Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings.

Background: Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care. Aim: This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings. Methods: We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted. Findings: The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants. Conclusion: The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.

A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care.

Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professions students in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professions students that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.

Simulation as a key training method for inculcating public health leadership skills: a mixed methods study.

Background: Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method. Methods: We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022. Results: The questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb's experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions. Conclusion: Simulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.

Seeing the patient as a person in interprofessional health professions education.

Increasing prevalence of chronic disease leads to an increased need for person-centered care. To prepare future health professionals for this need, educational institutions provide interprofessional education in which they actively involve patients (hereafter called experts by experience). The organization of inter-institutional, interprofessional education with the active involvement of experts by experience poses challenges. To overcome these challenges, a joint student- and expert by experience-led organization was established, named Patient as a Person Foundation. This organization functions as the linking pin between three educational institutions. Jointly, they enabled the involvement of 181 experts by experience in interprofessional education and 1313 students from nine study programs over the course of two curriculum years. To facilitate joint education involving patients, Patient as a Person Foundation realizes three main activities: (a) recruitment and instruction of experts by experience, (b) enabling the inter-institutional organization of education and facilitating its logistics and financing, and (c) universal training of teaching staff. This interprofessional Education and Practice Guide aims to provide lessons on how to sustainably organize interprofessional education involving experts by experience across multiple educational institutions. The key lessons provided in this guide, underpinned by research and key literature, aim to inspire and enable similar initiatives elsewhere.

Design and evaluation of a team-based interprofessional practice placement: A design-based research approach.

INTRODUCTION: Team-based Interprofessional Practice Placements (TIPPs) are innovative training practices. Evidence to substantiate the design of TIPPs is limited. This study explores the design and evaluation of TIPPs to support undergraduate students in gaining a better understanding of the complexity of patient problems in primary care settings and of collaboration within interprofessional teams. METHOD: We implemented TIPPs at a University of Applied Sciences, Belgium based on three principles: (1) authentic tasks with real clients, (2) students collaborated in small interprofessional teams, and (3) students were supported by teachers. TIPPs were evaluated using focus groups (N = 5) that explored teachers' (N = 13) and students' (N = 22) experiences. Data were analysed thematically. RESULTS: Three themes were constructed. First, TIPPs enhance students' understanding of the complexity of clients' problems and what matters to the client. Second, TIPPs support students to value the expertise of interprofessional team members. Finally, to enhance students' learning, TIPPs must strike an appropriate balance between teacher support and student autonomy. CONCLUSION: The three design principles used to underpin the TIPPs were viable. Although students reported to receive sufficient support, they also felt this support should have been gradually withdrawn to offer more opportunities for autonomous learning. Teachers reported difficulties in balancing their support.

Applying Landscapes of Practice Principles to the Design of Interprofessional Education.

ISSUE: Although interprofessional education (IPE) is acknowledged as a way to prepare health professions students for future interprofessional collaboration (IPC), there is a need to better ground IPE-design in learning theory. Landscapes of practice and its concepts of knowledgeability and identification are suggested as a framework that may help optimize IPE. This Observation paper provides an explanation of how these concepts might be used in IPE-design. EVIDENCE: We propose using three modes of identification, i.e., engagement, imagination, and alignment, described in this framework, for an IPE-design that fosters IPC skills, professional identity formation, and knowledgeability about a field and its actors. Identification and knowledgeability are through to enable successful collaboration across professional and practice boundaries. IMPLICATIONS: Focusing on identification implies that students develop a sense of relevance to one another in solving complex problems (engagement), they become aware of their own roles and responsibilities in relation to others (imagination), and they gain awareness of the context in which the different professions align and collaborate (alignment). Altogether, this enables students to become knowledgeable in the landscape, which prepares them for successful interprofessional collaboration in practice.

The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European-Israeli Knowledge Transfer Project.

Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of "Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach"-a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project's work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.

Optimizing collaborative learning in online courses.

Currently, higher education institutes are urged to adapt their education programmes rapidly to online courses. This toolbox article provides recommendations for optimising collaborative learning in online courses from the perspective of course design, and the roles of teachers and students, all illustrated in our example. With regards to course design, it is recommended to construct learning tasks for which students need to collaborate to reach a shared goal, use collaboration scripts to structure activities and communication, manage expectations about collaboration, provide room for discussion about the team process, facilitate autonomy and use existing communication tools. The presence of teachers online is essential, to provide feedback on the content and to guide team processes. Finally, students are recommended to get to know fellow students, to create a positive atmosphere and to reflect on the collaboration. We conclude that online collaborative learning can work well, but requires a balance between course structure and autonomy, and needs active monitoring during implementation. If this is done, it is perfectly possible to engage students and teachers, to support deep learning and to develop collaboration skills.

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review.

Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

Collaborative learning: Elements encouraging and hindering deep approach to learning and use of elaboration strategies.

AIM: The purpose of this research was to investigate students' approaches to learning and use of cognitive strategies in a collaborative learning environment with team-based learning. METHOD: In a mixed-methods study, 263 medical students from 6 different semesters answered the R-SPQ-2F Questionnaire and MSLQ's items that measure elaboration and rehearsal strategies. ANOVA was used to compare differences between semesters, and Pearson's correlation to investigate how approaches to learning, cognitive strategies, and academic achievement correlate. Focus groups elucidated which elements in the collaborative learning environment enhanced or hindered deep approach to learning or elaboration strategies and why. RESULTS: Students took a deep approach to learning and sometimes a surface approach. They used elaboration and rehearsal strategies. First semester's students had significantly higher deep approach than fifth and sixth semesters' students. Elaboration strategies significantly correlated with final grade. Commitment to the group, case discussions, feeling challenged by teachers, and patients' visits were perceived to enhance deep approach to learning and use of elaboration strategies, while overload in course activities hindered deep approach to learning. CONCLUSIONS: Particular elements of the learning environment triggered students to take deep approach to learning and use elaboration strategies, and this positively correlated to academic achievement.

Patient involvement in interprofessional education: A qualitative study yielding recommendations on incorporating the patient's perspective.

BACKGROUND: Patient involvement in interprofessional education (IPE) is a new approach in fostering person-centeredness and collaborative competencies in undergraduate students. We developed the Patient As a Person (PAP-)module to facilitate students in learning from experts by experience (EBEs) living with chronic conditions, in an interprofessional setting. This study aimed to explore the experiences of undergraduate students, EBEs and facilitators with the PAP-module and formulate recommendations on the design and organization of patient involvement in IPE. METHODS: We collected data from students, EBEs and facilitators, through eight semi-structured focus group interviews and two individual interviews (N = 51). The interviews took place at Maastricht University, Zuyd University of Applied Sciences and Regional Training Center Leeuwenborgh. Conventional content analysis revealed key themes. RESULTS: Students reported that learning from EBEs in an interprofessional setting yielded a more comprehensive approach and made them empathize with EBEs. Facilitators found it challenging to address multiple demands from students from different backgrounds and diverse EBEs. EBEs were motivated to improve the person-centredness of health care and welcomed a renewed sense of purpose. CONCLUSIONS: This study yielded six recommendations: (a) students from various disciplines visit an EBE to foster a comprehensive approach, (b) groups of at least two students visit EBEs, (c) students may need aftercare for which facilitators should be receptive, (d) EBEs need clear instruction on their roles, (e) multiple EBEs in one session create diversity in perspectives and (f) training programmes and peer-to-peer sessions for facilitators help them to interact with diverse students and EBEs.

Influencing factors in midwives' decision-making during childbirth: A qualitative study in the Netherlands.

BACKGROUND: Dutch maternity care is based on the principle that pregnancy and childbirth are physiological processes. However, the last decade an increase of intra-partum referrals to obstetric-led care has been observed. Most of these referrals are among nulliparous women, non-urgent and occur during the first stage of labour. The increase in referrals seems not associated with better perinatal outcomes. OBJECTIVE: Gain understanding of underlying factors in the decision-making process prior to referral to obstetric-led care among midwives attending childbirth in midwifery-led care. METHOD: A qualitative study based on in-depth interviews with Dutch midwives (n=10) working in midwifery-led care. We performed a thematic analysis based on the hypothetico-deductive and the intuitive-humanist theory. RESULTS: Midwives mentioned knowledge as the basis of a reasoned decision. This included both theoretical knowledge, and knowledge from clinical experience. Influences of others, like the needs and wishes of labouring women were another factor influencing the decision-making, especially in non-urgent situations. Under subjective factors, the fear of being held responsible for professional choices emerged. KEY CONCLUSION: The decision-making process during childbirth is multi-factorial. The women's needs and wishes are recognized as of great influence on the decision-making process during childbirth, which is not included as a factor in the hypothetico-deductive or the intuitive-humanist theory. IMPLICATION FOR PRACTICE: The influence of women's needs and wishes should be part of models about the intra-partum decision-making process. Midwives should find strategies to support women to make well-informed choices that include adequate information on the consequences of medicalisation in obstetric-led care.

Equity-specific effects of 26 Dutch obesity-related lifestyle interventions.

CONTEXT: Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES. EVIDENCE ACQUISITION: Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up. EVIDENCE SYNTHESIS: Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups. CONCLUSIONS: Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.

The use of implementation intentions to promote vitamin D supplementation in young children.

Only 50% of Dutch children aged 0-4 years receive sufficient daily vitamin D supplementation. This study aims to investigate the effectiveness of implementation intentions in promoting vitamin D supplementation among young children. An electronic survey was conducted among parents of children aged 0-4 (n = 171). These parents were randomly assigned to two groups: one that received implementation intention instructions and one that did not. At follow-up, there were no significant between group differences in any outcome measures. These results suggest that merely asking parents to formulate an implementation intention with respect to giving their child daily vitamin D supplementation is insufficient to improve vitamin D intake among young children. However, testing the intervention via the Internet may not have allowed us to exploit the full potential of the strategy. Investigation of the use of implementation intentions in the setting of toddler consultation clinics is therefore recommended.

Evaluation of the web-based Diabetes Interactive Education Programme (DIEP) for patients with type 2 diabetes.

OBJECTIVE: The objective in this study was to evaluate a web-based type 2 diabetes self-management education programme aimed at improving knowledge, encouraging active patient participation and providing supportive self-management tools. METHODS: (1) An effect evaluation was conducted using a randomized controlled trial with a pre-test and post-test design (n=99) and a knowledge questionnaire. (2) A user evaluation was conducted using an online questionnaire (n=564) and one-on-one interviews (n=11) to examine the perceived quality, use of functionalities and use of the programme as a supportive tool in education. RESULTS: The effect evaluation showed a significant intervention effect (p<0.01) on knowledge. The user evaluation showed high satisfaction with the programme's content, credibility and user-friendliness. However, functionalities and self-management tools were used by less than half of the participants. CONCLUSION: The programme can improve knowledge, but it is not fully used as intended. A more optimal use of the programme is necessary for higher efficacy. PRACTICE IMPLICATIONS: The use of mostly spoken text instead of written text was highly appreciated and could be used more often for educational websites. Furthermore, health care practitioners need support in implementing new educational programmes during consultations.

Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review.

BACKGROUND: The Internet has become a popular medium for the delivery of tailored healthy lifestyle promoting interventions. The actual reach of Internet-delivered interventions seems, however, lower than expected, and attrition from interventions is generally high. Characteristics of an intervention, such as personally tailored feedback and goal setting, are thought to be among the important factors related to of use of and exposure to interventions. However, there is no systematic overview of which characteristics of Internet-delivered interventions may be related to more exposure. OBJECTIVE: The present study aims to identify (1) which potentially exposure-promoting methods and strategies are used in existing Internet interventions, (2) which objective outcome measures are used to measure exposure to Internet interventions, and (3) which potentially exposure-promoting methods and strategies are associated with better exposure. METHODS: A systematic review of the literature was conducted based on the Cochrane guidelines. Papers published between 1995 and 2009 were searched in the PubMed, PsycINFO, and Web of Science databases. In total, 64 studies were included that reported objective exposure measures such as completion of an initial visit, number of log-ins, and time spent on the website. Information about intervention-related characteristics (ie, interactive behavior change strategies, interactive elements for fun, peer or counsel support, email/phone contact, and regular updates of the website) that could potentially contribute to better exposure and objective exposure outcomes were abstracted from the studies and qualitative systematic descriptive analyses were performed. RESULTS: The results showed that a large variety of behavior change techniques and other exposure-promoting elements were used in the interventions and that these methods and strategies varied for the various lifestyle behaviors. Feedback, interactive elements, and email/phone contact were used most often. In addition, there was much variety and a lack of consistency in the exposure measures that were reported. Of all the categories of intervention characteristics that may be associated with better exposure, there were indications that peer and counselor support result in a longer website visit and that email/phone contact and updates of the website result in more log-ins. CONCLUSIONS: Results of this qualitative systematic review indicate that of all intervention characteristics that could potentially enhance exposure, only peer support, counselor support, email/phone contact with visitors, and updates of the intervention website were related to better exposure. The diversity of intervention methods used and the inconsistency in the report of exposure measures prevented us from drawing firmer conclusions. More research is needed to identify whether other characteristics of Internet interventions are associated with greater exposure.

Intervening via chat: an opportunity for adolescents' mental health promotion?

Mental health problems are highly prevalent among adolescents, but a majority of adolescents is reluctant to seek help at mental health services because of shame and lack of anonymity. Intervening via chat (i.e. offering online support) could be a solution to remove these barriers and to reach adolescents. The dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) served as a guiding principle for discussing the potential of offering online support via chat. It appeared that the use of chat may be an appropriate way to reach adolescents and may have a positive impact on outcome measures related to mental health. Additional efforts are needed to stimulate adoption at the individual level (target group, intermediaries) and the organizational level. Future research needs to focus on the dissemination of chat-based interventions, differences between online peer support and online professional support, and the content of conversations via chat about mental health problems.

Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review.

The Internet is considered to be a promising delivery channel of interventions aimed at promoting healthful behaviors, especially for adolescents and young adults. Exposure to these interventions, however, is generally low. A more extensive exploration of methods, strategies, and their effectiveness with regard to facilitating exposure is therefore timely, because this knowledge is crucial to improve the use of such interventions and, subsequently, to increase behavioral change. Therefore, a systematic review of the literature was conducted, resulting in 838 studies based on title selection, of which 26 studies met the eligibility criteria. The systematic review resulted in an overview of methods and strategies that have been used to facilitate exposure. Patterns of effective strategies could be observed, such as the combination of tailored communication and the use of reminders and incentives. Nevertheless, exposure-specific theories need to be developed and objective exposure measures should be tracked and reported in future studies.

Vitamin D supplementation in young children: associations with Theory of Planned Behaviour variables, descriptive norms, moral norms and habits.

OBJECTIVE: In the Netherlands, a supplementation of 10 microg vitamin D is recommended for children (aged 0-4 years), given that vitamin D contributes to the development of healthy bones and deficiency during childhood is a risk factor for osteoporosis at a later age. However, only 60 % of the Dutch children receive sufficient vitamin D supplementation a day. In order to develop interventions to improve supplementation intake, it is necessary to gain insight into the behaviour of parents in giving their children vitamin D supplementation and its association with variables of the Theory of Planned Behaviour, moral and descriptive norms and habits. DESIGN: A cross-sectional survey to assess present supplementation-related behaviour, knowledge, received information, intention, attitude, subjective norm, perceived behavioural control, moral norm, descriptive norm and habit. SETTING: Data obtained from a representative Internet Panel by means of electronic questionnaires. SUBJECTS: Parents (n 270) of children aged 0-4 years. RESULTS: Half of the parents (48.9 %) gave their child sufficient vitamin D supplementation. Giving the supplement at a fixed time, a positive intention and habit were significantly associated with actual behaviour. The higher age of the child, first-born status, a fixed time for taking vitamin supplementation, descriptive norm and moral obligation were significantly associated with intention. CONCLUSIONS: These results indicate that because many parents do not give their children adequate vitamin D supplementation, the promotion of supplementation during the first years of life is a necessity. Effective yet simple strategies should be developed, focused on improving moral obligation, descriptive norms and habit formation.