Role of resilience and social support in dietary adherence and alleviating celiac disease symptoms
Main Article Content
Abstract
OBJECTIVES: To evaluate the association between resilience and social support with dietary adherence and symptom alleviation in celiac disease patients, while also exploring the effects of gender and disease severity.
METHODS: This cross-sectional study involved 73 patients, consisting of 20 men (27.4%) and 53 women (72.6%), recruited from three tertiary care hospitals (Mayo Hospital, Services Hospital, and Sir Ganga Ram Hospital) in Lahore, Pakistan between January 2022 and August 2023. Following ethical guidelines, participants completed a demographic form and four validated psychometric instruments Resilience Scale-25, Multidimensional Scale of Perceived Social Support, Celiac Dietary Adherence Test and The Celiac Symptom Index. Patients with comorbidities such as diabetes, arthritis, renal issues, or cancer were excluded. Data were analyzed using SPSS V24.0.
RESULTS: Mean age of participants was 30.15±1.13 years. Among the 73 participants, 16 (21.91%) were in stage 1, 20 (27.39%) in stage 2, 20 (27.39%) in stage 3, and 17 (23.28%) in stage 4 of CD. Resilience was significantly associated with adherence to a gluten-free diet (r = .73, p < .01), and other resilience factors also positively influenced dietary compliance. Additionally, participants receiving social support showed a greater tendency to adhere to the dietary regimen (r = .78, p < .01). However, dietary adherence and symptom alleviation varied by disease stage, with no significant gender differences observed.
CONCLUSION: Resilience and social support enhance the likelihood of adhering to a gluten-free diet and managing symptoms, regardless of gender. However, the severity of illness can hinder symptom alleviation in celiac disease patients.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
1. Arshad V, Inam M, Awan S, Ismail FW. Clinical spectrum of Celiac Disease in adults at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci 2022;38(3Part-I):445-9. https://doi.org/10.12669/pjms.38.3.4446
2. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018;16:823-36.e2. https://doi.org/10.1016/j.cgh.2017.06.037
3. Singh P, Arora S, Singh A, Strand TA, Makharia GK. Prevalence of celiac disease in Asia :A systematic review and meta-analysis. J Gastroenterol Hepatol 2016;31:1095-101. https://doi.org/10.1111/jgh.13270
4. Bai JC, Ciacci C, Melberg J. World Gastroenterology Organisation Global Guidelines: Celiac Disease February 2017. J Clin Gastroenterol 2017;51(9):755-68. https://doi.org/10.1097/MCG.0000000000000919
5. Haase JE, Kintner EK, Monahan PO, Robb SL. The resilience in illness model, part 1: exploratory evaluation in adolescents and young adults with cancer. Cancer Nurs 2014;37(3):E1-E12. https://doi.org/10.1097/NCC.0b013e31828941bb
6. Romana B, Babic M, Rastovic P, Curlin M, Simic J, Mandic K, Pavlovic K. "Resilience in health and illness." Psychiatria Danubina 2022;32(2):226-32.
7. Moller SP, Apputhurai P, Tye-Din JA, Knowles SR. Quality of life in coeliac disease: relationship between psychosocial processes and quality of life in a sample of 1697 adults living with coeliac disease. J Psychosom Res 2021;151:110652.
8. Shani M, Kraft L, Müller M, Boehnke K. The potential benefits of camps for children and adolescents with celiac disease on social support, illness acceptance, and health-related quality of life. J Health Psychol 2022;27(7):1635-45. https://doi.org/10.1177/1359105320968142
9. Sehgal P, Ungaro RC, Foltz C, Iacoviello B, Dubinsky MC, Keefer L. High Levels of Psychological Resilience Associated With Less Disease Activity, Better Quality of Life, and Fewer Surgeries in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021;27(6):791-6. https://doi.org/10.1007/s10620-017-4835-010.1093/ibd/izaa196
10. Chmitorz A, Kunzler A, Helmreich I, Tüscher O, Kalisch R, Kubiak T, et al. Intervention studies to foster resilience-a systematic review and proposal for a resilience framework in future intervention studies. Clin Psychol Rev 2018;59:78-100. https://doi.org/10.1016/j.cpr.2017.11.002
11. Canty-Mitchell J, Zimet GD. Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. Am J Community Psychol 2000; 28: 391-400.
12. Naveed A, Naz F. Risk factors for postpartum depression, interpersonal relationship anxiety, neuroticism and social support in women with postpartum depression. Pak J Soc Sci 2015;35(2):911-24.
13. Leffler DA, Dennis M, Edwards George JB, Jamma S, Magge S, Cook EF, et al. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol 2009;7:5306. .https://doi.org/10.1016/j.cgh.2008.12.032
14. Wagnild GM, Young HM. Development and Psychometric Evaluation of the Resilience Scale. J Nurs Measure 1993;1:165-78.
15. Leffler DA, Dennis M, Edwards George J, Jamma S, Cook EF, Schuppan D, et al. A validated disease-specific symptom index for adults with celiac disease. Clin Gastroenterol Hepatol 2009;7(12):1328-34.e13343. https://doi.org/10.1016/j.cgh.2009.07.031
16. Randle M, Eckersley R, Miller L. Societal and personal concerns, their associations with stress, and the implications for progress and the future. Futures 2017;93:68-79.
17. Keefer L, Gorbenko K, Siganporia T, Manning L, Tse S, Biello A, et al. Resilience-based Integrated IBD Care is Associated with Reductions in Health Care Use and Opioids. Clinic Gastro Hepatol 2022;8:1831-8. https://doi.org//10.1016/j.cgh.2021.11.013
18. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care 2018;7(3):497-500. https://doi.org/10.4103/jfmpc.jfmpc_145_17
19. Adisa R, Olajide OO, Fakeye TO. Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria. Ghana Med J 2017;51(2):64-77.
20. Shahin W, Kennedy GA, Stupans I. The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract (Granada) 2021;19(2):2300. https://doi.org/10.18549/PharmPract.2021.2.2300
21. Hussain N, Said ASA, Khan Z. Influence of Health Literacy on Medication Adherence Among Elderly Females With Type 2 Diabetes in Pakistan. Int Quart Comm Health Edu 2020;41(1):35-44. https://doi.org/10.1177/0272684X19896724
22. Niedling K. & Hämel K. Longing for normalcy in couple relationships: How chronic illness and care dependency change the relationship of long-married couples. Aging Gen Health 2023; 11:17786. https://doi.org/10.3389/fpubh.2023.1117786
23. Galli G, Amici G, Conti L, Lahner E, Annibale B, Carabotti M. Sex-Gender Differences in Adult Coeliac Disease at Diagnosis and Gluten-Free-Diet Follow-Up. Nutrients 2022;14(15):3192. https://doi.org/10.3390/nu14153192
24. Jansson-Knodell C.L., King K.S., Larson J.J., Van Dyke C.T., Murray J.A., Rubio-Tapia A. Gender Based Differences in a Population-Based Cohort with Celiac Disease: More Alike than Unalike. Dig Dis Sci 2018;63:184-92. https://doi.org/10.1007/s10620-017-4835-0
25. Lenti M.V., Di Sabatino A. Disease- and gender-related characteristics of coeliac disease influence diagnostic delay. Eur J Intern Med 2021;83:12-3. https://doi.org/10.1016/j.ejim.2020.09.023
26. Freeman HJ. Olmesartan enteropathy. Inter J Celiac Dis 2016;4:24-6.
27. Hære P, Høie O, Schulz T, Schönhardt I, Raki M, Lundin KE. Long-term mucos al recovery and healing in celiac disease is the rule - not the exception. Scand J Gastroenterol 2016;51:1439-46.
28. Freeman HJ. Mucosal recovery and mucosal healing in biopsy-defined adult celiac disease. Inter J Celiac Dis 2017;5:10-13.
29. Freeman HJ. Dietary compliance in celiac disease. World J Gastroenterol 2017;23(15):2635-9. https://doi.org/10.3748/wjg.v23.i15.2635