Abstract
BackgroundA 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.MethodsIn 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.ResultsThe 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).ConclusionsThe 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.
Highlights
A gluten-free diet (GFD) is the only effective treatment for celiac patients and assessing adherence to this diet is important
The result of a systematic review showed that adherence to the GFD was low and it ranged from 42 to 91% depending on the definition and method of assessment [9]
Considering the approved validity of the Celiac disease Adherence Test (CDAT) questionnaire for use in the evaluation of adherence to GFD [11], in the present study, it was aimed to translate the CDAT questionnaire in Persian and evaluate its validity and reliability
Summary
A gluten-free diet (GFD) is the only effective treatment for celiac patients and assessing adherence to this diet is important. Assessing adherence to a GFD is methodologically challenging Different methods such as clinician evaluation, serology tests, or endoscopy with duodenal biopsy histology are used to define the level of non-adherence to the GFD [10]. These tests have limitations such as inadequate accuracy, low sensitivity, high cost, and invasiveness. Leffler et al developed a Celiac Dietary Adherence Test (CDAT) which is the fast, and sensitive method of assessing the adherence to the GFD [11] This questionnaire has seven items, easy to administer and the validity and reliability of the English version were confirmed [11]. It was used in different studies [12,13,14] and it has been translated into the Spanish language with appropriate psychometric properties [15]
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