title: Transcultural adaptation and validation of the Celiac Dietary Adherence Test. A simple questionnaire to measure adherence to a gluten-free diet.
abstract: OBJECTIVE
  A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler's Celiac Dietary Adherence Test.
  
  
  METHODS
  A two-stage observational transversal study: translation and back translation by four qualified translators followed by a validation stage in which the questionnaire was administered to 306 celiac disease patients aged between 12 and 72 years and resident in Aragon. Factorial structure, criteria validity and internal consistency were evaluated.
  
  
  RESULTS
  The Spanish version maintained the 7 items in a 3-factor structure. Reliability was very high in all the questions answered and the floor and ceiling effects were very low (4.3% and 1%, respectively). The Spearman correlation with the self-efficacy and life quality scales and the self-informed question were statistically significant (p < 0.01). According to the questionnaire criteria, adherence was 72.3%.
  
  
  CONCLUSIONS
  The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments.
authors.affiliation: Departamento de Medicina, Psiquiatría y Dermatolog, Universidad de Zaragoza, España.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fueyo-Díaz
authors.affiliation: Departamento de Sociología y Psicología, Universidad de Zaragoza, España.
authors.forename: Santiago
authors.initials: S
authors.lastname: Gascón-Santos
authors.affiliation: Departamento de Sociología y Psicología, Universidad de Zaragoza, España.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Asensio-Martínez
authors.affiliation: Departamento de Medicina, Psiquiatría y Dermatolog, Universidad de Zaragoza, España.
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Sánchez-Calavera
authors.affiliation: Departamento de Medicina, Psiquiatría y Dermatolog, Universidad de Zaragoza, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Magallón-Botaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000178:diet therapy*; D002648:Child; D003469:Culture; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D013030:Spain; D011795:Surveys and Questionnaires; D014177:Translations; D055815:Young Adult