Individual and Social Influences on College Student Compliance with a Gluten-Free Diet

The objective of this study was to examine individual and social influences on college student compliance with a gluten-free diet. Individual semi-structured interviews were conducted in 2016-2017 with undergraduates (n=24) at a large public university. Eligible participants were 18-25 years old with self-reported physician-diagnosed celiac disease. The interview question path was based on the Health Belief Model and assessed individual and social influences on eating choices. Transcribed interviews were independently coded by three researchers (ICR=.82) then analyzed for themes using the Health Belief Model as a guiding framework. Barriers to complying with a gluten-free diet included the college meal plan, meal planning and cooking skills, negotiating social interactions around food, financial burden of purchasing gluten-free food, and intentionally eating gluten as self-confidence grew. Students often reframed non-compliance as a “cheat day,” discussing it as they would a reduced-calorie diet, which could reduce perceived threat. Providers discussed threats to health in terms of long-term outcomes but students focused on the immediate impact of eating gluten. Nutritionists, parents, and health care providers can better prepare college students for the transition to independent food choices and how to remain compliant with a gluten-free diet within the challenging college food environment.