That was what made it. What made it, like I guess, what made it easy[…] it was really helpful that you guys provided that all. Because if I would have been like, oh, educate your players on skin safety or skin cancer stuff. And like, well, I don’t know what to pick and what is actually factual and so it was really helpful just to know that you guys had it all there for us and, and made it really easy to get it to the parents and the players.” (Summer Sport Coach) “Everyone was pretty receptive on my text messages to remind what time to show up for practice or games. I just put along with you know, bringing water and to apply sunscreen and wear sleeves and a hat. So whether or not they did I don’t know.” (Fall Sport Coach) “.where there was shade there was a ton of people. And then the first thing kids did when they got done playing or taking a break ran to the shade.” (Fall Sport Coach)
	Positive feedback and support for RAYS as a whole	14/14 100%	“I liked everything about it. The meeting was very helpful and explanatory. I just I liked everything about it…I don’t think there wasn’t, there wasn’t really anything that I didn’t like. Yeah, nothing. I liked everything about it.” (Summer Sport Coach) “I like that it made me more cognizant of the, of what’s going on in general. So one I was more aware of it. Two, I did like the fact that it helped subsidize the cost for the rec center for a program sponsoring it. Um, and I thought it was a helpful time to be able to pass out that information to parents as well. So, I guess those are the, those are the points that I liked.” (Fall Sport Coach)
	RAYS content was helpful and interesting for coaches	10/14 71%	“I just, I liked being informed. I didn’t know Utah was so high in the country. And I didn’t know that rural communities in Utah were so high and so once I knew that I thought yeah there’s something to that. I can take an active role as a coach pretty easily and helping these kids at a young age.” (Fall Sport Coach) “Oh I loved all that information I keep um reading it. I thought it was educational. Makes me realize, ya know just have more awareness. Ya know, the, the damages that the sun can do on our skin and the possibility of getting cancer and I don’t know. Ya know, just the, I thought that was good information. I really liked the packet.” (Fall Sport Coach)
	RAYS was helpful to players and parents	10/14 71%	“I thought it was very informative, even as a parent and a parent coach and the kids really liked the sunglasses and my little boy we really liked that. So I guess it was nice to get that and for the kids.” (Summer Sport Coach) “I think they’re aware. I think they’re aware now well, and they probably were before too. I have, there were a couple kids that would always come with sunscreen, so I know that they’re aware and if not before they are now.” (Summer Sport Coach)