Melissa Smith

Defense Date


Graduation Date



Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Linda Goodfellow

Committee Member

Luann Richardson

Committee Member

Michael M. Van Ness


celiac disease, gluten free, coping, stress, quality of life


Until recently, celiac disease was thought to be rare in the United States. However over the past ten years, the reported prevalence has increased from 1 in 4600 persons to 1 in 133 persons. The latest estimate makes the prevalence comparable to the prevalence in Europe, where the disease is considered to be common.

Celiac disease is a chronic illness occurring in genetically susceptible persons resulting in inflammatory changes in the upper small bowel as a consequence of intolerance to the gliadin in ingested wheat, rye, and barley. Fortunately, celiac disease can be effectively managed by strict adherence to a gluten free diet. However, dietary management can be quite challenging.

The present descriptive, correlational research study included 156 adults self-reporting a diagnosis of celiac disease. The purpose of this study was to examine factors and perceived causes that interfere with adherence to a gluten free diet, to identify coping strategies, and to examine the relationship between coping strategies and quality of life. The theoretical framework was a combination of two theoretical models: 1) Lazarus model of stress and 2) the model of behavioral self-regulation by Carver and Sheier. Instruments used were the Demographic Information and Health and Diet History Questionnaire, the Psychological General Well-Being Index, and the Brief COPE.

Results from the study indicated that problems outside the home, especially in restaurants and the expense of gluten free foods are factors that interfere with dietary adherence. A moderate negative relationship was found between quality of life and stress with 54 percent of participants reporting a minimal amount of stress. Emotion focused coping was found to have a negative effect on quality of life.

Recommendations based on research findings suggest further investigation of the negative relationship between quality of life and stress with a more controlled sample. Nurses can also investigate the use of cognitive-behavioral interventions to decrease the negative effects of emotion focused coping.