Development and Validation of a Specific Self-Efficacy Scale in Adherence to a Gluten-Free Diet

Abstract

The aim of this study was to develop a scale to assess the levels of specific self-efficacy in order to enhance adherence to a gluten-free diet and the life quality of celiac patients. Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed people. The only treatment is a strict lifelong gluten-free diet. Within the framework of Social Cognitive Theory, expectation of self-efficacy is understood as the degree in which a person believes himself to be capable of performing a certain task (e.g., adhering to a gluten-free diet), a construct which has been widely studied in its relation with adopting healthy behaviors, but scarcely in relation to celiac disease. A validation study was carried out in various stages: preparation of the protocol; construction of the questionnaire and a pilot run with 20 patients; validation of the scale with 563 patients and statistical analysis. A 25-item scale was developed. Feasibility was excellent (99.82% of participants completed all the questions). Factorial analysis pointed to the existence of five factors that explained 70.98% of the variance with a Cronbach alpha of 0.81 for the scale overall and between 0.64 and 0.90 for each factor. The scale showed a Spearman's Rho coefficient of 0.279 with the General self-efficacy Scale. This easily administered scale provides good psychometric properties for evaluating specific self-efficacy of celiac patients in adhering to treatment. It seeks to be the first scale that provides not only a measurement of specific self-efficacy in celiac disease, but also to determine its levels for each of the areas as a first step toward designing interventions of self-management and empowerment programs to cope with the disease.

Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain

“…Considering regression analysis, it seems that specific rather than general self-efficacy plays a role in predicting adherence to a GFD, which is in line with previous research [27], and which emphasizes the need to measure control beliefs more specifically rather than in a general way. The results in our study support the idea, as in other studies [27,29,39], that the areas in which people with CD are less confident are "traveling," "shopping," and "eating out".…”

“…This research shows that specific self-efficacy, adherence to the GFD as well as risk perception, time since diagnosis, and age play an important role in the HRQoL of patients with CD. Results show that it is self-efficacy, when specifically measured, that best predicts adherence to the GFD and the resulting HRQoL [27,39].…”

“…Although the authors do not set a cut-off point, we will consider the 70% of the theoretical rank (score ≥ 31) as indicative of high general self-efficacy [37,38]. CD specific self-efficacy was evaluated using the celiac disease self-efficacy scale (Celiac-SE) [39] designed to measure the degree of perceived self-efficacy in adherence to the GFD in patients aged 12 years or older, in different situations such as shopping, eating at home with others, traveling, eating out, or eating at work or school. Patients answered a 25-question questionnaire between 0 (I could definitely not do this) and 10 (I am completely certain I could do this).…”

Food Neophobia in Celiac Disease and Other Gluten-Free Diet Individuals

“…The FNS is, at the same time, closely linked to adverse eating patterns and reduced dietary quality, which is related to an increased risk of obesity and non-communicable diseases which was proven in the recent study of Sarin et al [24]. It must be emphasized, that in literature there are also other tools to measure traits related to the quality of life of CD patients and other aspects, such as the Celiac Dietary Adherence Test (CDAT) [53,54], Celiac Disease Self-Efficacy (Celiac-SE) questionnaire [55] or Celiac Disease Questionnaire (CDQ) [56]. In spite of the fact that the FNS and CD-FAB are different tools, it must be emphasized that common elements exist here, which are associated with identifying eating attitudes and behaviors, as it was demonstrated that food neophobic individuals have not only a tendency to avoid new food products, but also to dislike them [57] or to evaluate them in a negative way [18].…”

Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

“…For instance, a RCT found that six months of psychological counselling improved GFD adherence and reduced depression in CD patients with depression at baseline [ 89 ]. While no studies exist that support or repute our findings that a lower proportion of children achieved strict adherence than adults, practical tools have been shown to promote self-management, dietary adherence and well-being in children and adolescents with CD [ 90 ]. Hence, the development of both standardised measurement methods and tools to promote dietary adherence would be useful for future research, as well as patient management.…”