Prediction of adherence to a gluten-free diet using protection motivation theory among adults with coeliac disease

J Hum Nutr Diet. 2016 Jun;29(3):391-8. doi: 10.1111/jhn.12321. Epub 2015 Apr 28.


Background: Coeliac disease is a chronic autoimmune disease that requires strict adherence to a gluten-free diet. However, strict adherence to a gluten-free diet is difficult, with findings from a recent review suggesting that up to 42% of individuals with coeliac disease do not eat a strict gluten-free diet.

Methods: The present study aimed to examine psychosocial predictors of adherence (purposeful and accidental) to a gluten-free diet among adults with coeliac disease over a 1-month period. In this longitudinal study, 212 North American adults with coeliac disease completed online questionnaires at two time points, baseline and 1 month later.

Results: The results revealed that intentions partially mediated the effects of symptom severity, self-regulatory efficacy, planning and knowledge on purposeful gluten consumption. Intentions did not mediate the effects of severity, response cost, self-regulatory efficacy, planning and knowledge for accidental gluten consumption but, interestingly, self-regulatory efficacy directly predicted fewer accidental incidents of gluten-consumption.

Conclusions: These findings delineate the differential psychological processes in understanding accidental and purposeful gluten consumption among adults with coeliac disease and emphasise the importance of bolstering self-regulatory efficacy beliefs to prevent accidental and purposeful consumption of gluten.

Keywords: adherence behaviour; coeliac disease; gluten-free diet; psychosocial.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Behavior
  • Canada
  • Celiac Disease / diet therapy*
  • Diet, Gluten-Free / psychology*
  • Glutens / administration & dosage
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intention
  • Longitudinal Studies
  • Middle Aged
  • Motivation*
  • Patient Compliance / psychology*
  • Self Efficacy
  • Surveys and Questionnaires


  • Glutens