Barriers of Adherence to a Gluten-Free Diet in Iranian Adults With Celiac Disease

Gastroenterol Nurs. 2021 Sep-Oct 01;44(5):320-327. doi: 10.1097/SGA.0000000000000575.


This cross-sectional study aimed to evaluate and classify barriers to adherence to the gluten-free diet in 137 Iranian adults with celiac disease. We used a 23-point Likert questionnaire and exploratory factor analysis to identify and classify the barriers. Adherence to gluten-free diet was assessed by measuring the serum level of anti-tTG-IgA. The correlation between the barriers and adherence to gluten-free diet was assessed using logistic regression. A total of 117 subjects completed the study. Seven factors were extracted: "gluten-free diet restrictions," "self-awareness and social awareness," "psychological barriers," "education," "situational barriers and gatherings," "lack of access/labeling," and "cost." There was a significant correlation between the situational barriers and gatherings and nonadherence to the diet in the adjusted model (odds ratio = 1.63; 95% confidence interval [1.03, 2.54], p = .03). Nutritionists and physicians should consider these barriers when consulting patients with celiac disease.

MeSH terms

  • Adult
  • Celiac Disease*
  • Cross-Sectional Studies
  • Diet, Gluten-Free*
  • Humans
  • Iran
  • Patient Compliance