title: Supplementing vitamin D through sunlight: associating health literacy with sunlight exposure behavior.
abstract: OBJECTIVE
  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.
authors.affiliation: School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; Research Centre on Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China. Electronic address: angleung@hku.hk.
authors.forename: Angela Yee Man
authors.initials: AY
authors.lastname: Leung
authors.affiliation: Centre on Research and Advocacy, Hong Kong Society for Rehabilitation, Hong Kong, China.
authors.forename: Mike Kwun Ting
authors.initials: MK
authors.lastname: Cheung
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Chi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D019587:Dietary Supplements; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006306:Health Surveys; D006801:Humans; D008297:Male; D009042:Motivation; D013472:Sunlight; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000209:etiology / Q000517:prevention & control*; D014930:Women / Q000193:education* / Q000523:psychology
chemical_list: D014807:Vitamin D
keywords: Attitudes; Chinese; Health literacy; Knowledge; Sunlight exposure; Vitamin D