The ABC of Vitamin D: A Qualitative Study of the Knowledge and Attitudes Regarding Vitamin D Deficiency amongst Selected Population Groups
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Sample & Recruitment
2.3. Procedure
2.4. Discussion Guide Content
2.5. Data Coding and Analysis
3. Results
Participants | Male N | Female N | |
---|---|---|---|
Group 1 | Office workers | 4 | 5 |
Group 2 | Independent living adults (65 years+) | 5 | 4 |
Group 3 | Office workers | 4 | 5 |
Group 4 | Community aged home residents (65 years+) | 4 | 5 |
Group 5 | Primary School teachers | 1 | 6 |
Group 6 | Secondary School teachers | 5 | 4 |
3.1. Knowledge
3.1.1. General Vitamin D Knowledge
3.1.2. Sources of Information about Vitamin D
- Media: articles in newspapers, magazines and current affairs programs;
- Doctors: some participants (primarily with a deficiency in vitamin D) had learnt about vitamin D from their doctor, although often information they had received was limited;
- Family members/friends: few participants mentioned that they had heard about vitamin D through family members, friends or significant others;
- School and further education: a small number of participants said they had learnt what they know from school or further education.
3.1.3. Vitamin D Testing and Education
“… I have a cholesterol test usually at least once a year, but I have got no idea whether there is a vitamin D component in that.” (Independent aged)
“No, he [doctor] didn’t [explain why Vitamin D was important], he just recommended [...] I take Caltrac with vitamin D. That was it.” (Office worker)
3.2. Awareness
3.2.1. Knowledge of Times and Seasons for Sun Protection
3.2.2. Knowledge about Amount of Sun Exposure Required for Adequate Vitamin D
“How much exposure, too, I mean, I was out in the sun yesterday with arms exposed. I mean, is that the same as, do I need 20 min of that, whereas I can stay outside in the nude for three minutes?” (Primary school teacher)
3.2.3. Knowledge about Groups at Higher Risk of Vitamin D Deficiency
3.3. Personal Behaviours and Perceived Risk
Personal UV Exposure for Adequate Vitamin D
“No. I don’t think in winter I would in a day. Especially when you have a week, like days of rain and ... I don’t think in winter.” (Primary school teacher)
General Population | |
a | Fair skinned people can achieve adequate vitamin D levels (>50 nmol/L) in summer by exposing the face, arms and hands or the equivalent area of skin to a few minutes of sunlight on either side of peak UV periods on most days of the week. In winter, in the southern regions of Australia, where UV radiation levels are less intense, maintenance of vitamin D levels may require 2–3 h of sunlight exposure to the face, arms and hands or equivalent area of skin over a week. |
b | In Sydney, in December to January (Australian summer), 6 to 8 min at 10 am or 2 pm. In Sydney, in July to August (Australian winter), 26 to 28 min at 10 am or 2 pm or 16 min at 12 noon. |
People at high risk of vitamin D deficiency | |
a | Naturally dark skinned people (Fitzpatrick skin type 5 and 6) are relatively protected from skin cancer by the pigment in their skin; they could safely increase their sun exposure. Other people at high risk of vitamin D deficiency should discuss their vitamin D status with their medical practitioner, as some might benefit from dietary supplementation with vitamin D. |
b | Vitamin D supplementation is likely to be required for this population group. |
3.4. Barriers
3.4.1. Barriers to Receiving Sun Exposure for Adequate Vitamin D
“The consequences I think are greater. It’s [skin cancer] deadly, and you die a lot quicker from cancer than you can from vitamin D deficiency...” (Secondary school teacher)
3.4.2. Ways to Address the Barriers to Increase Sun Exposure
3.4.3. Communicating the Vitamin D Message
4. Discussion
4.1. Low Knowledge and Awareness about Balancing the Benefits and Risks of Sun Exposure
4.2. High Levels of SunSmart Awareness and Sun Avoidance Behaviours
4.3. Barriers to Sun Exposure for Vitamin D
4.4. Strategies to Overcome the Barriers
4.5. Study Strengths and Weaknesses
Conflict of Interest
Author Contributions
References
- Garland, C.F.; Garland, F.C.; Gorham, E.D.; Lipkin, M.; Newmark, H.; Mohr, S.B.; Holick, M. The role of vitamin D in cancer prevention. Am. J. Public Health 2005, 96, 252–261. [Google Scholar]
- Holick, M.F. Sunlight and vitamin D for bone health and the prevention of autoimmune diseases, cancers and cardiovasular disease. Am. J. Clin. Nutr. 2004, 80, 1678s–1688s. [Google Scholar]
- Hypponen, E. Vitamin D and the Risk of Type 1 Diabetes. In Vitamin D: Physiology, Molecular Biology, and Clinical Applications (Nutrition and Health); Hollick, M.F., Ed.; Humana Press: New York, NY, USA, 2010; pp. 867–879. [Google Scholar]
- Holick, M.F. vitamin D and bone health. J. Nutr. 1996, 126, 11595–11645. [Google Scholar]
- Moan, J.; Porojnicu, A.C.; Dahlback, A.; Setlow, R.B. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc. Natl. Acad. Sci. USA 2008, 105, 668–673. [Google Scholar]
- Vik, T.; Try, K.; Stromme, J.H. The vitamin D status of man at 70 degrees north. Scand. J. Clin. Lab. Invest. 1980, 40, 227–232. [Google Scholar] [CrossRef]
- Brustad, M.; Alaser, E.; Engelsen, O.; Aksnes, L.; Lund, E. Vitamin D status of middle aged women at 65–71 degrees north in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr. 2004, 7, 327–335. [Google Scholar]
- McGrath, J.J.; Kimlin, M.G.; Saha, S.; Eyles, D.; Parisi, A. Vitamin D insufficiency in southeast queensland. Med. J. Aust. 2001, 174, 150–151. [Google Scholar]
- Pasco, J.A.; Henry, M.J.; Nicholson, G.C.; Sanders, K.M.; Kotowicz, M.A. Vitamin D status of women in the geelong osteoporosis study: Association with diet and casual exposure to sunlight. Med. J. Aust. 2001, 175, 401–405. [Google Scholar]
- Risks and benefits of sun exposure position statement, updated 2007. Available online: http://www.Dermcoll.Asn.Au/downloads/ccrisksandbenefitsmarch8.Pdf (accessed on 20 January 2011).
- American Academy of Dermatology Updated position statement on vitamin D. Available online: http://www.aad.org/media/background/news/Releases/American_Academy_of_Dermatology_Issues_Updated_Pos/ (accessed on 20 January 2011).
- Osteoporosis Australia. Calcium, vitamin D and osteoporosis. A guide for gps, 2nd ed. 2008. Available online: http:/www.Osteoporosis.Org.Au/files/factsheets/oth-7665-eng.Pdf (accessed on 20 January 2011).
- Flicker, L.; Mead, K.; Macinnis, R.J.; Nowson, C.; CScherer, S.; Stein, M.S.; Thomasx, J.; Hopper, J.L.; Wark, J.D. Serum vitamin D and falls in older women in residential care in australia. J. Am. Geriatr. Soc. 2003, 51, 1533–1538. [Google Scholar] [CrossRef]
- Sambrook, P.N.; Cameron, I.D.; Cumming, R.G.; Lord, S.R.; Schwarz, J.M.; Trube, A.; March, L.M. Vitamin D deficiency is common in frail institutionalised older people in northern sydney. Med. J. Aust. 2002, 176, 560. [Google Scholar]
- Grover, S.R.; Morley, R. Vitamin D deficiency in veiled or dark skinned pregnant women. Med. J. Aust. 2001, 175, 251–252. [Google Scholar]
- Diamond, T.; Smerdely, P.; Kormas, N.; Sekel, R.; Vu, T.; Day, P. Hip fracture in elderly men: The importance of subclinical vitamin D deficiency and hypogonadism. Med. J. Aust. 1998, 169, 138–141. [Google Scholar]
- Hatun, S.; Islam, O.; Cizmecioglu, F.; Kara, B.; Babaoglu, K.; Berk, F.; Gökalp, A.S. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J. Nutr. 2005, 135, 218–222. [Google Scholar]
- Janda, M.; Youl, P.; Bolz, K.; Niland, C.; Kimlin, M. Knowledge about the health benefits of vitamin D in queensland australia. Prev. Med. 2010, 50, 215–216. [Google Scholar] [CrossRef]
- Rosenstock, I.M.; Strecher, V.J.; Becker, M.H. Social learning theory and the health belief model. Health Educ. Q. 1988, 15, 175–183. [Google Scholar] [CrossRef]
- McGuire, W.J. Public communication as a strategy for inducing health-promoting behavioural change. Prev. Med. 1984, 13, 299–319. [Google Scholar] [CrossRef]
- Rogers, E.M. Diffusion of Innovations; The Free Press: New York, NY, USA, 1993. [Google Scholar]
- Kirby, S.; Baranowski, T.; Reynolds, K.D.; Taylor, G.; Binkley, D. Children’s fruit and vegetable intake:Socioeconomic, adult-child, regional, and urban-rural influences. J. Nutr. Educ. 1995, 27, 261–271. [Google Scholar] [CrossRef]
- Green, L.W.; Kreuter, M. Health Promotion Planning: An Educational and Environmental Approach, 2nd ed; Mayfield: Mountain View, CA, USA, 1991. [Google Scholar]
- Glanz, K.; Lewis, F.M.; Rimer, B.K. Health Behavior and Health Education: Theory, Research, and Practice, 2nd ed; Jossey-Bass: San Francisco, CA, USA, 1997. [Google Scholar]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (coreq): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef]
- Bandura, A. Social Foundations of Thought and Action: A Social Cognitive Theory; Prentice-Hall: Englewood Cliffs, NJ, USA, 1986. [Google Scholar]
- Strecher, V.J.; Rosenstock, I.M. The Health Belief Model, 2nd ed; Jossey-Bass: San Francisco, CA, USA, 1997. [Google Scholar]
- NVivo Qualitative Data Analysis Software, version 8, QSR International Pty Ltd.: Doncaster, Australia, 2008.
- Holloway, I.; Wheeler, S. Qualitative Research in Nursing, 2nd ed; Blackwell Publishing: Melbourne, Australia, 2002. [Google Scholar]
- Youl, P.; Janda, M.; Kimlin, M.G. vitamin D and sun protection: The impact of mixed messages in australia. Int. J. Cancer 2008, 124, 1963–1970. [Google Scholar] [CrossRef] [Green Version]
- Sinclair, C. Risks and benefits of sun exposure: Implications for public health practice based on the australian experience. Prog. Biophys. Mol. Biol. 2006, 92, 173–178. [Google Scholar] [CrossRef]
- Diffey, B.L. Is casual exposure to summer sunlight effective at maintaining adequate vitamin D status? Photodermatol. Photoimmunol. Photomed. 2010, 26, 172–176. [Google Scholar] [CrossRef]
- Wilson, A.; Bonevski, B.; Jones, A.; Henry, D. Deconstructing cancer: What makes a good quality news story. Med. J. Aust. 2010, 193, 702–706. [Google Scholar]
- Kemp, G.A.; Eagle, L.; Verne, J. Mass media barriers to social marketing interventions: The example of sun protection in the uk. Health Promot. Int. 2010, 26, 37–45. [Google Scholar] [CrossRef]
- Scully, M.; Wakefield, M.; Dixon, H. Trends in news coverage about skin cancer prevention, 1993-2006: Increasingly mixed messages for the public. Aust. N. Z. J. Public Health 2008, 32, 461–466. [Google Scholar] [CrossRef]
- Politi, M.C.; Han, P.K.J.; Col, N.F. Communicating the uncertainty of harms and benefits of medical interventions. Med. Decis. Mak. 2007, 27, 681. [Google Scholar]
- Bonevski, B.; Girgis, A.; Magin, P.; Horton, G.; Brozek, I.; Armstrong, B. Prescribing sunshine: A survey of general practitioners’ knowledge, attitudes and practices relating to the sun and vitamin D. Int. J. Cancer 2011, 130, 2138–2145. [Google Scholar]
- Woo, D.K.; Eide, M.J. Tanning beds, skin cancer, and vitamin D: An examination of the scientific evidence and public health implications. Dermatol. Ther. 2010, 23, 61–71. [Google Scholar] [CrossRef]
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Bonevski, B.; Bryant, J.; Lambert, S.; Brozek, I.; Rock, V. The ABC of Vitamin D: A Qualitative Study of the Knowledge and Attitudes Regarding Vitamin D Deficiency amongst Selected Population Groups. Nutrients 2013, 5, 915-927. https://doi.org/10.3390/nu5030915
Bonevski B, Bryant J, Lambert S, Brozek I, Rock V. The ABC of Vitamin D: A Qualitative Study of the Knowledge and Attitudes Regarding Vitamin D Deficiency amongst Selected Population Groups. Nutrients. 2013; 5(3):915-927. https://doi.org/10.3390/nu5030915
Chicago/Turabian StyleBonevski, Billie, Jamie Bryant, Sylvie Lambert, Irena Brozek, and Vanessa Rock. 2013. "The ABC of Vitamin D: A Qualitative Study of the Knowledge and Attitudes Regarding Vitamin D Deficiency amongst Selected Population Groups" Nutrients 5, no. 3: 915-927. https://doi.org/10.3390/nu5030915
APA StyleBonevski, B., Bryant, J., Lambert, S., Brozek, I., & Rock, V. (2013). The ABC of Vitamin D: A Qualitative Study of the Knowledge and Attitudes Regarding Vitamin D Deficiency amongst Selected Population Groups. Nutrients, 5(3), 915-927. https://doi.org/10.3390/nu5030915