This study investigated differences in self-reported habit between individuals who do and do not strictly adhere to the gluten free diet. The study found that 83% of participants strictly adhered to the diet. Higher scores on the self-reported habit index predicted strict adherence, and items measuring automaticity distinguished adherers from non-adherers. Habit may be a better predictor of accidental non-adherence to the gluten free diet than intention alone. Interventions could focus on increasing habit to improve adherence.

1. DIFFERENCES IN SELFREPORTED HABIT BETWEEN
INDIVIDUALS WHO DO AND
DO NOT STRICTLY ADHERE
TO THE GLUTEN FREE DIET
EMILY KOTHE
BARBARA MULLAN
CRICOS Provider Code: 0113B

2. BACKGROUND
• Coeliac disease is a multi-systems autoimmune disorder that
effects about 1% of the world’s population.
• The autoimmune response within coeliac disease is triggered by
exposure to gluten; protein in wheat, rye and barley
CRICOS Provider Code: 0113B

3. BACKGROUND
• Strict adherence to a gluten free diet is the only effective
method of managing coeliac disease
• However, many individuals with coeliac disease fail to strictly
adhere to the gluten free diet.
• Recent research shows that the majority of non-adherence is
accidental and that intention may be a relatively poor
predictor of such non-adherence.
CRICOS Provider Code: 0113B

4. THE PRESENT STUDY
• The aim of the present study was to investigate factors that
distinguish between individuals who and do not successfully
adhere to the diet
• This research was primarily interested in identifying factors
that account for non-adherence within individuals who report
that they do not intentionally consume gluten.
• It was hypothesized that habit strength may be a predictor of
accidental non-adherence and would distinguish between
individuals who do and do not successfully adhere to the diet.
CRICOS Provider Code: 0113B

5. METHOD
• Individuals with biopsy confirmed coeliac disease were
recruited from the Coeliac Society of Victoria and Tasmania.
• Participants completed a range of measures including:
– Demographic and disease characteristics
– A validated self-report measure of gluten-free diet
adherence (CDAT)
– The self-report habit index (SRHI).
• Prior to analysis, data was screened to identify individuals who
reported that they did not voluntarily consume gluten.
CRICOS Provider Code: 0113B

6. RESULTS
• One-hundred and twenty five participants met criteria for the
study.
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Mean age = 48.13 years
Mean age at diagnosis = 42.13 years
Mean length of time following the diet = 7.78 years
Gender = 88% female
• Scores on the CDAT indicated that 83% of individuals were
strictly adherent to the diet (mean CDAT scores = 10.76)
• Independent samples t-tests were used to compare habit scores
between adherent and non-adherent individuals.
CRICOS Provider Code: 0113B

7. RESULTS
• A logistic regression analysis was conducted to predict CDAT
adherence category (strictly adherent vs. not strictly
adherent) using SHRI scores.
• A one unit increase in SRHI score increased the odds of being
strictly adherent by 1.6 times (Nagelkerke R2 =
.086, p=.007, OR=1.577).
• The automaticity sub-scale of the SHRI alone accounted for 6.2%
of the variance in adherence levels (Nagelkerke R2 =
.062, p=.021, OR=1.08)
CRICOS Provider Code: 0113B

8. RESULTS
• We also attempted to identify which items within the SHRI could
distinguish between individuals in different adherence
categories.
• Individuals who were strictly adherent to the diet were
significantly more likely to report that following a strict
gluten free diet is…
– Something that makes me feel weird if I do not do it
– I start doing before I realise I’m doing it
– That should would require effort not to do it
– That I have no need to think about doing
– That is “typically me”
– I have been doing a long time
– I do frequently
CRICOS Provider Code: 0113B

9. CONCLUSIONS
• Even among individuals who reported that they did not
intentionally consume gluten, only 83% of participants were
strictly adherent to the gluten free diet.
• Results suggest that habit may be an important factor for
determining whether or not individuals are strictly adherent
to the gluten free diet.
• This study identified several indicators of automaticity that
appeared to distinguish between individuals that were
successful in adhering to the diet and those that were not.
CRICOS Provider Code: 0113B

10. CONCLUSIONS
• Recent research suggests that motivational factors such as
intention may be limited in their ability to help understand
accidental non-adherence to a gluten free diet. Habit may
provide a better method of understanding this type of nonadherence.
• These findings would suggest that interventions may benefit
from a focus on increasing habit in order to improve gluten
free diet adherence.
CRICOS Provider Code: 0113B

11. THANK YOU
EMILY.KOTHE@DEAKIN.EDU.AU
BARBARA.MULLAN@CURTIN.EDU.AU
CRICOS Provider Code: 0113B