Poster Session I – A97 BARRIERS AND FACILITATORS TO GLUTEN-FREE DIET ADHERENCE IN ADULTS WITH CELIAC DISEASE: A QUALITATIVE STUDY

Abstract Background A strict gluten-free diet (GFD) is the only effective treatment for celiac disease (CeD); however, maintaining adherence can be challenging for many adults. Barriers vary across populations and settings. Understanding these factors is essential to improve adherence and optimize clinical outcomes in CeD. Aims To identify factors influencing adherence to a GFD among adults with CeD and to explore the care and support needs that healthcare teams should address to improve adherence. Methods A qualitative study was conducted using semi-structured interviews with adults (18–75 years) with biopsy-confirmed CeD who had followed a GFD for at least 30 days. Purposive sampling ensured variation in GFD duration and self-reported adherence. Interviews were conducted virtually, audio-recorded, and transcribed verbatim. Data were managed in NVivo and analyzed using reflexive thematic analysis. Two researchers independently coded transcripts to identify key themes and subthemes, resolving discrepancies through discussion to ensure analytical rigour. Results From July 2024 to June 2025, 38 participants were enrolled (83% female; mean age 37 years). Most (97.6%) reported strict GFD adherence, and 87.8% had followed the diet for over one year. Participants described multiple, interrelated factors affecting adherence. Social pressures, cross-contamination risks, cravings, and financial or workplace constraints were frequent challenges. Supportive family and friends, effective planning, flexible work arrangements, and adequate income facilitated adherence. Cultural barriers emerged when traditional foods were difficult to adapt, while supportive hosts and adaptable recipes promoted inclusion. 73.7% of participants have experienced some form of stigma related to GFD. Limited access to trained dietitians and inconsistent guidance were key healthcare barriers, whereas multidisciplinary care, practical education, and peer support were strong facilitators. Conclusions Adherence to a GFD in CeD is shaped by social, personal, financial, cultural, and healthcare factors. Strengthening family, workplace, and healthcare support—particularly through improved dietitian access and practical education—may enhance adherence and long-term disease management. Funding Agencies Balsam Douglas Foundation