5 Recommendations for research
The Public Health Advisory Committee (PHAC) recommends that the following research questions should be addressed. It notes that 'effectiveness' in this context relates not only to the size of the effect, but also to cost effectiveness and duration of effect. It also takes into account any harmful or negative side effects.
All the research should aim to identify differences in effectiveness among groups, based on characteristics such as socioeconomic status, age, gender and ethnicity.
Outcomes for all the questions below may include vitamin D status, user adherence or any unintentional consequences. The recommendations apply to all specific population groups, but there is a particular need for research in people over 65, people with darker skin and people living in institutions.
5.1 How effective and cost effective are interventions to increase vitamin D access, uptake, adherence or status among identified specific population groups? Does effectiveness vary by age, gender, ethnicity, socioeconomic or other specific population characteristics (such as depression or a disability)? The following could be considered:
availability and uptake of supplements (including the impact of the cost of supplements)
type of supplements provided and how that impacts on adherence
knowledge and attitudes (of both the public and health and social care practitioners).
5.2 How cost effective are preventive approaches to vitamin D deficiency among all specific population groups, compared with the cost of testing and treatment? This should include a comparison of universal provision of free supplements with the provision of low or standard cost supplements for different specific population groups. (If there is any new legislation allowing for the sale of Healthy Start supplements, this would provide an opportunity to test this question.)
5.3 How can a multiagency approach to improving awareness, availability and uptake of vitamin D supplements best be established, improved and sustained? For example, what are the key components, who are the key partners and how does the local context affect effectiveness? The latter may include local population characteristics (such as age, ethnicity or levels of deprivation), setting and the approach to commissioning. Research should be conceived, developed and implemented as a collaboration between academics and local practitioners or the local community.
5.4 What type of training and awareness-raising can improve how health and social care practitioners:
promote vitamin D supplements among specific population groups
improve the local population's awareness of, and attitudes towards, vitamin D supplements
uptake of vitamin D supplements?
5.5 What is the best way of monitoring the local system for distributing vitamin D supplements? Assessments of methods that enable robust data collection – such as computerised data capture systems – would be particularly useful. (The aim would be to use that data to improve the service.)
More detail identified during development of this guideline is provided in gaps in the evidence.