April 02, 2013
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Online intervention improved adherence to gluten-free diet in patients with celiac disease

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Patients with celiac disease who completed a 6-week, interactive online intervention adhered better to a gluten-free diet than those who did not in a recent study.

Researchers randomly assigned 189 adults with celiac disease to either an interactive online intervention (n=101) or a waiting list (n=88, controls). To varying degrees, participants had followed a gluten-free diet for a mean of 4.6 years. Based on the Celiac Dietary Adherence Test, mean basal score (12.2) was in the excellent to very good range, with 58.9% of the group in this category, 33.2% considered moderately adherent and 7.9% considered fair to poor.

Intervention consisted of six weekly online modules that included education about gluten-free diet, behavior change techniques and strategies for treating anxiety and depression symptoms and improving coping behavior. After each module, participants answered questions about the program’s acceptability. Fifty patients completed intervention, with post-intervention data evaluated in 70 participants and 64 controls, plus follow-up data at 3 months from 46 recipients.

Immediately after intervention, recipients indicated improved adherence (P<.001), with no change in controls (P=.674). The effect size was small to medium in the intention-to-treat population, and medium to large among those with inadequate adherence at baseline with available post-intervention data (n=26 in the intervention group, n=29 controls; P=.014).

More intervention recipients improved their adherence category than controls (65.4% vs. 37.9%; P=.042). The difference in adherence between baseline and 3 months post-intervention was significant (P=.001), but the difference between adherence immediately after intervention and 3-month follow-up was not (P=.6).

“This is the first study to demonstrate that gluten-free diet adherence can effectively be targeted using behavior change techniques and cognitive behavior therapy strategies that have been successfully applied in other areas of health and clinical psychology and across a wide range of illness populations,” researcher Kirby Sainsbury, BA/BEd, psychologist at the University of Sydney, told Healio.com. “When combined with the online format of the program (which was well received), these results suggest that the dissemination of this evidence-based resource to individuals with celiac disease who are struggling to achieve or maintain adherence is likely to lead to meaningful improvements in adherence.”