Psychometric properties of the Persian version of the celiac disease adherence test questionnaire

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Abstract

Background

A gluten-free diet (GFD) is the only effective treatment for celiac patients and assessing adherence to this diet is important. Celiac disease Adherence Test (CDAT) is a valid English-language questionnaire that is used for assessing the adherence to the GFD. In the present study, we aimed to translate the CDAT questionnaire in Persian and evaluate its validity and reliability.

Methods

In the present cross-sectional study, CDAT was translated and back-translated by three bilingual professional translators. Content validity was evaluated by 12 gastroenterologists and nutritionists. To assess the construct validity, 230 patients with celiac disease were randomly selected from the national celiac disease registry database. Internal consistency of the items and test-retest reliability were assessed by Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). To assess the convergent validity of the questionnaire, the correlation coefficient between the CDAT score and anti-tissue transglutaminase immunoglobulin A (anti-t-TG-IgA) titer was assessed.

Results

The content validity index, content validity ratio, and impact score of the Persian version of CDAT (Pv-CDAT) were 0.97, 0.95, and 4.61 respectively. Three significant factors were extracted and according to the confirmatory factor analysis the three-factor model had adequate fitness (chi-square p-value of 0.74, root mean error of approximation: 0.001 [95% CI: 0.001–0.083], comparative fit index: 1, standardized root mean squared residual: 0.04, and coefficient of determination: 0.78). The questionnaire had good feasibility with the floor effect of 3.1% and the ceiling effect of 0.4%. Moreover, it has high internal consistency (Cronbach-alpha: 0.71) and test-retest reliability (ICC: 0.78). The correlations between CDAT categories and anti-tTG-IgA categories showed a significant correlation between the two tests ( r = 0.53; P < 0.001).

Conclusions

The results of the present study showed that the Pv-CDAT questionnaire with high validity, reliability, and internal consistency can be used for assessing adherence to the GFD in adult celiac patients in Iran.

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Most cited references 13

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Factors Associated with Dietary Adherence in Celiac Disease: A Nationwide Study

Kalle Kurppa, Olli Lauronen, Pekka Collin … (2013)

Aims: Diagnostics and follow-up of celiac disease have gradually shifted from tertiary centers to secondary and primary health care. In order to establish whether this has affected the success of treatment, and to identify predictors for dietary non-adherence, we carried out a study in a nationwide cohort of treated celiac patients. Patients and Methods: 843 biopsy-proven patients, 94 children and 749 adults, were enrolled and interviewed. Adherence to a gluten-free diet was determined by means of an interview and serological testing. Results: Altogether, 88% were on a strict gluten-free diet; the rest had occasional dietary transgressions. Younger age at diagnosis, being currently a teenager, and current symptoms were associated with non-adherence. There was no association between non-adherence and place of diagnosis, gender, disease phenotype or severity of symptoms before diagnosis, presence of comorbidities, family history of celiac disease, smoking, duration of diet, use of oats, self-efficacy for the diet or lack of follow-up. Conclusions: Good dietary adherence can be achieved also in patients diagnosed and followed in primary health care. In a country with a high prevalence and good general knowledge of celiac disease, only age at diagnosis and age at present would appear to be major determinants for adherence.

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Advances in celiac disease and gluten-free diet.

Mary Niewinski (2008)

Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals. Screening studies have revealed that celiac disease is most common in asymptomatic adults in the United States. Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a strict gluten-free diet is the only treatment for celiac disease to date. Early diagnosis and treatment, together with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life. The purpose of this review is to provide clinicians with current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance of intense expert dietary counseling for all patients with celiac disease. Recent advances in the gluten-free diet include food allergen labeling as well as the US Food and Drug Administration's proposed definition of the food-labeling term gluten-free. The gluten-free diet is complex and patients need comprehensive nutrition education from a skilled dietitian.

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A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease.

Carolina P Bianchi, Catherine Klersy, Alida Andrealli … (2009)

A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no straightforward and non-subjective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0-IV). To verify whether our questionnaire is an efficient tool, we applied it to 168 coeliac patients (126 females and 42 males; mean age 42.4 (SD 12.9) years) on a gluten-free diet (median 82, 25th-75th percentile 50-108, range 15-389 months). The score we obtained was compared with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet.

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Author and article information

Contributors

Masood Shirmohammadi: drmasood.shirmohammadi@gmail.com

Journal

Journal ID (nlm-ta): BMC Gastroenterol

Journal ID (iso-abbrev): BMC Gastroenterol

Title: BMC Gastroenterology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-230X

Publication date (Electronic): 29 July 2020

Publication date PMC-release: 29 July 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 247

Affiliations

[1 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Liver and gastrointestinal diseases research center, , Tabriz University of medical sciences, ; Tabriz, Iran

[2 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Road Traffic Injury Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, , Tabriz University of Medical Sciences, ; Tabriz, Iran

[3 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Medical Education Research Centre, Health Management and Safety Promotion Research Institute, , Tabriz University of Medical Sciences, ; Tabriz, Iran

[4 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Student research committee, , Tabriz University of medical sciences, ; Tabriz, Iran

Article

Publisher ID: 1396

DOI: 10.1186/s12876-020-01396-8

PMC ID: 7389158

SO-VID: c80df8e1-8819-4e5d-826e-778dfb910f02

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 March 2020

Date accepted : 22 July 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100010216, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences;

Award ID: 62026

Award Recipient : Zeinab Nikniaz

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: celiac disease,gluten-free diet,adherence,cdat,validation,persian

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: celiac disease, gluten-free diet, adherence, cdat, validation, persian

Psychometric properties of the Persian version of the celiac disease adherence test questionnaire

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Karger: Gastroenterology

Most cited references 13

Factors Associated with Dietary Adherence in Celiac Disease: A Nationwide Study

Advances in celiac disease and gluten-free diet.

A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease.

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