{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:56:17Z","timestamp":1790139377981,"version":"4.0.1"},"reference-count":57,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T00:00:00Z","timestamp":1588118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Coeliac disease (CD) is a chronic, autoimmune disease that prevents individuals from processing gluten, leading to adverse health effects. People with CD should adhere to a gluten\u2010free diet (GFD); however, adherence rates are well below optimal in adults with CD, ranging between 42% and 91%. To date, limited evidence is available on the nature and magnitude of factors that affect adherence to GFD. The present study aimed to develop a systematic review that critically appraises and synthesises evidence on facilitators and barriers that affect adherence to GFD among adults with CD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four databases were searched (Ovid Medline, CINAHL, PsychInfo and Embase) using variant keywords to identify empirical studies meeting the inclusion\/exclusion criteria. A coding scheme was developed to extract relevant information from each article.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty articles were included. Grounded in the bioecological theory of development, we synthesised the facilitators and barriers in the literature into a social ecological model with multiple levels: system, community, organisational, interpersonal and individual. The studies varied by design and level of evidence; only one randomised trial was identified. The most significant facilitators include (% of studies): increased education (22.5%); increased knowledge of a GFD (20%); increased intention\/self\u2010regulatory efficacy (17.5%); and coeliac association membership (12.5%). The most significant barriers include: lower knowledge of CD (35%); restaurant\/supermarket shopping (30%); poor patient education from practitioner (17.5%); and low intention\/motivation to adhere to a GFD (17.5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improving knowledge of a GFD, becoming a member of a coeliac association, and improving practitioners\u2019 abilities to educate patients on CD will create opportunities for improved adherence to GFD among adults with CD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jhn.12754","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T12:38:36Z","timestamp":1588163916000},"page":"786-810","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Facilitators and barriers to adherence to gluten\u2010free diet among adults with celiac disease: a systematic review"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8865-7522","authenticated-orcid":false,"given":"N.","family":"Abu\u2010Janb","sequence":"first","affiliation":[{"name":"Health Systems Management Telfer School of Management University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9795-6281","authenticated-orcid":false,"given":"M.","family":"Jaana","sequence":"additional","affiliation":[{"name":"Health Systems Management Telfer School of Management University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,29]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"RampertabSD&MullinGE(2014)Celiac disease. 1 online resource (xvii 323 pages) p."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/140289"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2005.02783.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i42.6036"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111646"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2013.849383"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-016-1238-5"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04053.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i15.2635"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(03)00302-4"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470147658.chpsy0114"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02820685"},{"key":"e_1_2_7_15_1","unstructured":"PopayJ RobertsH SowdenAet al. 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