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Appetite. 2018 Jun 1;125:356-366. doi: 10.1016/j.appet.2018.02.023. Epub 2018 Feb 24.

Maintenance of a gluten free diet in coeliac disease: The roles of self-regulation, habit, psychological resources, motivation, support, and goal priority.

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Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE2 4AX, United Kingdom. Electronic address:
Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia.
Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Bentley, Western Australia, 6102, Australia.
Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia; Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3052, Australia.



A strict lifelong gluten free diet (GFD) is the only treatment for coeliac disease (CD). Theory-based research has focused predominantly on initiation, rational, and motivational processes in predicting adherence. The aim of this study was to evaluate an expanded collection of theoretical constructs specifically relevant to the maintenance of behaviour change, in the understanding and prediction of GFD adherence.


Respondents with CD (N = 5573) completed measures of GFD adherence, psychological distress, intentions, self-efficacy, and the maintenance-relevant constructs of self-regulation, habit, temptation and intentional and unintentional lapses (cognitive and behavioural consequences of lowered or fluctuating psychological resources and self-control), motivation, social and environmental support, and goal priority, conflict, and facilitation. Correlations and multiple regression were used to determine their influence on adherence, over and above intention and self-efficacy, and how relationships changed in the presence of distress.


Better adherence was associated with greater self-regulation, habit, self-efficacy, priority, facilitation, and support; and lower psychological distress, conflict, and fewer self-control lapses (e.g., when busy/stressed). Autonomous and wellbeing-based, but not controlled motivations, were related to adherence. In the presence of distress, the influence of self-regulation and intentional lapses on adherence were increased, while temptation and unintentional lapses were decreased.


The findings point to the importance of considering intentional, volitional, automatic, and emotional processes in the understanding and prediction of GFD adherence. Behaviour change interventions and psychological support are now needed so that theoretical knowledge can be translated into evidence-based care, including a role for psychologists within the multi-disciplinary treatment team.


Coeliac disease; Distress; Gluten free diet adherence; Habit; Maintenance; Self-regulation; Theory

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