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Knowledge and Perceptions of a Gluten-Free Diet: a Mixed-Methods Approach

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Knowledge and Perceptions of a Gluten-Free Diet: a Mixed-Methods Approach Knowledge and Perceptions of a Gluten-Free Diet: A Mixed-Methods Approach A thesis presented to the faculty of the College of Health Sciences and Professions of Ohio University In partial fulfillment of the requirements for the degree Master of Science Hannah E. Johnson August 2017 © 2017 Hannah E. Johnson. All Rights Reserved. 2 This thesis titled Knowledge and Perceptions of a Gluten-Free Diet: A Mixed-Methods Approach by HANNAH E. JOHNSON has been approved for the School of Applied Health Sciences and Wellness and the College of Health Sciences and Professions by Robert G. Brannan Associate Professor of Food and Nutrition Sciences Randy Leite Dean, College of Health Sciences and Professions 3 Abstract JOHNSON, HANNAH E., M.S., August 2017, Food and Nutrition Sciences Knowledge and Perceptions of a Gluten-Free Diet: A Mixed-Methods Approach Director of Thesis: Robert G. Brannan The practice of gluten-free diets is on the rise, yet many people are still unaware of what gluten is and how it functions in food. It is important that food and nutrition professionals are knowledgeable on this topic due to the prevalence of gluten-related disorders and the popularity of gluten-free as a fad diet. The purpose of this research was to use a mixed methods approach using qualitative and quantitative methods to obtain and evaluate knowledge and perceptions of a gluten-free diet from future and current food and nutrition professionals. In the first phase of the research, a laboratory questionnaire was administered to assess students enrolled in the Food Science course on their knowledge of gluten. Concurrently, focus groups on the topic of gluten-free, consisting of former Food Science students, faculty, and/or other nutrition professionals were conducted. Thematic analysis was used to determine key concepts generated from the focus groups, and to foster the formation of a second questionnaire. The questionnaire was distributed to Registered Dietitians (RDs) to assess their knowledge and attitudes towards the gluten-free diet. A representative sample obtained from the Commission on Dietetic Registration of 516 RDs across the United States completed the questionnaire on gluten and a gluten-free diet. Over 18% of respondents incorrectly identified gluten as a carbohydrate. Additionally, less than 80% of RDs correctly identified the presence or absence of gluten in semolina, spelt, kamut, and buckwheat. Regarding perceptions of a 4 gluten-free diet, participants reported that the public is not aware of what gluten is, a gluten-free diet is not appropriate for the general public or for weight loss, and the gluten- free diet is a fad when used outside of celiac disease and nonceliac gluten sensitivity. Results of this research have determined that there is a need for further education about sources of gluten, labeling, and gluten-related disorders among future and current Registered Dietitians. 5 Preface Chapters 3 and 4 contained within the thesis document serve as prepublication manuscripts. These manuscripts have been formatted to meet the guidelines set forth by Thesis and Dissertation Services at Ohio University. The style adhered to the APA Publication Manual; otherwise the abstract style and the content of headings conformed to the Journal of the Academy of Nutrition and Dietetics and the Journal of Food Science Education in chapters 3 and 4, respectively. 6 Dedication I would like to dedicate this to my family and friends who supported me through this endeavor. 7 Acknowledgments I would like to thank everyone that helped in the completion of this research. To Dr. Robert Brannan, thank you for all of your hard work and dedication for this research. Your insight and guidance allowed me to completed research that I am truly proud of. Thank you to Dr. Elizabeth Beverly and Ms. Deborah Murray for being a part of my thesis committee. Your feedback has been incredibly helpful throughout the past two years. Dr. Elizabeth Beverly, your experience in qualitative research was exceptionally invaluable when working on my focus groups and questionnaires. Deborah Murray, your experience as a Registered Dietitian was instrumental in determining how to assess a large sample of Registered Dietitians. 8 Table of Contents Page Abstract ................................................................................................................................ 3 Dedication ............................................................................................................................ 6 Acknowledgments ............................................................................................................... 7 List of Tables ..................................................................................................................... 11 List of Figures .................................................................................................................... 13 Chapter 1: Introduction ...................................................................................................... 14 Statement of the Problem .............................................................................................. 15 Objectives ...................................................................................................................... 16 Research Questions ....................................................................................................... 16 Significance ................................................................................................................... 16 Limitations and Delimitations ....................................................................................... 17 Chapter 2: Literature Review ............................................................................................ 18 Cereals ........................................................................................................................... 18 Gluten ............................................................................................................................ 18 Function of gluten. ..................................................................................................... 21 Gluten-free products. ................................................................................................. 23 Labeling. .................................................................................................................... 27 Gluten-Related Disorders .............................................................................................. 29 Celiac disease. ........................................................................................................... 29 Nonceliac gluten sensitivity. ...................................................................................... 35 9 Wheat allergy. ............................................................................................................ 37 Gluten-Free Diet ............................................................................................................ 40 Chapter 3: Knowledge and Perceptions of a Gluten-Free Diet: A Mixed Methods Approach ........................................................................................................................... 44 Abstract .......................................................................................................................... 44 Introduction ................................................................................................................... 45 Materials and Methods .................................................................................................. 47 Focus groups. ............................................................................................................. 47 Questionnaire. ............................................................................................................ 48 Results and Discussion .................................................................................................. 50 Focus groups. ............................................................................................................. 50 Questionnaire. ............................................................................................................ 55 Relevance to Ohio. .................................................................................................... 68 Conclusions ................................................................................................................... 68 References ..................................................................................................................... 70 Chapter 4: Does a Hands-On Laboratory on the Topic of Gluten-Free Baking Increase Knowledge of Gluten in Foods? ........................................................................................ 83 Abstract .......................................................................................................................... 83 Introduction ................................................................................................................... 84 Materials and Methods .................................................................................................. 86 Questionnaire. ............................................................................................................ 86 Data analysis. ............................................................................................................. 88 10 Results
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