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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Introduction 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.Methods 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.Results 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.Discussion 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.
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This result is discrepant from other findings that associated self-efficacy with better adherence in a different health context, dieting.
“However, this result is discrepant from other findings (e.g., Sainsbury et al., 2018) that associated self-efficacy to better adherence in a different health context, dieting.”
From Can We Boost Treatment Adherence to an Online Transdiagnostic Intervention by Adding Self-Enhancement Strategies? Results From a Randomized Controlled Non-inferiority Trial (2021) · cites this paper as Sainsbury et al., 2018
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Abaoğlu, H., & Türkmen, Z. Y. (2026) · Cadernos Brasileiros de Terapia Ocupacional · doi:10.1590/2526-8910.cto431342822
Seamark, L., Radcliffe, O., Williams, M., Gotto, J., Watson, B., Trudgeon, J., Reeves, S., & Jeanes, Y. (2026) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70350
Satherley, R., Hollyfield, S., Shahab, A., Pitt, A., Trott, N., Toft, L., Ala, A., & Jones, C. J. (2026) · Health Expectations · doi:10.1111/hex.70905
- Authors
- Sainsbury, K., Halmos, E. P., Knowles, S., Mullan, B., & Tye-Din, J. A.
- Affiliations
- Newcastle University (GB)
- The Royal Melbourne Hospital (AU)
- Curtin University (AU)
- Corresponding author
- Sainsbury, Kirby
- Venue
- Appetite
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 125
- Pages
- 356-366
- ISSN
- 0195-6663 (ISSN-L)
- OpenAlex
- W2793623627
- Cited by
- 46
- References
- 56
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 9 · 2020: 7 · 2019: 5 · 2018: 4
- FWCI
- 7.88
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Appetite (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- celiac disease, gluten-free diet, dietary adherence, self-regulation, habit, self-efficacy, psychological distress, motivation, social support, goal priorities, temptation, self-control, autonomous motivation, behavior change, psychological support
- MeSH terms
- Self-Control, Adaptation, Psychological, Adolescent, Adult, Aged, Aged, 80 and over, Celiac Disease, Conflict, Psychological, Feeding Behavior, Female, Goals, Habits, Humans, Male, Middle Aged, Motivation, Patient Compliance, Surveys and Questionnaires, Social Support, Stress, Psychological, Multivariate Analysis, Diet, Gluten-Free, Young Adult
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