TABLE 4.

Themes identified for adapting Caring Contacts clinical trial in AI/AN communities.

Themes	Subthemes	Example quotes
Intervention characteristics	• Message timing and frequency • Message form, content, and tone • Implementation issues	“Maybe an extra message at Christmas and an extra message at … early spring.” “Maybe, like, equinox?” “Holidays too. Holidays are a big time for people, especially around here. People don’t have enough funds to make their ends meet or whatever else. In our culture we’ve got away from our value system where you invite people and you visit and share your food, because it’s not just food, it’s medicine.” “… it could be like phrases here and there because not everybody speaks their languages in their regions. Yup’ik is a strong language but still, saying cama’i instead of hello or quyana … stuff like that, pepper the texts with words that people could easily figure out what that is in whatever language.”
Study characteristics	• Eligibility criteria • Recruitment methods • Instruments/measures • Participant experience	“It ain’t just 18–34 year olds that think about suicide. I’m 53 years old and I think about it almost every day.” “I’m wondering about that reading level. Intentionally—I don’t know if they would get that word, unless the context may work with it, but just something more that’s … I think it’s even less than eighth-grade level.” “You have just asked something. … You’ve just sat with somebody for 2 hours and you invest incredibly personal information and made them go deep into their own self. You will be connecting on a level that is not your average person’s level. You’ve been given the privilege and the honor to hear this information. You need to respect that and thank that person for that and continue that connection. If you go from that to a standardized something, you’ve discounted what you just had I think.”
Community-specific factors related to suicide prevention	• Suicide risk factors and methods • Resources and responses • Cultural considerations	“Instead of asking, ’how are you doing, how’s life treating you?’ Those are good questions, but to see it from a Native point of view, it’s different. I think of my parents and my grandparents, our ways are different. Our language is different. To make it culturally acceptable somehow like, come and make some fry bread, or let’s make a harpoon, or something, anything to spark that. Spark something in the hopelessness.” “I think that with [community] it’s so diverse. You can have someone that’s identifiably Native that’s not traditional at all, you can have someone that’s not identifiable that’s very traditional, and vice versa.” “That’s our number one thing, is stigma, around here, and so, even me asking for help is going to be a big deal. So if I ask for help, or you’ve identified, and then you just say, Hey, here, contact these people, and that’s it, is there any follow up to that?”