Abstract
OBJECTIVESTo develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos.METHODSThe study included adults (19-76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test.RESULTSA 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability.CONCLUSIONSWe developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.
Highlights
Vitamin D deficiency (VDD) is a major public health concern [1]. It is reflected by low serum 25-hydroxyvitamin D (25-OHD) levels, which lead to adverse changes in calcium and phosphate homeostasis and increased fracture risk
In the Philippines, a 2009 study of postmenopausal women found that 36% of the participants had insufficient 25-OHD levels (20-30 ng/mL), but only 30% of those women received calcium and vitamin D supplementation [2]
A contributing factor to the increasing prevalence of VDD in the Philippines is rapid urbanization, which has resulted in more young adults having indoor jobs and less sun exposure, raising concerns about bone health during the period when they are achieving peak bone mass
Summary
Vitamin D deficiency (VDD) is a major public health concern [1]. It is reflected by low serum 25-hydroxyvitamin D (25-OHD) levels, which lead to adverse changes in calcium and phosphate homeostasis and increased fracture risk. In the Philippines, a 2009 study of postmenopausal women found that 36% of the participants had insufficient 25-OHD levels (20-30 ng/mL), but only 30% of those women received calcium and vitamin D supplementation [2]. Exposure to ultraviolet rays (UVB) is the main source of vitamin D in humans. Air pollution in major Philippine cities decreases the amount of UVB that reaches the earth’s surface [5]
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