Celiac Disease Patients Struggling to Adhere to Gluten-free Diet Benefit From On-line Intervention

I recently came across an article posted on www.healio.com, reporting on a trial conducted by researchers in Australia. The objective of the randomized control trial was to determine the effectiveness of an On-line Intervention for Celiac Disease patients following a gluten-free diet.

Study Details

Methods: 189 adults with  biopsy-proven celiac disease were assigned to either an interactive online intervention (n=101) or a waiting list, the “intention to treat” patients (n=88, controls). The participants in the trial had been following a gluten-free diet for an average of 4.6 years. The participants were given a “Dietary Adherence Test” to reflect how well they were adhering to the gluten-free diet. Results showed a mean basal score: Excellent to Very Good (12.2), with 58.9% of the participants in this category; Moderately Adherent (33.2%); and Fair to Poor (7.9%).

The Intervention consisted of six weekly online modules that included:

The primary outcome measure was gluten-free diet adherence. Secondary outcomes were gluten-free diet knowledge, quality of life and psychological symptoms.

Healio reported, “After each module, participants answered questions about the program’s acceptability. Fifty patients completed intervention, with post-intervention data evaluated in 70 participants and 64 controls, plus follow-up data at 3 months from 46 recipients.”

Results (based on intention-to-treat analyses): “Immediately after intervention, recipients indicated improved adherence (P<.001), with no change in controls (P=.674). The effect size was small to medium in the intention-to-treat population, and medium to large among those with inadequate adherence at baseline with available post-intervention data (n=26 in the intervention group, n=29 controls; P=.014). More intervention recipients improved their adherence category than controls (65.4% vs. 37.9%; P=.042). The difference in adherence between baseline and 3 months post-intervention was significant (P=.001), but the difference between adherence immediately after intervention and 3-month follow-up was not (P=.6).”

One of the researchers, Kirby Sainsbury, BA/Bed, psychologist at the University of Sydney, told Healio “This is the first study to demonstrate that gluten-free diet adherence can effectively be targeted using behavior change techniques and cognitive behavior therapy strategies that have been successfully applied in other areas of health and clinical psychology and across a wide range of illness populations. When combined with the online format of the program (which was well received), these results suggest that the dissemination of this evidence-based resource to individuals with celiac disease who are struggling to achieve or maintain adherence is likely to lead to meaningful improvements in adherence.”

An interactive On-line Intervention program could be just the resource for those struggling to follow a gluten-free diet, when their health depends on it. Surprisingly, I do come across people with celiac who tell me they don’t live the gluten-free lifestyle 100 percent.  Perhaps some do not understand the seriousness of the need to eliminate gluten entirely to avoid further health complications, while others, despite their very best efforts, simply don’t possess the required discipline to remain 100% gluten-free. The diet can be challenging and because there is a  learning curve at the beginning, education and re-education (on what is safe & unsafe to eat) is often necessary. Add feelings of anxiety and depression, common in the newly diagnosed celiac, to the mix and cheating may result. Having this resource available to provide education, behavior techniques and helpful strategies will help set patients up for success in reaching their overall goal of healing. I hope we will see this option become available sooner rather than later.

QUESTION:  If you are having a difficult time adhering to the gluten-free diet/lifestyle, despite your best efforts, would you consider participating in an On-line Intervention Program, if/when one becomes available? Please share your thoughts below.

For more info:

Healio.com Article

Abstract listed on PubMed