Investigating barriers to celiac disease diagnosis and patient wellbeing in the U.S. : a comparative study of the United States and Italy
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This study compared awareness of and attitudes toward celiac disease (CD) among American and Italian medical professionals, patients, and the general public in order to better understand and identify barriers to celiac disease diagnosis and patient wellbeing in the United States. Although the U.S. prevalence of the disease is somewhat higher than in Italy, the rate of diagnosis in the United States is significantly lower. One of the biggest differences between the two countries is awareness level (Guandalini, 2012 & Fasano, 2001). Factors that impact awareness are an important topic for study because of the strong relationship between awareness level and successful celiac disease diagnosis. Untreated celiac disease is associated with reduced quality of life and increased healthcare costs (Biagi, 2010 & Hershcovici, 2010). In addition, screening for celiac disease is inexpensive and reliable treatment is readily available (Reddick, 2006). The main issue in the United States in underdiagnosing celiac disease is awareness of medical professionals and the public. The topic of how awareness level as well as social and medical support systems affect celiac disease diagnosis and wellbeing of patients with celiac disease in the United States and Italy was investigated by interviewing patients and celiac disease professionals from the two countries and comparing their perspectives. Data were also collected through social observation, visiting stores and restaurants that provided gluten-free products, and comparing information provided by awareness organizations from each country. Lack of awareness among both patients and medical professionals, the social environment surrounding celiac patients, and a lack of governmental regulation for the gluten-free food industry all proved to be significant barriers to patients with celiac disease in the United States. Fully identifying these barriers is the first step to addressing the issue of celiac under-diagnosis in the U.S. and will facilitate the development of more effective and efficient solutions.