Background: Celiac Disease (CD) is a chronic, autoimmune disease that prevents individuals from being able to process gluten. When individuals ingest gluten, their digestive system becomes severely damaged, leading to many adverse, health effects. It is, therefore, significantly crucial that individuals with CD adhere to a Gluten-Free diet (GFD). However, the adherence rate is well below optimal in the adult, CD population. Hence, it is crucial to identify and understand the factors that impact their ability to maintain a GFD.
Objective: To develop a systematic review that critically appraises and synthesizes evidence on the facilitators and barriers that affect adherence to GFD among the adult population with CD.
Data Sources: Ovid Medline, CINAHL, PsychInfo, and Embase were included, using a combination of keywords to retrieve relevant articles. The Inclusion Criteria consisted of empirical studies that focus on Adults with CD. Only English studies were considered. A coding scheme was developed to retrieve uniform information from each of the included studies, including: study design, population characteristics, facilitators and barriers presented, limitations, and a summary of each study.
Results: Facilitators and Barriers were organized based on a Social ecological model, derived from the bioecological theory of development, which emphasizes that individuals make choices in their lives based on the impact of various ecological levels that exist. The ecological levels include: System, Community, Organizational, Interpersonal, and Individual. The studies included in this systematic review reported many facilitators and barriers that exist at the different ecological levels, which significantly affect adherence to GFD. Based on the frequency of articles that reported each facilitator and each of the studies’ level of evidence, the most significant facilitators were: increased patient education; celiac association membership; financial compensation/food subsidies; and increased intention/self-regulatory efficacy. When taking into consideration the frequency of articles that reported each barrier along with each of the studies’ level of evidence, the most significant barriers were: restaurant dining/supermarket shopping; poor patient education from practitioner; specific cultural factors; and low intention/motivation to adhere to a GFD. Although other factors have been reported, there was limited evidence to support them due to weak study designs, limited samples, and inconsistencies found across the different studies. It is important to understand that there are many additional facilitators and barriers retrieved in the systematic review that do not have as much evidence to support them. These are discussed in the thesis.
Conclusion: Introducing policy changes at a health systems level will have the most influential impact on all the ecological layers in an individual’s life. Based on the magnitude of the results and the level of evidence of each of the studies, improvements to physician-patient communication, patient education interventions, and food subsidies, will create the most significant opportunity to positively impact the remaining ecological levels in one’s life, with the ultimate goal of improving adherence rates to a GFD among adults with CD in Canada.
Registration: Prospero registration ID number is CRD42018091854.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/38116 |
| Date | 14 September 2018 |
| Creators | Abu-Janb, Nicholas |
| Contributors | Jaana, Mirou |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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