Exploring Knowledge and Attitudes about Vitamin D among Adults in Saudi Arabia: A Qualitative Study.

Abstract: Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants' knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute to vitamin D deficiency in Saudi Arabia. Face-to-face interviews were carried out in the cities of Jeddah and Makkah between May and October 2015. The interview questions were semi-structured, and the data was analyzed using thematic analysis. Study participants showed a reasonable level of knowledge in different areas about vitamin D, including the effect of vitamin D deficiency on bone health and exposure to sunlight as the main source of vitamin D. Participants were also knowledgeable about vitamin D supplements as another source of this vitamin. Nevertheless, there was a shortage of knowledge in relation to dietary sources of vitamin D. In respect to attitudes toward sun exposure, some participants had positive attitudes toward sunlight and were willing to expose themselves to sunlight, but it was restricted to the early morning or late afternoon to avoid the heat. These participants who liked exposure to sunlight were largely exposing only their faces and hands to sunlight. Other participants had negative attitudes toward sun exposure and were avoiding sunlight. Moreover, the study participants identified several barriers to sun exposure, including hot climate, living in high-rise buildings, limited public areas allowing outdoor activities, lifestyle issues such as physical inactivity, and some religious concerns such as wearing the hijab. The study results also demonstrate that females were more enthusiastic about taking actions to improve their vitamin D status in comparison with males. Recommendations for health education interventions that increase awareness about vitamin D sources, especially food sources, are made. Also, educational interventions should focus on increasing awareness about the sufficient time of the day and duration for sun exposure to improve vitamin D status and the importance of the intake of vitamin D supplements as an affordable source to improve vitamin D status. Increasing males' awareness of the benefits of vitamin D is important to encourage them to adopt behaviors to improve vitamin D.