Despite the benefits of a gluten-free diet (GFD), rates for strict adherence range from 42% to 91%. Studies have established the maximum tolerable daily dose at 50 mg/day and led the European Union to restrict labelling ‘gluten-free’ products to those with less than 20 mg/kg. Qualitative studies have determined that patients experience social problems in five areas: eating in the workplace, shopping, travelling, eating out and eating at home with others. These situations may lead to negative emotions and affect relationships. Therefore, further research into investigating the underlying factors behind effective adherence is essential, as is the need for a theoretical framework to design programmes to improve adherence and quality of life in coeliac patients. Albert Bandura´s Social Cognitive Theory can provide a better understanding of adherence and, moreover, a theoretical framework to design self-management programmes. Within this framework, the Health Action Process Approach (HAPA) model could provide a theoretical mechanism to better understand GFD adherence. The main aim of this paper is to review the factors related to GFD adherence and to present the HAPA model as a useful framework for the design of interventions to improve perceived self-efficacy, adherence to the diet and, thus, enhance quality of life in coeliac patients.
Part of the book: Celiac Disease and Non-Celiac Gluten Sensitivity