Association of health and nutritional literacy with sun exposure in adults using structural equation modelling

Abstract

Background: Inadequate health and nutritional literacy is a common problem among adults which is associated with poor health outcomes. Therefore, this study aimed to investigate the relationship between health and nutritional literacy to sun exposure behavior. Methods: We conducted a cross-sectional study on 261 adults (18-65 years) in Iran. Knowledge, motivation, health literacy, nutritional literacy and sun exposure behavior using an interview-assisted questionnaire was evaluated. Using the information–motivation–behavioral skills model and structural equation modeling, we tested whether health and nutritional literacy was associated with the complex relationships among knowledge of vitamin D, attitudes toward sun exposure and sun exposure behavior. Beta and p values were calculated.Results: Health literacy (β= 0.29, p<0.001) and nutritional literacy (β= 0.14, p=0.02) was directly associated with sunlight exposure. Indirect relationships also existed between knowledge and sunlight exposure through health literacy (β = 0.33, p<0.001) and nutritional literacy (β = 0.22, p=0.01). The model had good fit (x2/df = 1.422; RMSEA = 0.040; CFI = 0.851; NFI = 0.657). There were no significant relationship between health literacy and motivation (β = 0.11, p=0.16), nutritional literacy and motivation (β = 0.06, p=0.42) and motivation and sun exposure (β = 0.01, p=0.91). Conclusions: Our findings showed that individuals with sufficient health and nutritional literacy more likely to have exposure to sunlight. Health and nutritional literacy should be considered when educating adults about vitamin D supplements and sunlight exposure.