Celiac disease is one of the most prevalent diet-related diseases in adolescents. This study explored the relationship between adherence to gluten-free diet, physical, social, psychological, and management self-care practices and perceived family support in adolescents with celiac disease. A cross-sectional study was conducted in 118 adolescents with celiac disease using Celiac Dietary Adherence Test, Youth Self-Care Practice and Management Questionnaire and Perceived Family Support. Adolescents with celiac disease showed low adherence to gluten-free diet and physical self-care practices. A moderate level of psychological, social and self-care management self-care practices. The perceived family support was high. A positive association was found between adherence gluten-free diet, physical self-care practices, self-care management, family support perceived, celiac disease family history and father profession. The finding highlights the importance of school nursing for promoting health in the educational setting, preventing complications from lack of adherence to a gluten-free diet and encouraging self-care practices.
AguilarE. (2018). Hábitos alimentarios y problemática nutricional en niños con alergia y/o asma en comparación con niños sanos. Tesis doctoral, Universidad Complutense de Madrid. https://hdl.handle.net/20.500.14352/15575
2.
AktaşE. F.Ünlü KaynakçiF. Z. (2025). The adolescent celiac experience: A holistic perspective on self-care among the “invisible” segment of society. Disability and Rehabilitation, 47(23), 1–10. https://doi.org/10.1080/09638288.2025.2496352
3.
BerbigliaV. A.ThuyL. T. (2022). Dorothea E. Orem: Self-care deficit theory of nursing. En AlligoodM. R. (Ed.), Nursing theorists and their work (10th ed., pp. 198–212). Elsevier.
4.
BravoL.KillelaM. K.ReyesB. L.SantosK. M. B.TorresV.HuangC. C.JacobE. (2020). Self-management, self-efficacy, and health-related quality of life in children with chronic illness and medical complexity. Journal of Pediatric Health Care, 34(4), 304–314. https://doi.org/10.1016/j.pedhc.2019.11.009
5.
CadenheadJ. W.WolfR. L.LebwohlB.LeeA. R.ZybertP.ReillyN. R.SchebendachJ.SatherleyR.GreenP. H. R. (2019). Diminished quality of life among adolescents with celiac disease using maladaptive eating behaviours to manage a gluten-free diet: A cross-sectional, mixed-methods study. Journal of Human Nutrition and Dietetics, 32(3), 311–320. https://doi.org/10.1111/jhn.12638
6.
CardoA.ChurrucaI.LasaA.NavarroV.Vázquez-PoloM.Perez-JunkeraG.LarretxiI. (2021). Nutritional imbalances in adult celiac patients following a gluten-free diet. Nutrients, 13(8), 2877. https://doi.org/10.3390/nu13082877
7.
ChecaJ. C.MonserratM.ArjonaÁ (2024). Factor structure and reliability of the youth self-care practice and management questionnaire (PGJ) in a sample of high school students. Revista CENTRA Ciencias Sociales, 3(2), 97–122. https://doi.org/10.54790/rccs.87
8.
ChungS. J.ErsigA. L.McCarthyA. M. (2017). The influence of peers on diet and exercise among adolescents: A systematic review. Journal of Pediatric Nursing, 36, 28888511. https://doi.org/10.1016/j.pedn.2017.04.010
9.
DowneyR. G.KingC. V. (1998). Missing data in Likert ratings: A comparison of replacement methods. The Journal of General Psychology, 125(2), 175–191. https://doi.org/10.1080/00221309809595542
10.
FaulF.ErdfelderE.BuchnerA.LangA.-G. (2009). Statistical power analyses using G*power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
11.
Fueyo-DíazR.Gascón-SantosS.Asensio-MartínezÁSánchez-CalaveraM. A.Magallón-BotayaR. (2016). Transcultural adaptation and validation of the celiac dietary adherence test: A simple questionnaire to measure adherence to a gluten-free diet. Revista Española de Enfermedades Digestivas, 108(3), 138–144. https://doi.org/10.17235/reed.2016.4033/2015
12.
García-HermosoA.EzzatvarY.López-GilJ. F.Ramírez-VélezR.OlloquequiJ.IzquierdoM. (2022). Is adherence to the Mediterranean diet associated with healthy habits and physical fitness? A systematic review and meta-analysis including 565,421 youths. British Journal of Nutrition, 128(7), 1433–1444. https://doi.org/10.1017/S0007114520004894
13.
GranrudM. D.KvarmeL. G.HalvorsenK. (2022). School nurses’ experiences in dealing with adolescents having mental health problems: A qualitative study. The Journal of School Nursing, 38(6), 523–532. https://doi.org/10.1177/10598405211068120
14.
GuedesN. G.SilvaL. A. D.BessaC. C.SantosJ. C. D.SilvaV. M. D.LopesM. V. O. (2020). Anxiety and depression: A study of psychoaffective, family-related, and daily-life factors in celiac individuals. Revista Brasileira de Enfermagem, 73(Suppl 1), e20200086. https://doi.org/10.1590/0034-7167-2020-0086
15.
HoW. H. J.AtkinsonE. L.DavidA. L. (2023). Examining the psychosocial well-being of children and adolescents with coeliac disease: A systematic review. Journal of Pediatric Gastroenterology and Nutrition, 76(1), e1–e14. https://doi.org/10.1097/MPG.0000000000003652
KaskounJ.McCabeE. (2022). Perceptions of school nurses in addressing student mental health concerns: An integrative review. The Journal of School Nursing, 38(1), 35–47. https://doi.org/10.1177/10598405211046223
18.
KiveläL.KurppaK.HuhtalaH.MäkiM.KaukinenK. (2021). Inequalities in access to healthcare among patients with celiac disease. United European Gastroenterology Journal, 9(8), 986–995. https://doi.org/10.1002/ueg2.12152
19.
KoçN.ÖzünÖİBaşaranE. G.ÇalişkanH. A.AyB.ÖzkeçeciC. F.BalamtekinN. (2025). The relationship between diet quality, social participation, quality of life, and occupational balance in adolescents with celiac disease. Journal of Health, Population and Nutrition, 44(1), 1–12. https://doi.org/10.1186/s41043-025-01024-9
20.
KutahyaliogluN. S.AlayG. K. (2024). Lived experiences of parents of children with celiac disease: A descriptive qualitative study. Pediatric Gastroenterology, Hepatology & Nutrition, 27(3), 146. https://doi.org/10.5223/pghn.2024.27.3.146
21.
Lacomba TrejoL.Valero MorenoS.Montoya CastillaI. (2019). Adolescente con diabetes mellitus tipo 1: Problemas emocionales, conductuales y de autoestima. Revista de Psicología de la Salud, 7(1), 22–44. https://doi.org/10.21134/pssa.v7i1.876
22.
LeeA. R.LebwohlB.LebovitsJ.WolfR. L.CiaccioE. J.GreenP. H. R. (2021). Factors associated with maladaptive eating behaviors, social anxiety, and quality of life in adults with celiac disease. Nutrients, 13(12), 4494. https://doi.org/10.3390/nu13124494
23.
LionettiE.AntonucciM.MarinelliM.BartoliF.FranceschiniC.GattiR.CrinòA. C.GuidaL.LioneM. E.Naspi CatassiS.Gonnelli-NaspiA.ColantuonoF.CatassiC. (2020). Nutritional status, dietary intake, and adherence to the Mediterranean diet of children with celiac disease on a gluten-free diet: A case–control study. Nutrients, 12(1), 143. https://doi.org/10.3390/nu12010143
MacedoL.CatarinoM.FestasC.AlvesP. (2024). Vulnerability in children with celiac disease: Findings from a scoping review. Children, 11(6), 729. https://doi.org/10.3390/children11060729
26.
MakhariaG. K.SinghP.CatassiC.SandersD. S.LefflerD.Raja AliR. A.BaiJ. C. (2022). The global burden of coeliac disease: Opportunities and challenges. Nature Reviews Gastroenterology & Hepatology, 19(5), 313–327. https://doi.org/10.1038/s41575-021-00552-z
27.
MiróM.Alonso-GarridoM.LozanoM.ManyesL. (2020). Estudios clínicos sobre la enfermedad celíaca (2014–2019): Revisión sistemática de la prevalencia de la presentación clínica y enfermedades asociadas por edades. Revista Española de Nutrición Humana y Dietética, 24(3), 234–246. https://doi.org/10.14306/renhyd.24.3.998
28.
Monserrat-HernándezM.Checa-OlmosJ. C.GarridoÁ. A.Galera-MartínezR. (2024). Comparison of self-care practices and BMI between celiac and non-celiac adolescent populations. Healthcare, 12(17), 1796–1814. https://doi.org/10.3390/healthcare12171796
29.
Monserrat-HernándezM.Jiménez-RodríguezD. (2024). Relationship of genetic polymorphisms and microbial composition with binge eating disorder: A systematic review. Healthcare, 12(14), 1441–1458. https://doi.org/10.3390/healthcare12141441
30.
MouslihA.El AbkariM.El Alaoui-FarisM.El AbkariM. (2023). Gluten-free diet compliance in children with celiac disease and associated factors: A retrospective cohort study. Cureus, 15(1), e50217. https://doi.org/10.7759/cureus.50217
31.
MozzilloE.MariglianoM.CuccurulloI.BerchielliF.AuricchioR.MaffeisC.RosanioF. M.IafuscoD.PedrolliC.PertileR.DelvecchioM.PassanisiS.SalzanoG.Di CandiaF.FranceschiR. (2024). Maintaining the gluten-free diet: The key to improve glycemic metrics in youths with type 1 diabetes and celiac disease. Diabetes Research and Clinical Practice, 207, 111074. https://doi.org/10.1016/j.diabres.2023.111074
Neumark-SztainerD. (2020). Project EAT: Eating and activity among teens and young adults. University of Minnesota. Retrieved February 14, 2025, from https://www.sph.umn.edu/research/project-eat/
34.
OremD. E. (1999). Nursing: Concepts of practice (5th ed.). Mosby.
35.
PawilsS.HeumannS.SchneiderS. A.MetznerF.MaysD. (2023). The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews. PLoS One, 18(2), e0275724. https://doi.org/10.1371/journal.pone.0275724
36.
PittA.LerigoF.SatherleyR. M. (2024). Health-related stigma and challenges faced by men living with celiac disease: A qualitative analysis. Journal of the Academy of Nutrition and Dietetics, 124(6), 674–685. https://doi.org/10.1016/j.jand.2023.11.018
37.
Quiroz FigueroaM. S.Gómez AndradeA. S.García VillavicencioC. A.Fonseca RamírezA. N.JiménezR. Y.Litardo LucasA. D. (2024). Prácticas de autocuidado en adolescentes y su influencia emocional. Ciencia Latina: Revista Científica Multidisciplinar, 8(1), 4220–4233. https://doi.org/10.37811/cl_rcm.v8i1.9768
38.
RashidM.CranneyA.ZarkadasM.GrahamI. D.SwitzerC.CaseS.WarrenR. E. (2023). Gluten-free diet knowledge and adherence in adolescents with celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 76(2), 230–235. https://doi.org/10.1097/MPG.0000000000003650
39.
Real PérezM. C.López AlonsoS. R. (2017). Influencia de los factores psicosociales en adolescentes con diabetes mellitus tipo I. Cultura de los Cuidados, 21(48), 190–198. https://doi.org/10.14198/cuid.2017.48.21
40.
RimárovaK.DorkoE.DiabelkováJ.SulinováZ.BakováP.UhrinT.JencaA.JencováJ.PetrásováA.JencaA.JenkaJ. (2018). Compliance with gluten-free diet in a selected group of celiac children in the Slovak Republic. Central European Journal of Public Health, 26(supplement), s19–s24. https://doi.org/10.21101/cejph.a5369
41.
RohnerR. P. (2021). Introduction to interpersonal acceptance-rejection theory (IPARTheory) and evidence. Online Readings in Psychology and Culture, 6(1), 4–65. https://doi.org/10.9707/2307-0919.1055
42.
RussoC.WolfR. L.LeichterH. J.LeeA. R.ReillyN. R.ZybertP.GreenP. H. R.LebwohlB. (2020). Impact of a child's celiac disease diagnosis and management on the family. Digestive Diseases and Sciences, 65(10), 2959–2969. https://doi.org/10.1007/s10620-020-06316-0
43.
SahinÖOTasdelenY.KutahyaliogluN. S.GuneyE. U.OzerK. (2024). School experiences in the disease management of children with celiac disease: A qualitative study. Child: Care, Health and Development, 50(6), e70010. https://doi.org/10.1111/cch.13010
44.
SahinY. (2021). Celiac disease in children: A review of the literature. World Journal of Clinical Pediatrics, 10(4), 53–71. https://doi.org/10.5409/wjcp.v10.i4.53
45.
SainsburyK.MullanB. (2016). Coeliac disease and the gluten-free diet: A review of the burdens; factors associated with adherence and impact on health-related quality of life. Appetite, 107(1), 654–666. https://doi.org/10.1016/j.appet.2016.08.019
46.
SeeJ. A.KaukinenK.MakhariaG. J.GibsonP. R.MurrayJ. A. (2020). Practical insights into gluten-free diets. Nature Reviews Gastroenterology & Hepatology, 17(2), 112–122. https://doi.org/10.1038/s41575-019-0244-5
47.
ShahE. N.SzwedoD. E.AllenJ. P. (2024). Adolescent close friendships, self-perceived social acceptance, and peer-rated likeability as predictors of wellbeing in young adulthood. Frontiers in Developmental Psychology, 11(2), 1435727. https://doi.org/10.3389/fdpys.2024.1435727
48.
SilvesterJ. A.KuradaS.SzwajcerA.KellyC. P.LefflerD. A.DuerksenD. R. (2017). Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: A meta-analysis. Gastroenterology, 153(3), 689–701.e1. https://doi.org/10.1053/j.gastro.2017.05.015
49.
SimónE.Molero-LuisM.Fueyo-DíazR.Costas-BatlleC.Crespo-EscobarP.Montoro-HuguetM. A. (2023). The gluten-free diet for celiac disease: Critical insights to better understand clinical outcomes. Nutrients, 15(18), 4013. https://doi.org/10.3390/nu15184013
50.
SmithM. M.UrrutiaR.BetzW. J. (2020). Family dynamics and celiac disease: The role of parental support in adolescent adherence to a gluten-free diet. Journal of Family Psychology, 34(5), 567–576. https://doi.org/10.1037/fam0000632
51.
SokolR. L.CliftJ.MartínezJ. J.GoodwinB.RusnakC.GarzaL. (2022). Concordance in adolescent and caregiver report of social determinants of health. American Journal of Preventive Medicine, 63(5), 708–716. https://doi.org/10.1016/j.amepre.2022.06.004
52.
StahlM.LiQ.LynchK.KoletzkoS.MehtaP.GragertL.NorrisJ. M.Andrén AronssonC.LindforsK.KurppaK.IlonenJ.KrischerJ.AkolkarB.ZieglerA. G.ToppariJ.RewersM. J.AgardhD.HagopianW.LiuE., & TEDDY Study Group. (2023). Incidence of pediatric celiac disease varies by region. The American Journal of Gastroenterology, 118(3), 539–545. https://doi.org/10.14309/ajg.0000000000002056
53.
Taşdelen BaşM.ÇavuşoğluH. (2020). Evaluation of daily lives of children and adolescents with celiac disease and nursing approaches. Gastroenterology Nursing, 43(6), 202–213. https://doi.org/10.1097/SGA.0000000000000509
54.
ThomasC. S.NielsenT. K.BestN. C. (2025). A rapid review of mental health training programs for school nurses. Journal of School Nursing, 41(1), 158–171. https://doi.org/10.1177/10598405241277798
55.
ThompsonK.LeeA. R.GraceT. (2021). The impact of celiac disease on family functioning and the importance of family support. Journal of Pediatric Nursing, 58, 17–23. https://doi.org/10.1016/j.pedn.2020.11.007
56.
Trejos-HerreraA. M.BahamónM. J.Alarcón-VásquezY.VélezJ. I.VinacciaS. (2018). Validity and reliability of the multidimensional scale of perceived social support in Colombian adolescents. Psychosocial Intervention, 27(1), 56–63. https://doi.org/10.5093/pi2018a1
57.
ViolatoM.GrayA. (2019). The impact of diagnosis on health-related quality of life in people with coeliac disease: A UK population-based longitudinal perspective. BMC Gastroenterology, 19(1), 68. https://doi.org/10.1186/s12876-019-0980-6
58.
von ElmE.AltmanD. G.EggerM.PocockS. J.GøtzscheP. C.VandenbrouckeJ. P., & STROBE Initiative. (2014). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. International Journal of Surgery, 12(12), 1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013
59.
VychováH. (2024). The cost of coeliac condition: Economic availability of gluten-free foods for patients with celiac disease in the Czech Republic. British Food Journal, 126(12), 588–600. https://doi.org/10.1108/BFJ-04-2024-039
60.
WangX.AndersS.JiangZ.BruceM.GidrewiczD.MarconM.TurnerJ. M.MagerD. R. (2024). Food insecurity impacts diet quality and adherence to the gluten-free diet in youth with celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 79(6), 1180–1191. https://doi.org/10.1002/jpn3.12398
61.
WesselsM. M. S.DolinsekJ.CastillejoG.VriezingaS. L.van VeenI. I.VenterC.VeenvlietA. R. G.AuricchioR.BraviE.BuderusS.ChongS. Y.CroftN. M.DiasJ. A.DolinsekJ.GillettP. M.HauerA. C.HomanM.HorvathA.HusbyS.MearinM. L. (2022). Follow-up practices for children and adolescents with celiac disease: Results of an international survey. European Journal of Pediatrics, 181(3), 1213–1220. https://doi.org/10.1007/s00431-021-04318-2
62.
WilsonN.SingerS. A.SiegelR. M. (2022). Parental influence on dietary adherence among adolescents with celiac disease. Journal of Pediatric Gastroenterology and Nutrition, 75(2), 234–239. https://doi.org/10.1097/MPG.0000000000003456
63.
ZimetG. D.DahlemN. W.ZimetS. G.FarleyG. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
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