{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:30:52Z","timestamp":1772166652421,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nutr"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adult vitamin D deficiency, which is a public health problem in low-income countries, is correlated with increased mortality. Although health care workers (HCWs) in Ethiopia are educated on important minerals their counseling on the uses of vitamin D and its possible sources was not witnessed since their knowledge and practice is low. The main aim of this study is to explore barriers to good knowledge, positive attitude, and practice of health care providers on adult vitamin D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory qualitative study is done in three ecologies covering highland, midland, and lowland. The size of 27 participants was fixed by saturation of ideas. In-depth interviews were conducted among leaders and HCWs of different professional groups in health centers and hospitals. Moderators were Ph.D. holders. An interview guide was developed after reviewing research that was translated into the local language. Interviews were audio-taped, transcribed and, translated. Open Code software was used to code and categorize the data. Themes were developed using thematic analysis which is presented using themes and sub-themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The main barriers are related to health systems, HCWs\u2019 understandings, and the educational system. Lack of attention by the health systems\u2019 leadership, missing adult vitamin D as a priority in health programs, lack of capacity building scheme and the absence of adult vitamin D management and treatment guidelines are barriers related to the health system\n                      <jats:italic>.<\/jats:italic>\n                      On the other hand, health care professionals believed that the prevalence of adult vitamin D deficiency is insignificant and vitamin D deficiency is only an issue related to children. Besides, the absence of studies,the focus of the medical curriculum on child vitamin D and the inadequacy of laboratory investigation are barriers related to the education system and research.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adult vitamin D deficiency is a neglected public health problem with many barriers related to diagnosis and treatment. Barriers are related to the professionals themselves, their leadership, health facilities, and the education system. The government should give attention to adult vitamin D management and treatment, continuous on the job training, development of guidelines, purchase of laboratory equipment, the inclusion of adult vitamin D in pre-service and, in-service training curriculums.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-021-00492-6","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T19:15:13Z","timestamp":1640200513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers in adult vitamin D service provision by health care workers: a qualitative study in three ecologies of Ethiopia"],"prefix":"10.1186","volume":"7","author":[{"given":"Wubegzier","family":"Mekonnen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeweyenhareg","family":"Feleke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wubetsh","family":"Asnake","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yakob","family":"Desalegn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jemal","family":"Haidar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biruk","family":"Lambisso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tewabech","family":"Zewdie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"492_CR1","doi-asserted-by":"crossref","unstructured":"Binkley NNRKD, Kawahara T, Daida Y, Lensmeyer G, Hollis B, Drezner M. Low vitamin D status despite abundant sun exposure. J Clin End Met. 2007;92.","DOI":"10.1210\/jc.2006-2250"},{"key":"492_CR2","doi-asserted-by":"crossref","unstructured":"Ko\u010dovsk\u00e1 E1 AG WP, Halling J, Fernell E, St\u00f3ra T, Biskupst\u00f8 R, Gillberg IC, Shea R, Billstedt E, Bourgeron T, Minnis H, Gillberg C. Vitamin d in the general population of young adults with autism in the faroe islands.. J Autism Dev Disord Dec 2014;44(12).","DOI":"10.1007\/s10803-014-2155-1"},{"key":"492_CR3","doi-asserted-by":"crossref","unstructured":"Luxwolda MF KR KI, Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol\/l. BrJ Nutr 2012;108(9).","DOI":"10.1017\/S0007114511007161"},{"key":"492_CR4","unstructured":"Stoecker TGaBJ. Vitamin D insufficiency in a sunshine-sufficient area: southern Ethiopia. Food Nutr Bull 2013;33(1)."},{"key":"492_CR5","unstructured":"12 KRBtpncbpasopcpPM."},{"issue":"5","key":"492_CR6","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1177\/0884533610379606","volume":"25","author":"KMKM Adams","year":"2010","unstructured":"Adams KMKM, Powell M, Zeisel SH. Nutrition in medicine: nutrition education for medical students and residents. Nutr Clin Pract. 2010;25(5):471\u201380.","journal-title":"Nutr Clin Pract"},{"key":"492_CR7","unstructured":"Makowske M FRNeaqfaatNJhdo---."},{"issue":"4","key":"492_CR8","doi-asserted-by":"publisher","first-page":"963S","DOI":"10.1093\/ajcn\/83.4.963S","volume":"83","author":"STKJ St Jeor","year":"2006","unstructured":"St Jeor STKJ, Plodkowski RA, Veach TL, Tolles RL, Kimmel JH. Medical nutrition: a comprehensive, school-wide curriculum review. Am J Clin Nutr. 2006;83(4):963S\u20137.","journal-title":"Am J Clin Nutr"},{"key":"492_CR9","doi-asserted-by":"publisher","unstructured":"Nutrition Care Practices B, Competencies and Education in Nutrition: a Survey Among Ghanaian Medical Doctors Victor Mogre 1,2 &Fred C. J. Stevens 2 &Paul A. Aryee 3 &Femke L. atorwmasen-Akkermans 1 &Braimah Abubakari 4 & Albert J. J. A. Scherpbier Medical Science Educator(2018) 28:815\u2013824 https:\/\/doi.org\/10.1007\/s40670-018-0591-9.","DOI":"10.1007\/s40670-018-0591-9"},{"issue":"5","key":"492_CR10","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1093\/ajcn\/77.5.1330","volume":"77","author":"TVSC Mihalynuk","year":"2003","unstructured":"Mihalynuk TVSC, Coombs JB. Self-reported nutrition proficiency is positively correlated with the perceived quality of nutrition training of family physicians in Washington state. Am J Clin Nutr. 2003;77(5):1330\u20136.","journal-title":"Am J Clin Nutr"},{"key":"492_CR11","unstructured":"Bonevski B CE, Sanson-Fisher R. Primary care practitioners and health promotion: a review of current practices. Health Promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Professionals Health Promot J Austr 1996;6(1):22."},{"issue":"3","key":"492_CR12","first-page":"e109","volume":"56","author":"KTJ Wynn","year":"2010","unstructured":"Wynn KTJ, Taunton K, Gowans M, Scott I. Nutrition in primary care: current practices, attitudes, and barriers. Can Fam Physician. 2010;56(3):e109\u2013e16.","journal-title":"Can Fam Physician"},{"issue":"4","key":"492_CR13","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1177\/156482651303400408","volume":"34","author":"BJS Tafere Gebreegziabher","year":"2013","unstructured":"Tafere Gebreegziabher BJS. Vitamin D insufficiency in a sunshine-sufficient area: southern Ethiopia. Food Nutr Bull. 2013;34(4):429\u201333.","journal-title":"Food Nutr Bull"},{"key":"492_CR14","volume-title":"The National Research Ethics Guideline. Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia","author":"MOST","year":"2014","unstructured":"MOST. The National Research Ethics Guideline. Addis Ababa, Ethiopia: Federal Democratic Republic of Ethiopia: Ministry of Science and Technology; 2014."}],"container-title":["BMC Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-021-00492-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40795-021-00492-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-021-00492-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T19:15:57Z","timestamp":1640200557000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnutr.biomedcentral.com\/articles\/10.1186\/s40795-021-00492-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["492"],"URL":"https:\/\/doi.org\/10.1186\/s40795-021-00492-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-141414\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-141414\/v2","asserted-by":"object"}]},"ISSN":["2055-0928"],"issn-type":[{"value":"2055-0928","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"16 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All protocols involving human data has to be prepared in accordance with the <b>guidelines of Declaration of Helsinki. Accordingly,<\/b> all methods were carried out in accordance with the National Research Ethics Guideline (NREG) [\n                      \n                      ]. <b>E<\/b>thical clearance was obtained from the institutional review board (IRB) of the College of Health Sciences (CHS) in Addis Ababa University and the School of Public Health (SPH) research ethics committee (REC). Both the SPH\/REC and CHS\/IRB approved verbal consent since the research did not involve invasive procedure that requires written consent according to NREG. Permission was also secured from the Regional Health Bureaus as well as from the respective district administration and Health Offices. Verbal consent was also obtained from each respondent after the objective of the study was explained to all of them in their local language and the right to withdraw from the study at any time was also communicated. Adequate clarification was made on any concern study participants had. Anonymity and confidentiality of the information was assured and privacy of each respondent was maintained throughout the data collection process. Information sheet and the completed verbal consent form are uploaded into the Open Data Kit data collection template and archived electronically.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors declare that we do not have competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"87"}}