Date of Award

Spring 5-25-2024

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Food Science

First Advisor

Simone Camel

Abstract

Celiac disease (CD) is a chronic, autoimmune disorder with an increasing global prevalence. As the only current treatment is a strict gluten-free diet (GFD), adherence is imperative to maintain optimal health in individuals with the disease. There are many potential barriers to GFD adherence, including social, mental, and financial difficulties. College also presents a unique set of challenges for students with CD that may not be experienced by those without the disease. The purpose of this study was to determine the potential barriers to GFD adherence experienced by college students with celiac disease in the United States. This study also explored the relationships between GFD adherence, health-related quality of life (HRQOL), self-efficacy (SE), grade point average (GPA), and registered dietitian nutritionist (RDN) diet education. This descriptive, exploratory study utilized a cross-sectional, electronic survey design with a network sampling technique. The questionnaire included items from the Celiac Dietary Adherence Test (CDAT), the Health-Related Quality of Life Scale (HRQOL-14), the Celiac Disease Self-Efficacy Scale (CD-SE), researcher-developed questions, and demographic data. Participant eligibility criteria included physiciandiagnosed CD, age of 18 years or older, current enrollment in a college or university in the United States, and ability to read English. Those who completed the questionnaire were eligible to enter a gift card raffle. Responses from 78 participants were used for analysis. The majority of students were White, non-Hispanic (83.3%) females (70.5%) between the ages of 18-38 years old (M = 22.4, SD = 4.5). The majority of participants reported having a meal plan (70.5%), having past GFD education with an RDN (55.7%), and having an additional food allergy (65.8%). Mean GPA (n = 65) was 3.4 (SD = 0.76). The mean CDAT score for participants (n = 75) was 16.3 (SD = 4.9), indicating overall good diet adherence. HRQOL was determined by the total number of healthy days reported by participants in a 30-day window. The mean number of healthy days experienced by 74 participants was 13.3 (SD = 9.6) indicating less than half of all days to be healthy. The mean total score was 6.2 (SD = 1.2), indicating overall low SE. Participants showed the highest average SE in the Shopping subcategory (M = 7.0, SD = 1.8) with the lowest mean in the Work and Studies (M = 5.5, SD = 1.7) subcategory. Dietary adherence measured by CDAT scores was significantly, negatively correlated to total healthy days, r(72) = -.38, p < .001, and CD-SE scores r(62) = -.49, p < .001. Total healthy days and CD-SE scores were significantly, positively correlated, r(62) = .28, p = .03. There was no significant relationship found between GPA, CDAT scores, total healthy days, and CD-SE scores. Years since diagnosis was significantly, positively correlated to CD-SE scores, r(62) = .26, p = .04. A significant, negative relationship was found between past GFD education from an RDN and self-efficacy in the CD-SE travel subcategory only, t(61) = -2.93, p = .005. When compared to students without RDN diet education, students with RDN experience had lower travel SE scores. Confidence in GFD knowledge was significantly, negatively related to CDAT scores, t(65) = -.33, p < .001, indicating confident participants had greater diet adherence. No significant relationships were found between ownership of a meal plan with CDAT scores, total healthy days, and CD-SE scores. Regression analysis found that RDN counseling, years since diagnosis, and total CD-SE scores were able to significantly predict diet adherence measured by CDAT scores, R2 = .234, F(3,58) = 5.92, p = .001. Total mean CD-SE scores significantly predicted diet adherence, ß = -2.08, p < .001. Regression analysis found that CDAT scores, years since diagnosis, question five of the HRQOL-14, and RDN counseling were able to significantly predict HRQOL measured in total healthy days, R2 = .195, F(4,62) = 3.75, p = .009. CDAT scores significantly predicted the number of total healthy days ß = -.604, p = .011. In response to the researcher-designed questions, the majority of participants reported feeling confident in their GFD knowledge (74.36%), feeling financially burdened (51.28%), feeling pressured in social situations (47.4%), and feeling additional barriers during college (61.54%). Some of the most reported additional barriers to adherence were navigating the campus dining halls, facing social pressures, finding food while traveling, and financially supporting the GFD. Prior to this study, there has been little research on this topic focused on a college population. The findings of this study suggest that GFD adherence is related to HRQOL and SE. By increasing SE among college students with CD, dietary adherence and subsequently HRQOL may be improved.

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