A Model Testing on Health Literacy, Knowledge about Vitamin D, and Actual Behavior in Sunlight Exposure

Purpose: To test whether health literacy is associated with actual 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 how health literacy was associated with the complex relationship among knowledge about vitamin D, attitudes towards sunlight exposure, doctor recommendations regarding sunlight exposure, and actual sunlight exposure behavior. Health literacy was directly associated with sunlight exposure (beta = .20, p < .01). Indirect relationships also existed between knowledge and sunlight exposure through health literacy (beta = .46, p < .001) and between attitudes and sunlight exposure through health literacy (beta = -.12, p < .05).

Results: The model had good fit (chi-square/df = 2.79; RMSEA = .053, p = .346; CFI = .95; TLI = .92). 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.

Conclusion: Training should be focused on individuals with low health literacy who would be less likely to receive sunlight exposure.