{
  "abstract": "Coeliac disease (CD) is an autoimmune condition, and its management is strict adherence to a gluten-free diet (GFD). 1 There are multiple factors that can affect adherence. This study aims to quantitatively evaluate the barriers to GFD adherence to enable targeted intervention and service development in identified domains.A questionnaire study was conducted with 60 participants with confirmed coeliac disease identified through the Paediatric Gastroenterology Service. Participants were divided into two groups based on age: 8–12 years (n=26) and 13–17 years (n=34). Participants completed measures assessing adherence to a gluten-free diet and the impact of potential psychosocial and practical barriers. Correlational analyses were used to explore associations between individual barriers and adherence scores within each age group.Difficulty when travelling and eating out was a prominent domain in both groups, achieving the highest scores in the 13–17 years and the second and third highest in the 8–12 years (figures 1 and 2). Whilst Coeliac UK offers gluten-free restaurant accreditation,2 options can often be limited, leading to a lack of desire to eat out. In the 13+ patient group, travel was the most influential barrier to GFD adherence, which could limit social development and independence compared to their peers.3 To address this, interventions would need to focus on the hospitality industry to improve education and gluten-free options, which could be aided by further research and lobbying.Interestingly, the highest scoring barrier to adherence in the 8-12 years age group was ‘wanting to eat food with gluten in.’ This is most likely due to the burden of buying and preparing a GFD falling on caretakers, whereas the desire for a non-GFD is more burdensome on the child themselves. This could signal a lack of understanding, so interventions would need to focus on education, both of children with CD as well as their peers.Overall, this data shows that the majority of the barriers to GFD adherence are practical, based on the availability and cost of a GFD. On average, shopping for a GFD costs 35% more compared to a non-GFD.4 This limits further intervention, as changes to the food landscape on a national scale would be required to increase options and decrease costs associated with a GFD. One potential solution could be the reintroduction5 of gluten-free prescriptions to ensure access to gluten-free necessities.In conclusion, this study has shown that whilst adherence to a GFD is multi-factorial, external factors are the most burdensome, which requires further research and potential involvement from restaurants and supermarkets. Within the scope of paediatric gastroenterology, further education and signposting to resources could be key in helping to address these barriers.References Hill P, Austin A, Forsyth J, Holmes G. British society of gastroenterology guidelines on the diagnosis and management of coeliac disease. Gut 2014;64(4):691–692.Coeliac UK. Eating out [Internet]. Available from: https://www.coeliac.org.uk/information-and-support/living-gluten-free/the-gluten-free-diet/eating-out/MacCulloch K, Rashid M. Factors affecting adherence to a glutenfree diet in children with celiac disease. Paediatr Child Health. 2014;19(6):305309. doi:10.1093/pch/19.6.305Coeliac UK. New coeliac UK report sheds light on cost, access & availability of gf food [Internet]. 26 June 2024. Available from: https://www.coeliac.org.uk/about-us/media-centre/news/new-coeliac-uk-report-sheds-light-on-cost-access-and/?set=true&type=rfst - needs citationWest Yorkshire Health & Care Partnership. Treatments paid for by the NHS [Internet]. West Yorkshire (UK): West Yorkshire Health & Care Partnership; 2024 Feb 28. Available from: https://www.wypartnership.co.uk/our-priorities/improving-planned-care/our-westyorkshireandharrogatecommissioningpolicies/treatments-paidAbstract OC66 Figure 1(above) shows the scores for barriers to adherence for 8–12-year-oldsAbstract OC66 Figure 2(above) shows the scores for barriers to adherence for those 13 years and older",
  "authors": [
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Robert Bridle"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Louise Maclean"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Cathryn Evans"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Charlotte Hewitson"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Nicole Russell"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Ashleigh Blood"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS Trust"
      ],
      "name": "Veena Zamvar"
    }
  ],
  "title": "OC66 Exploring the barriers to dietary adherence in children and young people with coeliac disease",
  "uid": "4a6021cc-6816-5bef-ab34-5a977bccd2fd"
}