Supplementing vitamin D through sunlight: associating health literacy with sunlight exposure behavior.

PURPOSE OF THE RESEARCH:To test whether health literacy is associated with sunlight exposure behavior, we interviewed 648 Chinese adults aged 65 years or older. METHODS:Using the information-motivation-behavioral skills model and structural equation modeling, we tested whether health literacy was associated with the complex relationships among knowledge about vitamin D, attitudes toward sunlight exposure, doctor recommendations regarding sunlight exposure, and sunlight exposure behavior. RESULTS:Health literacy was directly associated with sunlight exposure (β=.20, p<.01). Indirect relationships also existed between knowledge and sunlight exposure through health literacy (β=.46, p<.001) and between attitudes and sunlight exposure through health literacy (β=-.12, p<.05). The model had good fit (χ(2)/df=2.79; RMSEA=.053, p=.346; CFI=.95; TLI=.92). CONCLUSIONS:Health literacy should be considered when educating older adults about vitamin D supplements and sunlight exposure. Providing relevant knowledge or making doctor recommendations might not be effective. Training should focus on individuals with low health literacy who may be less likely to receive sunlight exposure.