Purpose. In 2005, one in three cancers worldwide was skin-related with an estimated 132,000 malignant melanoma and more than three million non-melanoma cancers. The primary cause of photocarcinogenesis is exposure to ultraviolet radiation. Seven million secondary school students who participate in athletics annually and their coaches are at elevated risk for ultraviolet radiation. The purpose of this study was to use a two-phase sequential exploratory mixed methods design to explore adolescent athletes' views about sun protection and skin cancer.

Method. Two research questions guided the study: (a) what factors affect adolescent athletes' knowledge, outcome expectations, and behaviors of sun protection; and (b) how valid and reliable is the Sun Protection of Athletes instrument? During phase one of the study, the researcher used cognitive interviews to explore how participants understand items, whether responses reflected constructs of Social Cognitive Theory, and whether additional items should be added. During phase two, the researcher piloted the instrument with a sample of Alabama adolescent athletes, and estimated the reliability and construct validity of scales using exploratory factor analysis.

Analysis/Results. 14 male and female adolescent athletes who represented six spring sports participated in two rounds of cognitive interviews. Item clarity and survey format were improved following the interviews, member checking, and peer debriefing. Specifically, three items were revised, 14 were eliminated, and six were added. Changes were made to the directions, item prompts, response options, and layout. The revised instrument was pilot tested with 803 student athletes (56% females, 76% white) representing 108 schools and each state board district. The outcome expectation section of the instrument yielded a three-factor solution explaining 60% of the variance. For the behavior section, a four-factor solution explained 69% of the variance. A two-factor solution for the knowledge section explained 54% of the variance.

Conclusions. The researcher used a systematic mixed methods approach to explore constructs as understood by participants. The combination of cognitive interviews and exploratory factor analysis enhanced understanding of adolescent athletes' knowledge, outcome expectations, and behaviors of sun protection.

Keywords. adolescent, athletes, mixed methods, psychometrics, sun protection, Social Cognitive Theory.