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How do primary care providers and the public deal with vitamin D uncertainty?

Posted on: February 28, 2014   by  Jeff Nicklas


As I’m sure most all of our readers and members know, there is a big debate in vitamin D right now. Some researchers think that we need more research before we can raise vitamin D recommendations. Other researchers believe that there is enough research right now to raise vitamin D recommendations. The Vitamin D Council is in the latter camp. We believe that unless research proves otherwise, people need the same vitamin D levels of outdoor living peoples, which is nearly double the American mean level.

A term information scientists and researchers use for this kind of debate in research is uncertainty. Information scientists would say there is uncertainty in vitamin D research, particularly because we haven’t reached an apex of knowledge about vitamin D. Research in vitamin D is still building.

This uncertainty and debate in vitamin D leads to much confusion in medical literature and in the media. In consequence, this uncertainty trickles down to health care providers and patients, and can cause uncertainty and inconsistency between patients and providers.

Recently, researchers surveyed primary care providers and patients. They wanted to know what they knew and thought about vitamin D and how that was affecting their relationship between the two. They wanted to know how much uncertainty about vitamin D clouted providers and patients.

If themes emerged, this could help both educators like the Vitamin D Council and providers, to help them better understand their patients.

Researchers recruited 7 primary health care providers and 89 community members from different regions throughout Kentucky. The healthcare providers underwent semi-structured interviews focused on vitamin D. The community members were put into 6 focus groups where they participated in open-ended discussions that all began with the question, “What have you heard about vitamin D?”

Among the primary care providers, the three most common themes were:

  • Many primary health care providers stated that they only recently had become aware of vitamin D. Most of the knowledge of vitamin D that the providers had related to testing and treating vitamin D deficiency.
  • The primary health care providers noted they were uncertain about indicators, testing, treatment, and benefits and risks of vitamin D. Additionally, all of the health care providers stated that when they tested their patients, they were uncertain about what the results meant.
  • The primary health care providers felt that their patients’ awareness of vitamin D ranged all over the place, from knowing nothing to knowing a lot.

Among the focus groups, the three most common themes were:

  • Many of the community members expressed uncertainty, doubt, and skepticism regarding the potential benefit of raising vitamin D levels. Additionally, a few people had gotten their blood tested but were unsure if they had their vitamin D levels checked.
  • The community members obtained information on vitamin D from various sources including healthcare providers, television and other media sources, the internet, and family and friends.
  • Like the provider’s perception of patients, the level of awareness of vitamin D ranged. Many people hadn’t heard of testing for vitamin D or taking supplements. However, other participants knew of various doses and sources of vitamin D.

The researchers only included 7 health care providers, meaning their responses cannot be generalized to all health care providers. Additionally, the researchers note that the community members were not matched to their own providers but were instead meant to represent a typical patient. Finally, most of the community members who participated were well-educated women, which means that their responses may not represent other populations.

The researchers noted that most patients’ goal is to adapt and cope with uncertainty in health care and that provider’s underestimate their patient’s willingness to learn about the uncertainty.

The Vitamin D Council works hard to present this vitamin D debate and uncertainty for similar reasons. We believe that if we present the debate and both sides to the argument as best we can on a consistent basis, the public will feel more comfortable with vitamin D and develop a better understanding of how they want to incorporate vitamin D in their health.

Future public health strategies and research should be targeted at providing adequate vitamin D information and helping to establish effective vitamin D practices in patient-provider communication.


Bennett, K. et al. Vitamin D: An Examination of Physician and Patient Management of Health and Uncertainty. Qualitative Health Research, 2014.

4 Responses to How do primary care providers and the public deal with vitamin D uncertainty?

  1. Rita and Misty

    “Future public health strategies and research should be targeted at providing adequate vitamin D information and helping to establish effective vitamin D practices in patient-provider communication.”

    Please give me an example of future public health research. I’m asking sincerely.

    By the way: everyone here knows that raising my vitamin D levels to optimal vastly improved my health.

    But, not everyone here would agree with my definition of optimal.

    Additionally, I know that I am sample of 1.

  2. Brant Cebulla

    Rita, good question. An example study in this context is if researchers developed a few different strategies for providers to use to get patients to take vitamin D. You could study each strategy in a controlled setting, and at the end of the study, see which strategy was most effective in raising vitamin D levels, vitamin D knowledge, vitamin D intake, etc. on the patient level.

    This is needed because not only do you want good evidence for whatever it is you’re recommending, but you also want good evidence for how you’re recommending. This ensures that good health care is put to practice.

  3. Rita and Misty

    Brant, what about a study looking at let’s say the flu, comparing cases of flu to 4 groups:

    1. Vaccinated only
    2. Vaccinated and supplementing with D
    3. Not vaccinated, not supplementing with D
    4. Not vaccinated But supplementing with D

    Of course, then we have the question of how much daily D…

  4. Rita and Misty

    To add to my above comment (because I am wordy 😉 )

    I fear compliance issues with supplements, and I wonder if a bolus dose would be warranted..and I wonder if it were possible to ensure that such a bolus dose would get all participants to a certain 25(OH)D level for the entire flu season.

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