Vitamin D, often referred to as the "sunshine vitamin," plays an indispensable role in maintaining bone health, calcium homeostasis, and overall musculoskeletal function. Despite its critical biological functions, Vitamin D deficiency has emerged as a global public health concern, affecting populations across diverse age groups and geographical locations. Particularly in countries like India, where abundant sunlight is available year-round, the paradox of widespread Vitamin D deficiency underscores the complexity of contributing factors such as changing lifestyles, inadequate dietary intake, limited sun exposure, and cultural practices that restrict outdoor activities. Compounding the problem, Vitamin D deficiency remains largely silent and asymptomatic until it culminates in serious skeletal consequences, notably osteoporosis, osteomalacia, increased fracture risk, and impaired quality of life [1-3].

Globally, osteoporosis—a metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue—has reached epidemic proportions, leading to increased morbidity, mortality, and healthcare costs, especially among aging populations. In India, rapid urbanization, sedentary lifestyles, and nutritional transitions have amplified the burden of osteoporosis and Vitamin D deficiency even among rural and semi-urban populations. Despite the growing prevalence, public awareness about the importance of Vitamin D, its sources, recommended sun exposure, and its role in preventing bone-related disorders remains inadequate. Misconceptions about sun avoidance, unbalanced diets, and lack of routine Vitamin D screening further exacerbate the risk of long-term skeletal complications [4-6].

Solan district of Himachal Pradesh, with its mix of rural, semi-urban, and emerging urban populations, offers a unique context to study Vitamin D-related health awareness. Although the region benefits from moderate sunlight throughout the year, lifestyle shifts, increased indoor occupations, and socio-cultural practices may be contributing to an underrecognized epidemic of Vitamin D deficiency and related bone health issues. Currently, there is limited localized data capturing the community’s knowledge, attitudes, and behaviors related to Vitamin D, osteoporosis risk, and lifestyle factors such as sun exposure and physical activity.

This study aims to assess the level of awareness about Vitamin D, its health implications, sources, and preventive strategies among the adult population of Solan district. By identifying knowledge gaps, misconceptions, and behavioral patterns related to sun exposure, dietary habits, and osteoporosis risk, the findings will help guide targeted public health interventions, nutritional education campaigns, and policy initiatives aimed at strengthening bone health and preventing the silent progression of Vitamin D deficiency in the region.

Study Design

This study employed a descriptive, cross-sectional survey design to evaluate awareness, knowledge, and behaviors related to Vitamin D, bone health, sun exposure, and osteoporosis risk among adults in the Solan district of Himachal Pradesh. A cross-sectional approach was chosen to obtain a snapshot of community perceptions and practices regarding Vitamin D at a single point in time, across diverse socio-demographic groups.

Study Area and Population

The study was conducted across various rural, semi-urban, and urban areas within Solan district, ensuring representation from a wide spectrum of social, economic, and occupational backgrounds. The target population included adults aged 18 years and above, regardless of existing diagnoses of Vitamin D deficiency, osteoporosis, or other musculoskeletal disorders. To maintain the focus on general community awareness, healthcare professionals and medical students were excluded.

Study Duration

The data collection period spanned three months, from January to March 2025, allowing sufficient time to engage participants across different locations and seasons, which could influence sun exposure habits.

Sample Size and Sampling Technique

A minimum sample size of 400 participants was determined using a 95% confidence level, 5% margin of error, and an estimated 50% prevalence of Vitamin D-related knowledge due to limited existing regional data. Purposive and snowball sampling techniques were utilized, beginning with participants recruited through local community centers, social groups, and online platforms (e.g., WhatsApp, Facebook). Participants were encouraged to share the survey link within their networks to ensure wider community reach.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Adults aged 18 years and above residing in Solan district.

• Ability to understand and respond to the survey in Hindi or English.

• Access to an internet-enabled device (smartphone, tablet, or computer).

• Willingness to provide informed consent prior to participation.

Exclusion Criteria:

• Practicing healthcare professionals (doctors, nurses, physiotherapists, dietitians).

• Medical and allied health students.

• Incomplete or partially filled survey responses.

Data Collection Tool

A structured, pre-validated bilingual (Hindi and English) questionnaire was designed in consultation with experts in public health, nutrition, orthopedics, and epidemiology. The survey, hosted on Google Forms for easy accessibility, consisted of four key sections:

• Demographic Information: Age, gender, educational background, occupation, and residential setting.

• Knowledge Assessment: Questions about Vitamin D sources, its role in bone health, symptoms of deficiency, and osteoporosis risk factors.

• Behavioral Assessment: Patterns of sun exposure, outdoor physical activity, dietary habits (consumption of Vitamin D-rich foods), and supplement use.

• Perceptions and Practices: Beliefs about sun avoidance, sunscreen use, preventive health measures, and willingness for Vitamin D testing and supplementation.

Data Collection Procedure

Participants accessed the online survey link accompanied by an information sheet explaining the study's objectives, confidentiality assurances, and informed consent declaration. Participation was voluntary and anonymous. Only fully completed surveys were considered for analysis to ensure data quality and reliability.

Scoring and Knowledge Classification

Each correct response in the knowledge section was awarded one point, while incorrect or "don't know" responses received zero points. Participants' knowledge levels were categorized as:

• Very Good Knowledge (≥80% correct responses)

• Good Knowledge (60%–79% correct responses)

• Fair Knowledge (41%–59% correct responses)

• Poor Knowledge (<40% correct responses)

Behavioral and perception data were analyzed descriptively to identify prevalent habits and misconceptions influencing Vitamin D status and bone health.

Data Analysis

Data were exported from Google Forms into Microsoft Excel for cleaning and coding and analyzed using SPSS version 26.0. Descriptive statistics such as frequencies, percentages, means, and standard deviations summarized the demographic characteristics, knowledge levels, sun exposure patterns, and lifestyle behaviors. Chi-square tests were applied to explore associations between socio-demographic factors and knowledge or practices related to Vitamin D and bone health. A p-value < 0.05 was considered statistically significant.

Ethical Considerations

Ethical approval for the study was obtained from the institutional ethics review board. Informed online consent was obtained from all participants before commencing the survey. The study ensured participant anonymity, confidentiality, and voluntary participation in accordance with the ethical guidelines outlined in the Declaration of Helsinki for research involving human participant.

Table 1 presents the socio-demographic profile of the 400 participants surveyed in Solan district. The largest proportion of respondents (39.0%) fell within the 26–35 years age group, followed by 25.0% aged 36–45 years, and 24.0% aged 18–25 years, highlighting a predominantly young to middle-aged adult population. Females constituted a slightly higher percentage (53.0%) compared to males (47.0%), aligning with typical trends observed in health-focused surveys where women often show greater participation. In terms of educational attainment, 36.5% had completed secondary schooling and 29.0% held an undergraduate degree, while 8.0% had no formal education, suggesting a moderate level of educational diversity among respondents. Homemakers formed the largest occupational group (35.5%), followed by self-employed individuals (21.5%) and students/unemployed participants (21.3%). Additionally, a significant majority of participants (65.8%) were rural residents, reflecting the largely rural demographic composition of Solan district and emphasizing the need for rural-focused health awareness strategies.

Table 2 summarizes the participants' knowledge and awareness regarding Vitamin D and bone health, revealing generally encouraging trends but also notable areas of improvement. A high percentage (79.8%) correctly identified Vitamin D’s primary function in bone health and calcium absorption, and 81.8% recognized sunlight as a major source of Vitamin D. Awareness was similarly strong regarding the relationship between Vitamin D deficiency and osteoporosis (76.0%), fracture risk (79.0%), and the benefits of physical activity in reducing osteoporosis risk (80.5%). However, awareness about the impact of sunscreen use on Vitamin D synthesis (62.8%) and the need for routine Vitamin D testing (61.5%) was comparatively lower, indicating specific gaps. Although 74.3% knew that supplementation could prevent deficiency and 71.5% recognized fortified foods as a source of Vitamin D, misconceptions about the necessity and timing of supplementation, testing, and lifestyle modifications persisted. Encouragingly, 82.8% of respondents correctly identified doctors as the appropriate source for supplementation guidance, demonstrating trust in healthcare professionals despite some broader knowledge limitations.

Table 1: Socio-Demographic Characteristics of Participants

Table 2: Awareness and Knowledge of Vitamin D and Bone Health Among Participants

Table 3: Knowledge Score Classification

Table 3 categorizes participants based on their overall knowledge scores regarding Vitamin D and bone health. About 30.3% of the respondents demonstrated "Very Good" knowledge (≥80% correct answers), while the largest segment, 43.3%, fell into the "Good" knowledge category (60%–79% correct answers), suggesting that a majority possess a reasonably solid understanding but with room for improvement. However, 19.5% were classified under "Fair" knowledge (41%–59%), and 7.0% fell into the "Poor" knowledge bracket (<40%), indicating that approximately one-quarter of the population remains at risk due to insufficient awareness. These findings highlight the critical need for targeted educational interventions aimed at bridging the knowledge gaps, particularly among individuals with fair to poor understanding, to effectively prevent Vitamin D deficiency and its associated bone health complications in the Solan population.

This study provides crucial insights into the awareness, knowledge, and behavioral patterns regarding Vitamin D and bone health among the adult population of Solan district, Himachal Pradesh. Despite the region's favorable climate offering abundant sunlight, the findings highlight a paradoxical situation where a significant portion of the community remains at risk of Vitamin D deficiency due to knowledge gaps, lifestyle factors, and misconceptions around sun exposure, nutrition, and preventive healthcare practices.

The socio-demographic profile of participants (Table 1) reveals a predominantly young to middle-aged adult population, with the majority aged between 26–35 years (39.0%) and 36–45 years (25.0%), aligning with the demographic segment most likely to benefit from preventive interventions targeting bone health. The slight female predominance (53.0%) is noteworthy, given that women are biologically more vulnerable to osteoporosis and often influence household health behaviors. The educational distribution, where 36.5% had completed secondary schooling and 29.0% held undergraduate degrees, suggests a moderately educated population. However, the presence of 8.0% of participants without formal education underscores the importance of literacy-sensitive health promotion strategies. The predominance of rural participants (65.8%) emphasizes the need to bridge urban-rural disparities in health awareness campaigns, especially considering that rural residents may face greater barriers to accessing healthcare services, routine screenings, and nutritional supplementation.

In terms of knowledge and awareness (Table 2), participants demonstrated a reasonably good foundational understanding, with 79.8% correctly identifying Vitamin D’s role in bone health and 81.8% recognizing sunlight as a primary source. Encouragingly, participants were also largely aware of the relationship between Vitamin D deficiency and osteoporosis (76.0%), fracture risk (79.0%), and the benefits of physical activity (80.5%)—key elements in maintaining bone health. However, several areas of concern emerged. Awareness about the negative impact of excessive sunscreen use on Vitamin D synthesis (62.8%), the importance of Vitamin D testing (61.5%), and the link between Vitamin D and immune function (67.3%) was relatively lower. Furthermore, although 74.3% acknowledged the role of supplementation in deficiency prevention, behavioral patterns regarding supplementation and regular testing were not assessed directly, suggesting a possible knowledge-action gap. These findings mirror similar trends observed in both national and international studies, where despite moderate levels of awareness, consistent behavioral adherence to Vitamin D health practices remains limited.

Misconceptions about sun exposure are particularly critical. Although Solan district enjoys year-round moderate sunlight, changing lifestyles characterized by indoor occupations, increased urbanization, and cultural tendencies to avoid direct sun exposure for cosmetic reasons or misconceptions about skin damage have likely contributed to suboptimal Vitamin D status. Only 65.8% of participants correctly recognized that 15–30 minutes of daily sun exposure is generally sufficient, highlighting an opportunity for public health messaging to focus on safe, adequate sun exposure practices.

The knowledge score classification (Table 3) further reinforces the mixed findings: while 30.3% of participants demonstrated "Very Good" knowledge and 43.3% showed "Good" knowledge, nearly 27% fell into "Fair" or "Poor" categories. This quarter of the population is particularly vulnerable to the adverse consequences of unrecognized Vitamin D deficiency, including heightened osteoporosis risk, increased susceptibility to fractures, chronic musculoskeletal pain, and impaired immune function. Moreover, the study’s results align with previous research from other regions of India, suggesting that Vitamin D-related public health education remains insufficiently prioritized, despite the growing burden of musculoskeletal and metabolic diseases.

From a public health and policy perspective, these findings call for several urgent interventions. First, health education campaigns must emphasize the importance of Vitamin D in skeletal and non-skeletal health, safe sun exposure practices, dietary sources, and the role of supplementation where necessary. Messaging should be tailored to the rural context of Solan, using vernacular language and engaging community leaders, schools, and primary health workers to effectively reach different socio-demographic groups. Second, routine screening for Vitamin D deficiency and osteoporosis risk should be integrated into primary healthcare services, especially targeting vulnerable populations such as women, the elderly, and individuals with limited outdoor activity. Third, strategies to promote the consumption of fortified foods and accessible supplements must be explored, considering the financial and logistical barriers that rural residents often face [7-8].

Furthermore, the association between lifestyle factors—such as physical inactivity, obesity, and smoking—and bone health must be emphasized to foster a holistic approach to disease prevention. The link between Vitamin D deficiency and broader health outcomes, including immune dysfunction and increased susceptibility to infections, should also be communicated, particularly in light of the heightened health consciousness following the COVID-19 pandemic.

Lastly, combating misinformation related to sun exposure, supplementation, and Vitamin D safety is essential. The findings that a considerable percentage of participants lacked awareness regarding supplementation timing, testing recommendations, and sunscreen’s effects indicate the pressing need for scientifically accurate, community-driven information dissemination campaigns. Mobile health units, health fairs, village health and nutrition days, and mass media platforms (e.g., radio, local television, and social media) could play pivotal roles in disseminating these messages effectively.

In conclusion, although there is a reasonably good baseline of knowledge regarding Vitamin D and bone health among adults in Solan district, significant knowledge gaps, misconceptions, and behavioral shortcomings persist, posing risks for an impending burden of osteoporosis and Vitamin D deficiency-related health issues. A multi-pronged, culturally sensitive approach encompassing education, early screening, supplementation programs, and community engagement is essential to address the "silent deficiency" and promote stronger, healthier lives across the region.

1. Goel S. Vitamin D status in Indian subjects: a retrospective analysis. Int J Res Orthop. 2020;6:603–10.

2. Queency Stylin AGS, Shanthi B, Narayan V, Subhashree MV, Kavitha A, Abdulla LM, et al. Understanding vitamin D awareness and deficiency in the youth of South India: A cross-sectional study. Front Health Inform. 2024;13(3):8952–62.

3. Selvarajan S, Gunaseelan V, Anandabaskar N, Xavier AS, Srinivasamurthy S, Kamalanathan SK, Sahoo JP. Systematic review on vitamin D level in apparently healthy Indian population and analysis of its associated factors. Indian J Endocrinol Metab. 2017;21(5):765–75.

4. Gupta GR, Gupta A. Vitamin D deficiency in India: Prevalence, causalities and interventions. Nutrients. 2014;6(2):729–75.

5. Lhamo Y, Chugh PK, Gautam SR, Tripathi CD. Epidemic of vitamin D deficiency and its management: Awareness among Indian medical undergraduates. J Environ Public Health. 2017;2017:2517207.

6. Pan T, Dasgupta A, Paul B, Bandyopadhyay L, Augustine ATV, Suman S. Bone health and its association with vitamin D and other covariates: A community-based study among women in a rural area of West Bengal. Indian J Public Health. 2020;64(2):135–40.

7. Khadilkar A, Kajale N, Oza C, et al. Vitamin D status and determinants in Indian children and adolescents: A multicentre study. Sci Rep. 2022;12:16790.

8. Marwaha RK, Tandon N, Reddy DRH, Aggarwal R, Singh R, Sawhney RC, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr. 2005;82(2):477–82.