{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:25:02Z","timestamp":1783596302767,"version":"3.55.0"},"reference-count":15,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,18]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Vitamin D plays a crucial role in maintaining bone health, regulating the immune system and enhancing metabolic function. Although supplementation is recommended for individuals with confirmed deficiency, the increasing trend of empirical prescribing and self-medication has raised concerns about inappropriate use, particularly in low- and middle-income countries like Pakistan. This study aimed to explore perceptions, attitudes and practices regarding the prescription of vitamin D supplementation among healthcare professionals and self-medicating patients in Pakistan, with a specific focus on identifying factors contributing to non-evidence-based prescribing and unregulated consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative, exploratory design was adopted to investigate the study objectives. In-depth, semistructured interviews were conducted with 20 doctors from five medical specialities and 17 patients who reported using vitamin D supplements. Participants were recruited from healthcare settings in Lahore using a purposive sampling approach. Thematic analysis was used to identify key patterns in prescribing and self-use behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four themes emerged from the doctor interviews: empirical prescribing without diagnostic testing, the influence of pharmaceutical marketing, the perceived harmlessness of vitamin D and the absence of standardised guidelines. From patients, themes included self-medication and over-the-counter access, belief in vitamin D as a general wellness booster, long-term unmonitored use and lack of awareness about dosing and risks. Neither group was aware of the potential toxicity and follow-up testing was done rarely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study\u2019s findings highlight a widespread perception of availability, potentially inappropriate and unregulated use of vitamin D, underscoring the need for nationwide action through education, regulation and public awareness. Coordinated efforts by health organisations, clinicians and pharmacists can promote safer supplementation practices and help prevent long-term adverse health effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004658","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:00:18Z","timestamp":1783594818000},"page":"e004658","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prescribing in the dark: a qualitative study exploring perceptions and practices behind potentially inappropriate vitamin D use in Pakistan"],"prefix":"10.1136","volume":"4","author":[{"given":"Irzah","family":"Farooq","sequence":"first","affiliation":[{"name":"Department of Public Health, University of the Punjab, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4295-7057","authenticated-orcid":false,"given":"Javeria","family":"Saleem","sequence":"additional","affiliation":[{"name":"Public Health, Green International University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of the Punjab, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afia","family":"Zafar","sequence":"additional","affiliation":[{"name":"Jinnah Hospital, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abida","family":"Tehreem","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of the Punjab, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Naeem","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of the Punjab, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz","family":"Waqas Ahmed","sequence":"additional","affiliation":[{"name":"Oral and Maxilofacial Surgeon, Mayo Hospital, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Arshed","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Baqai Medical University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026070904001118000_4.3.e004658.1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0385"},{"key":"2026070904001118000_4.3.e004658.2","first-page":"14","article-title":"High prevalence of vitamin D deficiency and inadequate treatment in Pakistani population: a cross-sectional study","volume":"11","author":"Shahzad","year":"2021","journal-title":"Pak J Public Health"},{"key":"2026070904001118000_4.3.e004658.3","first-page":"655","article-title":"Patterns of vitamin D prescription in outpatient clinical settings of Lahore: a retrospective analysis","volume":"72","author":"Iqbal","year":"2022","journal-title":"J Pak Med Assoc"},{"key":"2026070904001118000_4.3.e004658.4","unstructured":"Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium . Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press, 2011."},{"key":"2026070904001118000_4.3.e004658.5","first-page":"292","article-title":"Hypervitaminosis D: a systematic review of published cases","volume":"67","author":"Rocha","year":"2021","journal-title":"Rev Assoc Med Bras"},{"key":"2026070904001118000_4.3.e004658.6","first-page":"101","article-title":"Influence of pharmaceutical advertisements on doctors\u2019 prescription pattern: a cross-sectional study","volume":"21","author":"Mishra","year":"2021","journal-title":"J Med Mark"},{"key":"2026070904001118000_4.3.e004658.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"2026070904001118000_4.3.e004658.8","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026070904001118000_4.3.e004658.9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.29309\/TPMJ\/2022.29.04.6211","article-title":"Prevalence of Vitamin D deficiency among patients visited outpatients","volume":"29","author":"Shahzad","year":"2022","journal-title":"TPMJ"},{"key":"2026070904001118000_4.3.e004658.10","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2026070904001118000_4.3.e004658.11","doi-asserted-by":"publisher","DOI":"10.1177\/1468794112468475"},{"key":"2026070904001118000_4.3.e004658.12","first-page":"88","article-title":"Audit of vitamin D and B12 usage in neurology clinics: are we overprescribing?","volume":"26","author":"Rehman","year":"2020","journal-title":"Ann King Edward Med Univ"},{"key":"2026070904001118000_4.3.e004658.13","first-page":"1","article-title":"Impact of pharmaceutical marketing on prescribing practices in South Asia: a systematic review","volume":"16","author":"Ahmad","year":"2023","journal-title":"J Pharm Policy Pract"},{"key":"2026070904001118000_4.3.e004658.14","first-page":"55","article-title":"A survey-based analysis of vitamin self-medication practices in Karachi, Pakistan","volume":"13","author":"Naveed","year":"2021","journal-title":"Int J Pharm Pharm Sci"},{"key":"2026070904001118000_4.3.e004658.15","first-page":"1006","article-title":"Irrational use of vitamin B12 and D in clinical practice: an Indian perspective","volume":"29","author":"Gupta","year":"2019","journal-title":"Indian J Clin Pract"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:00:20Z","timestamp":1783594820000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":15,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,9]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-004658"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004658","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}