The everyday life of adolescent coeliacs: issues of importance for compliance with the gluten-free diet.

BACKGROUND: Noncompliance with the gluten-free diet is often reported among adolescents with coeliac disease. However, knowledge is limited regarding their own perspectives and experiences of managing the disease and the prescription of a gluten-free diet. The aim of this study was to explore how adolescents with coeliac disease perceive and manage their everyday lives in relation to a gluten-free diet. METHODS: In total, 47 adolescents with coeliac disease, divided into 10 focus groups, were interviewed. In the qualitative analysis, themes emerged to illustrate and explain the adolescents' own perspectives on life with a gluten-free diet. RESULTS: The probability of compliance with the gluten-free diet was comprised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of gluten-free food, insufficient social support and their perceived dietary deviance. Three different approaches to the gluten-free diet emerged: compliers, occasional noncompliers, and noncompliers. Each approach, as a coping strategy, was rational in the sense that it represented the adolescents' differing views of everyday life with coeliac disease and a prescription of a gluten-free diet. CONCLUSIONS: dolescents with coeliac disease experience various dilemmas related to the gluten-free diet. The study demonstrated unmet needs and implies empowerment strategies for optimum clinical outcomes.

Food provision and the meal situation in elderly care - outcomes in different social contexts.

BACKGROUND: Nutritional problems concerning older people in care can be affected both by their illness and by the standard procedures surrounding food provision, for example rigid routines of food supply and ritualized mealtime situations. METHOD: The aim was to study how organizational structure and staff members' routines and actions influence activities related to food and meals in different caring context in Sweden. The qualitative methodology chosen for this study was participant observation. RESULT: Care recipients were given different opportunities concerning what, how, when and with whom to eat, depending on where their meals were served. In restaurants, older people could choose from several foods and they could also choose the time of and company for the meal. At care units with 'part-of-day' care or 'around-the-clock' care, food choices, time and company were limited, especially at the units with 'around-the-clock' care, where the most ailing older people lived. CONCLUSIONS: Food provision and the mealtime situation for the elderly are shaped by the individual's living arrangements, and the social organization surrounding it, not determined by the individual's needs and wishes, including social and cultural meanings of food and meals, which could, thereby, affect nutritional intake.