Evidence suggests that compliance is related to knowledge of coeliac disease (Silvester & Rashid, 2007) as it places the onus on the individual to self-manage their coeliac disease and encourage adherence to the gluten-free diet. Structured advice on the gluten-free diet should be provided in line with the CREST, 2006, guidelines (see 'Providing Effective Education on the Gluten-Free Diet') with particular emphasis on ensuring that a strict, well-balanced gluten-free diet is followed, as well as the consequences of non-compliance with the gluten-free diet.

It is essential that patients understand that ingestion of gluten will cause damage to the intestinal mucosa, even if symptoms are not present. Coeliacs who understand the effects of gluten exposure appear to be more compliant with the gluten-free diet (Leffler, 2008). Regular follow-up is essential to achieve long-term compliance with the gluten-free diet as even experienced coeliac patients may inadvertently consume gluten. CREST guidelines recommend dietetic review bi-annually or annually for all coeliac patients. This regular nutritional counselling provides an opportunity to reinforce the need for adherence to the gluten-free diet and re-educate on foods to avoid (Pietzak, 2005).

Membership of coeliac support groups appears to be beneficial to those with coeliac disease and is a good source of information for coeliacs. One study found that coeliacs who were members of a coeliac support group were more compliant with the gluten-free diet than those who were not members (Leffler, 2008). Therefore, membership of the Coeliac Society of Ireland should be recommended to all coeliacs.

Specific issues identified as barriers to compliance by coeliacs should be addressed. Issues relating to poor palatability, poor labelling and poor variety of gluten-free foods may be improved by membership of the Coeliac Society of Ireland, as this provides a copy of the Food List which will identify the majority of gluten-free foods on the market. Members also gain access to a ‘Coeliac Friendly Restaurant List’ which will help with problems experienced when eating out. The Recipes section of this website provides a guide to gluten-free cooking which may provide variety to the diet and relieve reliance on packaged foods.

Cost has been outlined as barrier to compliance by coeliacs. Gluten-free foods are more expensive than their gluten-containing counterparts. However, in response to this there is some financial aid available to people with coeliac disease; see the Financial Support section of this website for information on the tax relief, the Drugs Payment Scheme, Medical Card entitlements and the Diet Supplement.