Supplementing vitamin D through sunlight: Associating health literacy with sunlight exposure behavior

• We tested how health literacy (HL) was associated with sunlight exposure behavior.
• Doctor recommendations were not sufficient to affect health behavior.
• HL was directly and indirectly associated with sunlight exposure behavior.
• Training individuals health literacy skills increase the chance of sunlight exposure.

Purpose of the researchTo test whether health literacy is associated with sunlight exposure behavior, we interviewed 648 Chinese adults aged 65 years or older.MethodsUsing 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.ResultsHealth 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 (χ2/df = 2.79; RMSEA = .053, p = .346; CFI = .95; TLI = .92).ConclusionsHealth 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.