Dr Rebecca Angus1,2, Ms Shelina Porykali2, Ms Katrina Tognolini1, Dr Rebekah Van Leest1, Dr Rati Jani2, Prof Rozanne Kruger2
1Gold Coast Health, Southport, Australia, 2Griffith University, Gold Coast, Australia
Biography:
Dr Rebecca Angus is an Accredited Practising Dietitian with a research specialty. She is employed within Gold Coast Hospital and Health Service to support development, conduct and dissemination of nutrition-related research, and more generally, to build the research capacity of allied health clinicians across the health service to enable best-practice patient care.
Abstract:
Background:
Coeliac disease (CD) is a chronic autoimmune disorder where gluten ingestion causes gastrointestinal and other manifestations. Affecting 1.4% of Australians, timely diagnosis is crucial to mitigate the numerous complications associated with enteropathy. Valid endoscopic investigation requires gluten consumption, but people referred may have already excluded gluten from their diet. If so, gluten challenge is required. We explored gluten challenge practices and the experiences of patients and clinicians aiming to identify determinants of adequate gluten intake for accurate CD diagnosis.
Methods:
This qualitative study interviewed patients within seven days of endoscopic investigation for suspected CD, and clinicians involved in their care within a Queensland tertiary health service. Inductive thematic analysis was used to explore experience, followed by deductive analysis against the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model to identify enablers and barriers to adequate gluten intake for CD diagnosis.
Results:
Fifteen patients and 11 clinicians (dietitians, nurses and gastroenterologists) were interviewed. Identified themes included ambiguity and inconsistency in gluten challenge recommendations, and varied patient experiences in adhering to recommendations. Deductive analysis revealed subthemes aligned with nine TDF domains within three COM-B components. Enablers included knowledge of CD pathophysiology and of gluten-containing foods, and clear communication from clinicians on the importance of gluten exposure. Barriers included memory lapses, paucity of gluten challenge educational resources, fear of consuming gluten, and limited time between booking and endoscopy.
Conclusion:
The identified determinants provide targets for improving future practice to support better diagnosis or exclusion of CD, and thus patient care.