Prescribing sunshine: A cross‐sectional survey of 500 Australian general practitioners' practices and attitudes about vitamin D

Abstract

This study aimed to assess the attitudes, practices and knowledge of general practitioners (GPs) with regards to vitamin D. A cross-sectional survey of a random sample of GPs stratified by location of practice (rural/remote or metropolitan) and employment status (full-time or part-time) in New South Wales (NSW), Australia was conducted. Of 500 respondents, 58.1% (95% CI 53.8-62.4) reported that up to 39% of their tested patients showed vitamin D deficiency or insufficiency and a further 37.7% (95% CI 33.5-41.9) of respondents said that over 40% of their patients were vitamin D insufficient. Vitamin D supplementation and advice to receive more natural sunlight were the most common ways vitamin D insufficiency was managed (97.1%; 95% CI 95.6-98.6 and 82%, 95% CI 78.6-85.4, respectively). Some gaps in knowledge were identified. Most respondents (64%; 95% CI 59.8-68.2) believed that a person of average sun sensitivity required 10 min of direct sun exposure during summer in peak UV time and a further 21.6% (95% CI 18.0-25.2) believed that people required 30 min of direct sun. A third of respondents (33.1%; 95% CI 29.0-37.2) advised their patients to use sun protection at all times during winter. In general, the attitude items showed that respondents expressed greater concern about vitamin D deficiency than skin cancer. The results reveal some confusion in general practice regarding vitamin D, sun exposure, sun protection and skin cancer risk. Some of the advice that GPs are offering may needlessly increase their patients' risk for vitamin D insufficiency or skin cancer.The scientific literature about vitamin D contains conflicting evidence. Although some estimates suggest that vitamin D deficiency has reached 'pandemic' proportions, 1 others caution that limitations in testing and definitions of deficiency may be inflating prevalence rates.2-4 Similarly, while evidence regarding the important role of vitamin D in bone and skeletal health is strong, 3 an Institute of Medicine (IOM) review has found that evidence regarding its role in preventing cancer, improving immune function, and preventing or treating other chronic conditions including diabetes and cardiovascular disease is mixed and mostly limited to observational data.2-4 Due to some degree to this uncertainty, vitamin D continues to be an important area for investigation. Sometimes referred to as the 'sunshine vitamin,'5 the main source of vitamin D is exposure to sunlight or more specifically ultraviolet-B (UV-B) radiation. 6 Although there is debate regarding optimal vitamin D levels, 4,7,8 a serum 25-hydroxy vitamin D3 [25(OH)D] level of 50 nmol/l and above is generally recognised as sufficient. 9,10Although there is greater insufficiency of vitamin D at high latitudes, [11][12][13] it is also found in fair-skinned people living at low latitudes like Australia, where ambient UV irradiance is high and the rates of skin cancer are amongst the highest in the world.14,15 This co-occurrence of vitamin D insufficiency and skin cancer has led to the development of ...

What Do People Know and Believe about Vitamin D?

“…Corresponding proportions in previous studies were 9% (Australia) and 6% (New Zealand). Surprisingly, while participants with darker skin are more at risk of insufficiency [1,38], they were the least concerned with their VitD status in our study, consistently with an Australian study on general practitioners [22] in which dark skin was not considered as a main risk factor for VitD insufficiency.…”

“…Such information would be of interest for practitioners and public health institutions to improve the communication regarding VitD. Previous studies performed in several countries (mostly targeting specific groups) showed that VitD-related knowledge was limited [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. To our knowledge, no study was performed in a large European sample from the general population and few linked VitD-related knowledge to various individual characteristics (including measured VitD status).…”

Sun protection and vitamin D status in an Australian subtropical community

“…Bonevski et al (2012) reported that some advice that general practitioners are providing may actually increase patients' risk for vitamin D insufficiency or skin cancer as a result of mixed attitudes and practices (Bonevski et al, 2012). Our findings somewhat alleviate this confusion, by showing that except for staying in the shade when spending a relatively short time outdoors, the use of sun protection methods on a regular basis is not associated with vitamin D levels of Australians in a sub-tropical community.…”

Psychometric Properties of a Developed Questionnaire to Assess Knowledge, Attitude and Practice Regarding Vitamin D (D-KAP-38)

“…In this regard, despite sufficient evidence on the various determinants of vitamin D deficiency including lack of sun exposure and dietary intake, studies conducted on general practitioners, university and school students, general adult populations, and athletes mostly found participants to have inadequate knowledge regarding the role of sunlight in vitamin D production, the function and sources of vitamin D, and also negative attitudes and behaviors toward sunlight [11,12,13,14,15,16,17,18,19,20,21]. Hence, it seems understanding individuals’ knowledge, attitude and practice (KAP) regarding vitamin D is essential in developing related health promotion programs.…”