Factors that Influence Adherence to a Gluten-Free Diet in Adults with Celiac Disease

Abstract

Objective-The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease.Methods-A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level.Results-Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001). Conclusions-This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence. NIH Public Access

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

“…Our findings add to those from other n.j.hall@durham.ac.uk (Nicola Hall) Not for publication -Tel: +44 (0) 191 33 4 0464 / Fax: +44 (0) 191 33 40361 10 studies looking at the association between concepts from existing theories of health behaviour (Ford et al, 2012;Leffler et al, 2008;Sainsbury & Mullan, 2011), by demonstrating the importance of this distinction in understanding adherence to the GFD. Both types of non-adherence are common with only 28% of respondents reporting not having consumed any gluten at all over the last six months and 40%…”

Measuring beliefs about gluten free diet adherence in adult coeliac disease using the theory of planned behaviour

“…This is important as patients suffering from comorbid depression were found to be three times more likely to be non-compliant with medical treatment recommendations, including several studies of dietary adherence in end stage renal disease (DiMatteo, Lepper, & Croghan, 2000). Similarly, previous research has also found that the perceived ability to maintain a GFD despite variations in mood and stress was a significant predictor of actual adherence (Leffler et al, 2008).…”

“…Another large study found that GFD adherence was influenced by perceptions of the GFD (akin to the attitude component of this study), the ability to follow the diet outside the home, and the ability to maintain adherence despite changes in emotional state such as mood and stress (Leffler et al, 2008). Sociodemographic variables such as age, gender, education, and socioeconomic status do not appear to be related to adherence levels (Hall et al, 2009).…”

“…It was predicted that the TPB would account for significant variance in the prediction of the intention to maintain a strict GFD and actual GFD adherence. Based on previous findings (e.g., Hall et al, 2009;Leffler et al, 2008) it was also predicted that lower levels of GFD knowledge and the presence of a psychiatric 7 diagnosis would negatively impact GFD adherence. QOL and adherence should also be related, although this relationship is likely bidirectional.…”

Coping with celiac disease: how heavy is the burden for caregivers?

“…Considering that gluten is a constitutive protein of wheat and other grains and that baked products and pasta are staple elements of the Western diet, a high number of patients end up facing the sudden change of their eating habits and their families' daily routine (13,14). Furthermore, GFD is highly restrictive and recent data have shown that patients report a substantial treatment burden similar or higher than many other chronic conditions in spite of a good long-term prognosis (15), leading to multiple limitations in common social activities and complaining of psychological distress, anxiety and social phobia (16)(17)(18). Therefore, given its chronic nature and the possible complications (i.e., autoimmune and/or neoplastic diseases, anemia and osteoporosis), CD requires on-going medical support, which has shown to improve the disease outcome and patients' compliance to GFD (19).…”