A study on health literacy and its relationship with vitamin D supplement among Chinese older adults

Abstract

Background: Vitamin D deficiency is prevalent among Chinese adults in Hong Kong and ignorance and confusion about vitamin D is common throughout the Hong Kong population. Health literacy is a crucial factor that influences the health actions and outcomes of individuals; however, little is known about the relationship between health literacy and behavior of supplementing vitamin D through sunlight exposure.

Objective: The aim of the current study was to identify the factors associated with the health literacy of Chinese older adults and to investigate the relationship between health literacy and the behavior of supplementing vitamin D through sunlight exposure.

Method: From May 2011 to January 2012, a cross-sectional survey was conducted among cognitively intact Chinese adults aged 60 or above. Recruitment of participants was through 23 residential care homes and 7 elderly community centers. A questionnaire elicited demographic and health literacy information and explored their knowledge about vitamin D, their attitude towards sunlight exposure, and their behavior related to sunlight exposure. Linear regression identified the factors associated with the health literacy among Chinese older adults. Path analysis investigated the relationship between health literacy and the behavior of participants regarding sunlight exposure.

Results: Participants and analysis included 648 Chinese adults. Among the population, respondents identified as having inadequate health literacy numbered 52.5%. Five factors, including age, marital status, educational attainment, residential status, and duration of living in residential care homes, had significant association with health literacy. In addition, health literacy had a direct relationship to respondents’ exposure to sunlight (direct effect = .075) and an indirect relationship through their knowledge about vitamin D and their attitude towards sunlight exposure (indirect effect = .015). However, knowledge about vitamin D and attitude towards sunlight exposure did not mediate the association between health literacy and behaviors concerning sunlight exposure.

Discussion and Conclusion: The results of this study showed that not only age, marital status, and educational attainment affected health literacy but also residential status and duration of living in residential care homes offered an effect. The study revealed that health literacy had both a direct and indirect relationship to health behavior (e.g., supplementing vitamin D through sunlight exposure). Health care professionals should note the relationship between health literacy and health behavior. Health education intervention about vitamin D supplement should focus training on individuals’ health literacy rather than their knowledge about vitamin D or attitude towards sunlight exposure.