In total, a convenient sample of 261 individuals participated in the study. The majority of participants were female (63.6%), overweight (42.1%), married (73.2%), Employed (51.7%), and had a higher education qualification (49.4%). The Participants’ characteristics are summarised in Table 1.
Vitamin D Knowledge
This study has indicated a high level of vitamin D Knowledge. 83.9% of participants had heard about vitamin D, 83.1% of surveyed population were agreed on that vitamin D is good for bone health and 72.4% knew that vitamin D is necessary for supporting calcium absorption. 69% participants knew that vitamin D could be supplemented by sunlight exposure. Moreover, 64% of them had information on the minimum time needed to spend outdoors to get enough Vitamin D (Table 2).
Attitude toward sunlight exposure
The level of attitude toward sunlight exposure was relatively low. Almost half (55.2%) responded that they like sunlight. 64.4% of participants used sunscreen products with sun-protection factor (SPF) ≥ 15 and 80.0% used a parasol to shade themselves from the sun. 67.8% reported that like outdoor activities and 21.1% reported that spend most of time outdoors. Overall, 31.8 % of the participants feel that have had sufficient sunlight exposure (Table 2).
Sun exposure behavior, Health literacy and Nutritional literacy
68.25% of participants spent 30 and more than 30 minutes outdoors on last weekend. In this study, the majority of adults (81.2%, n= 212) had adequate level of health literacy (Table 2).
Regarding cut of point of the nutritional literacy, 37.9% of the participants had adequate level of nutritional literacy.
Relationships among knowledge, attitude and behavior (first model)
The first model describes the relationship among knowledge, attitude and behavior in direct path. The model fit values (CMIN/df = 1.719, NFI= 0.561, CFI= 0.734 and RMSEA= 0.053), suggest the model has an acceptable predictive ability or fit. The relationships between knowledge and sunlight exposure behavior were not significant (β= 0.05, P=0.555). In addition, to attitude toward sun exposure was not directly associated with sunlight exposure behavior (β= 0.05, p=0.472) (Table 3).
Relationships among knowledge, attitude and behavior through of health literacy (second model)
The second model indicates the relationship between knowledge, attitude and behavior and the effect of health literacy on this relationship. The model fit indices )CMIN/df = 0.953, NFI= 0.777, CFI= 1.000 and RMSEA= 0.000( indicating a relatively satisfactory model fit to data. The paths between health literacy and sunlight exposure (β = 0.29, p < 0.001) and knowledge and health literacy (β = 0.34, p < 0.001) were statistically significant. Thus, health literacy had a direct effect on sunlight exposure. In addition, results confirmed the expected indirect effect of knowledge on sunlight exposure through health literacy. The path between attitude and health literacy (β = 0.10, p = 0.350) was not statistically significant (Table 3).
Relationships among knowledge, attitude and behavior through of nutritional literacy (Third model)
The third model indicates the relationship between knowledge, attitude and behavior and the effect of nutritional literacy on this relationship as observed variable. For the indirect effect of knowledge, attitude and behavior through nutritional literacy the model fit values were at acceptable level (CMIN/df = 1.011, NFI= 0.743, CFI= 0.996 and RMSEA= 0.006). Our result showed the significant path direct between knowledge and nutritional literacy (β =0.21, P = 0.020) and positive effect of nutritional literacy on sunlight exposure (β = 0.16, P = 0.009). This result revealed that the relation between knowledge and sunlight exposure may be nutritional literacy dependent. The path between attitudes and nutritional literacy (β = 0.05, p = 0.409) was not statistically significant (Table 3).
Relationships among knowledge, attitude and sun exposure behavior through of health and nutritional literacy (final model)
Final model shows the relationship between knowledge, attitude and sun exposure behavior and the effect of health and nutritional literacy on this relationship (Figure 1). Results of this analysis indicated that there is a relationship between knowledge and sun exposure behavior and health literacy (knowledge and health literacy: β= 0.33, p < 0.001 and health literacy and sun exposure: β =0.29, p< 0.001) and knowledge and sun exposure behavior and nutritional literacy (knowledge and nutritional literacy: β= 0.22, p= 0.013 and nutritional literacy and sun exposure: β= 0.14, p= 0.027). Indeed, this result indicates that relation between knowledge and sun exposure may be health and nutritional literacy dependent. There was not a significant relationship between attitude and sun exposure even engaging health literacy (attitude and health literacy: β =0.11, p=0.165 and health literacy and sun exposure: β =0.29, p< 0.001) and nutritional literacy (attitude and nutritional literacy: β = 0.06, p=0.429 and nutritional literacy and sun exposure: β = 0.14, p=0.027). The final model showed adequate goodness of fit (RMSEA= 0.040, CIF=0.85, NFI = 0.657, CMIN/df, = 1.422).