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Falcomer AL, Pratesi CB, Nakano EY, Chaves C, Rostami-Nejad M, Guennouni M, Aksan A, Pouchot J, Häuser W, Zandonadi RP. From Struggle to Strength: A Multicentric Study on How Public Policies for Celiac Disease Transform Lives. Nutrients 2024; 16:2855. [PMID: 39275172 PMCID: PMC11396799 DOI: 10.3390/nu16172855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
This multicenter study aims to assess the impact of public policies (PPs) on the health-related quality of life (HRQoL) of individuals with celiac disease (CD) using the Celiac Disease Questionnaire (CDQ) and PPs for Celiac Disease Score (PPCDS). This cross-sectional exploratory study was conducted in four stages: first, standardizing data from countries using the CDQ; second, analyzing PPs aimed at CD patients; third, statistically examining these data; and fourth, associating HRQoL indicators with corresponding PPs. This study analyzed 15 CDQ assessments from 12 countries from 2007 to 2023. It found that comprehensive PPs positively correlated with HRQoL outcomes (Spearman correlation of 0.358). However, policies specifically targeting gluten-free meals and certification did not significantly improve HRQoL individually, suggesting they may be more effective when implemented together. Additionally, specialized health services did not notably reduce gastrointestinal symptoms, underscoring the necessity for improved patient education to enhance the effectiveness of these services. This study concludes that implementing and rigorously monitoring regulations to support CD patients is crucial for enhancing their HRQoL.
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Affiliation(s)
- Ana Luísa Falcomer
- Department of Nutrition, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Claudia B Pratesi
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | | | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Mohammad Rostami-Nejad
- Celiac Disease and Gluten Related Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1416634793, Iran
| | - Morad Guennouni
- Science and Technology Team, Higher School of Education and Training, Chouaib Doukkali University of El Jadida, El Jadida 24000, Morocco
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences of Settat, Hassan First University of Settat, Settat 26000, Morocco
| | - Ayşegül Aksan
- Institute of Nutritional Science, Justus-Liebig University, 35392 Giessen, Germany
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, 75015 Paris, France
| | - Winfried Häuser
- Medizinisches Versorgungszentrum für Schmerzmedizin und Seelische Gesundheit Saarbrücken-St. Johann Health Care Center Pain Medicine and Mental Health Saarbrücken, St. Johann Großherzog-Friedrich-Straße 44, 66111 Saarbrücken, Germany
| | - Renata Puppin Zandonadi
- Department of Nutrition, School of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
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Crocker H, Lewis T, Violato M, Peters M. The affordability and obtainability of gluten-free foods for adults with coeliac disease following their withdrawal on prescription in England: A qualitative study. J Hum Nutr Diet 2024; 37:47-56. [PMID: 37723662 DOI: 10.1111/jhn.13231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Changes to prescribing policies in England have restricted or stopped access to gluten-free food on prescription for people with coeliac disease in some geographical areas. The present study aimed to explore the impact of these changes on the affordability and obtainability of gluten-free foods for adults with coeliac disease. METHODS Semi-structured qualitative interviews (n = 24) were conducted with people with coeliac disease living in areas where prescriptions for gluten-free foods were no longer available, were restricted or followed national guidelines. Interviews explored the impact of gluten-free prescribing changes on the affordability and obtainability of gluten-free food, as well as dietary adherence. RESULTS All participants considered gluten-free substitute foods to be expensive. Participants felt the availability of gluten-free foods has improved over time, also acknowledging some challenges remain, such as limited local availability. For most, the withdrawal of prescriptions had minimal impact requiring small adjustments such as reducing the quantity of foods obtained. However, greater challenges were faced by those less mobile, permanently sick or disabled and/or on lower incomes. CONCLUSIONS The majority of participants affected by the withdrawal of prescriptions were able to adapt to cope with these changes. However, participants with mobility issues, who are permanently sick or disabled and/or on lower incomes were struggling to afford and obtain gluten-free substitute foods from elsewhere. The withdrawal of prescriptions may further widen health inequalities. Further research should focus on the long-term impacts of prescription withdrawal for the vulnerable groups identified.
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Affiliation(s)
- Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sugavanam T, Crocker H, Violato M, Peters M. The financial impact on people with coeliac disease of withdrawing gluten-free food from prescriptions in England: findings from a cross-sectional survey. BMC Health Serv Res 2024; 24:146. [PMID: 38287389 PMCID: PMC10826048 DOI: 10.1186/s12913-024-10600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND A lifelong gluten-free diet is the only treatment for coeliac disease. The cost and availability of gluten-free substitute food (GFSF) remain challenging. Some local areas in England have stopped gluten-free prescriptions for coeliac disease. The aim of this paper is to present the quantitative findings of the financial impact of prescription withdrawal on people with coeliac disease. METHODS A cross-sectional survey with adults in England who reported having been diagnosed with coeliac disease by a health professional. The postal survey was distributed by Coeliac UK to their members in 13 prescribing and 13 non-prescribing local areas that were matched for geographical location and level of deprivation. Additionally, an advertisement for the survey was placed on social media. The questionnaire contained items on the availability and use of prescriptions; the weekly amount spent on GFSF; amount of specific GFSF bought; affordability of GFSF; demographics and health-related variables. Data were analysed by descriptive statistics, analysis of variance and regression analysis. RESULTS Of the 1697 participants, 809 resided in areas that provided prescriptions and 888 in non-prescribing areas. Participants self-report of their prescription did not always match the local area prescription policy. There was no statistically significant difference between prescribing and non-prescribing areas in how easy or difficult participants found it to obtain GFSF (p = 0.644) and its availability in various locations. Participants in non-prescribing areas purchased most types of GFSF items in statistically significantly higher quantities and thereby spent an additional £11.32/month on GFSF items than participants in prescribing areas (p < 0.001). While taking into account the self-reported prescription status, the amount increased to £14.09/month (p < 0.001). Although affordability to buy GFSF did not differ based on local area prescription policy or self-reported prescription status, it was dependent on equivalised annual income. However, affordability did not influence spending on GFSF. Regression analysis indicated that males and households with additional members with coeliac disease spent more on GFSF. CONCLUSIONS The study has highlighted that gluten-free prescription withdrawal can have financial implications for people with coeliac disease. Any future changes to the prescription policy of GFSF should consider the impact on the population, especially lower income households.
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Affiliation(s)
- Thavapriya Sugavanam
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford, OX3 7LE, UK.
| | - Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Zingone F, Zanini A. Gluten free diet, assessment of its adherence, and quality of life. PEDIATRIC AND ADULT CELIAC DISEASE 2024:189-198. [DOI: 10.1016/b978-0-443-13359-6.00011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Rose C, Law GU, Howard RA. The psychosocial experiences of adults diagnosed with coeliac disease: a qualitative evidence synthesis. Qual Life Res 2024; 33:1-16. [PMID: 37516676 PMCID: PMC10784387 DOI: 10.1007/s11136-023-03483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Coeliac disease is a chronic autoimmune condition associated with intestinal and extraintestinal symptoms. Coeliac Disease is managed through strict adherence to a gluten-free diet, which, though usually effective, is challenging to maintain. This review synthesised qualitative research on the psychosocial experiences of adults living with coeliac disease. METHODS Keyword searches were conducted of the academic databases CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS and Web of Science for articles published (2005-2021), followed by forward and backward searches. Thematic synthesis of included articles was carried out on sections reporting findings or results, discussion, conclusions, and supporting data. The inductive thematic synthesis identified descriptive and analytical themes from the included studies. RESULTS Of 1284 records identified, 17 articles from 15 original studies were included in the thematic synthesis. The majority of studies were from Europe (76%), with the remainder from North America and Australia. Data represented 371 adults with coeliac disease (72% female; 17-85 years old, diagnosed < 1-42 years ago) across eight countries. Findings identified six analytical themes relating to the psychosocial experience of coeliac disease: 'Living with ongoing risk'; 'Losing more than gluten'; 'A changed identity'; 'A changed relationship with food'; 'The gluten-free diet creates a multifaceted burden'; and 'Learning how to live well with Coeliac Disease'. CONCLUSIONS Coeliac disease changes adults' psychosocial experiences. Adaptation involves ongoing learning, and development of psychological acceptance facilitates adjustment. Increased public education about coeliac disease may reduce stigma and risk. Psychosocial assessment and support could improve quality of life post-diagnosis.
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Affiliation(s)
- Catharine Rose
- School of Psychology, University of Birmingham, Birmingham, UK.
| | - Gary U Law
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Ruth A Howard
- School of Psychology, University of Birmingham, Birmingham, UK
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de Sousa Franckilin LR, Dos Santos ACPM, Freitas FEDA, Vieira IG, de Freitas Jorge CE, Neri DG, de Abreu MVC, Fonseca JK, Loffi RG, Foureaux G. Gluten: do only celiac patients benefit from its removal from the diet? FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2021.2024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Renato Guimarães Loffi
- Departamento de Ciência, Tecnologia e Inovação, Treini Biotecnologia Ltda, Belo Horizonte, Brazil
| | - Giselle Foureaux
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Nutrição, Angiogold: Medicina Integrativa, Belo Horizonte, Brazil
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Dimidi E, Kabir B, Singh J, Ageridou A, Foster C, Ciclitira P, Dubois P, Whelan K. Predictors of adherence to a gluten-free diet in celiac disease: Do knowledge, attitudes, experiences, symptoms, and quality of life play a role? Nutrition 2021; 90:111249. [PMID: 33979762 DOI: 10.1016/j.nut.2021.111249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to identify the relationship between adherence to a gluten-free diet (GFD) and demographic characteristics, knowledge, attitudes, and beliefs regarding celiac disease (CD) and GFD, experiences of following a GFD, symptoms, and quality of life (QoL). METHODS Patients with CD were recruited from outpatient clinics. Adherence to GFD was assessed using the CD adherence test (CDAT) and GFD score (GFD-S). Knowledge, attitudes, experiences, symptoms, and QoL were assessed using existing questionnaires. A multivariate logistic regression was performed. RESULTS Overall, 116 patients with CD were included (48 ± 16 y; 70% female). Based on the CDAT, 58 patients (50%) were adequate adherers, but 86 patients (74%) were adequate adherers according to GFD-S. When adherence was measured using the CDAT, being female was associated with lower odds of adherence (odds ratio [OR]: 0.36; P = 0.028), and better emotional wellbeing was associated with higher odds of adherence (OR: 1.19; P < 0.001). When adherence was measured using GFD-S, membership in a support group (OR: 6.17; P = 0.002), stronger beliefs about the chronicity of CD (OR: 1.15; P = 0.059), and weaker beliefs on accident/chance causing CD (OR: 1.94; P = 0.05) were associated with greater odds of adherence. Difficulties when eating with family/friends (OR: 0.98; P = 0.005) and weaker beliefs on immunity causing CD (OR: 0.77; P = 0.031) were associated with lower odds of adherence. CONCLUSIONS The association between gender, attending support groups, attitudes, experiences, and QoL with adherence to a GFD should be considered by health care professionals managing patients with CD.
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Affiliation(s)
- Eirini Dimidi
- King's College London, Department of Nutritional Sciences, London, United Kingdom
| | - Bonita Kabir
- King's College London, Department of Nutritional Sciences, London, United Kingdom
| | - Jaspreet Singh
- King's College London, Department of Nutritional Sciences, London, United Kingdom
| | - Aikaterini Ageridou
- King's College London, Department of Nutritional Sciences, London, United Kingdom
| | - Charlotte Foster
- King's College London, Department of Nutritional Sciences, London, United Kingdom
| | - Paul Ciclitira
- The University of East Anglia, The Medical School, Norwich, United Kingdom
| | - Patrick Dubois
- King's College Hospital NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
| | - Kevin Whelan
- King's College London, Department of Nutritional Sciences, London, United Kingdom.
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Peters M, Crocker H, Jenkinson C, Violato M. Withdrawing gluten-free food from prescriptions in England: a mixed-methods study to examine the impact of policy changes on quality of life. J Hum Nutr Diet 2019; 33:453-464. [PMID: 31876360 PMCID: PMC7383817 DOI: 10.1111/jhn.12728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Some local areas in England stopped have gluten‐free prescriptions for coeliac disease. An explanatory mixed‐methods study has investigated the impact of these changes. Methods A cross‐sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on the use of prescriptions and healthcare services, as well as the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis, and the interviews were analysed by thematic analysis. Findings from the interviews guided the survey analysis. Results Dietary burden was significantly different between prescribing and nonprescribing areas, with little impact on other aspects of quality of life. Survey participants in nonprescribing areas who felt more impacted by the prescription changes reported a lower quality of life. Satisfaction with and use of services was lower in nonprescribing areas. Interviews indicated that, after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten‐free prescriptions to be available, in particular for staple foods. Conclusions The main quality of life impact was on Dietary burden. It is encouraging that most participants in the present study maintained a good quality of life. However, issues of worse experiences of care, lower follow‐up opportunities and inequity arose, and these should be taken into consideration in decisions on gluten‐free food prescriptions. The new guidelines for the National Health Service in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in the present study.
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Affiliation(s)
- M Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - H Crocker
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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