The Dietary Journey in Inflammatory Bowel Disease: A Grounded Theory From Medicalization to Empowerment

Rubina Khullar Mahajan; Ramit Mahajan; Ritu Sudhakar; Vandana Midha; Ishita Arora; Gursabeen Kaur; Arshdeep Singh; Kirandeep Kaur; Ajit Sood

doi:10.1111/jgh.70385

The Dietary Journey in Inflammatory Bowel Disease: A Grounded Theory From Medicalization to Empowerment

J Gastroenterol Hepatol. 2026 Apr 8. doi: 10.1111/jgh.70385. Online ahead of print.

Authors

Rubina Khullar Mahajan¹, Ramit Mahajan², Ritu Sudhakar³, Vandana Midha⁴, Ishita Arora³, Gursabeen Kaur⁵, Arshdeep Singh², Kirandeep Kaur⁶, Ajit Sood²

Affiliations

¹ Department of Critical Care Medicine, Dayanand Medical College, Ludhiana, Punjab, India.
² Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India.
³ Department of Dietetics, Dayanand Medical College, Ludhiana, Punjab, India.
⁴ Department of Internal Medicine, Dayanand Medical College, Ludhiana, Punjab, India.
⁵ Department of Clinical Psychology, Dayanand Medical College, Ludhiana, Punjab, India.
⁶ Department of Pharmacology, Dayanand Medical College, Ludhiana, Punjab, India.

PMID: 41948824
DOI: 10.1111/jgh.70385

Abstract

Background and aim: Grounded theory develops theoretical frameworks from systematic analysis of patient experiences. Translational research converts findings into clinical tools. Despite dietary management being crucial in inflammatory bowel disease (IBD), no framework exists for understanding patients' dietary journey phases. We explored how IBD patients psychologically and socially experience dietary changes over time and developed a clinical assessment tool.

Methods: Using grounded theory methodology with translational tool development, we conducted semi-structured interviews with 25 adult IBD patients (21 ulcerative colitis, 4 Crohn's disease; mean age 38.6 years, 56% male) at a tertiary center in North India. A non-clinical researcher conducted interviews minimizing bias. Data were analyzed using constant comparative analysis with open, axial, and selective coding. Qualitative findings were systematically translated into the IBD Dietary Journey Assessment Tool (IDJAT).

Results: Three journey phases emerged: (1) medicalization (psychological reconceptualization of food's role)-the transformation of food from nourishment to medicine, with fear-based restrictions and medical dependence for dietary decisions; (2) life disruption and rebuilding-profound emotional and social upheaval requiring adaptation (a psychological adjustment process); (3) empowerment (psychological sense of control and mastery)-understanding triggers, self-management, and helping others. Patients progressed through phases via evolving information navigation and coping (non-linear progression, cycling during flares). The IDJAT comprises quick screening questions, phase identification scales, and phase-specific intervention guidelines.

Conclusions: This grounded theory study provides the first framework for IBD dietary journey phases. The IDJAT enables clinicians to identify patients' phase and deliver appropriate support, transforming dietary care from generic advice to journey-informed, phase-matched care.

Keywords: clinical assessment tool; dietary management; grounded theory; inflammatory bowel disease; patient empowerment.