We conducted the Pool Cool Diffusion Trial (15
) nationally from June through August for 4 consecutive summers (2003-2006). Recruitment procedures are detailed elsewhere (15
). Recruited pools were both public and private and were required to be outdoor, offer swim lessons to children aged 5 to 10 years, and have enough parent/child patrons to recruit at least 20 parents to complete surveys. During the study, we provided participating pools with educational materials, including 8 sun-safety lessons, an illustrated flip book to make the lessons more engaging and interactive, and a Leader's Guide
to the Pool Cool program. We also provided poolside activities to complement the lessons, including ultraviolet index activity cards, a Play it Safe in the Sun poster, and a sun-safety-themed Jeopardy!
-style game board. We also gave pools a Decision Maker's Guide for Sun Safety
, a gallon jug of sunscreen, aluminum sun-safety signs, and small incentive items.
We made these materials available year-round to nonstudy pools through the Pool Cool and National Recreation and Park Association (NRPA) Web sites. On the Pool Cool Web site, materials could be downloaded as portable document files (PDFs) and reproduced for use at the pool. A Pool Cool e-mail address was provided on the Web site so that incentive items could be requested and purchased. Additional materials identical to those provided to study pools also could be purchased through the NRPA Web site.
Before downloading or purchasing materials from the Web sites, people from nonstudy pools were required to register online, provide contact information, and agree to be contacted about how their pool used the program materials. At the end of each summer, we sent registrants a survey about Pool Cool Web-based materials. We used data from the Web-based surveys and surveys from the diffusion study to compare study pools with nonstudy pools that accessed the materials online. We collected additional information about the spontaneous diffusion through e-mails sent to the official Pool Cool e-mail address during the diffusion study. We included only e-mails from people who inquired about the Pool Cool program and who had not participated in a Pool Cool research study. All data collection procedures were approved by the University of Hawaii Committee on Human Studies (CHS no. 11575) and the institutional review board at Emory University (IRB no. 156-2004).
The registration form for obtaining Web-based materials asked registrants for their name, organization, contact information, type of organization at which they planned to use the Pool Cool materials, the ages and number of children expected to be exposed to the program, and how they learned about the program. The survey about Web-based materials sent to registrants at the end of the summer included questions about pool characteristics, use of materials, environmental and organizational supports for sun safety at the pool, and obstacles and supporting factors for sun-safety efforts at the pool (Appendix
Questions about pool characteristics included community description (urban, suburban, or rural), weekly pool attendance, and number of staff. We included these questions on baseline pool manager surveys as well, allowing for comparison of the diffusion study pools with nonstudy pools that registered for program materials online.
We used SPSS version 16.0 (SPSS, Inc, Chicago, Illinois) to conduct all quantitative analyses. We used χ2 tests to compare people who completed the survey about Web-based materials with people who completed only the registration form and to compare diffusion study pools with nonstudy pools. We computed frequencies to assess use of program materials, levels of program implementation, and the importance of supporting factors and obstacles to sun safety at the pool. Some respondents returned more than 1 follow-up survey, so we conducted these analyses twice: once using the responses from each respondent's first survey and a second time using each respondent's highest response to each survey item across all returned surveys. Conducting analyses using each respondent's highest response allowed us to determine whether respondents ever used each program component and provided a summary of the highest levels of program use that occurred at all pools.
We used qualitative methods to analyze e-mail messages related to spontaneous diffusion that were sent to the official Pool Cool e-mail address. We received e-mails related to spontaneous diffusion from 11 people. One researcher reviewed the e-mails for thematic topics and categorized the e-mails into themes. A second researcher then independently categorized the e-mails into the thematic categories, and the study team discussed any discrepancies until consensus was achieved. The thematic categories were not mutually exclusive, and some e-mails were captured by more than 1 theme.