The affordability and obtainability of gluten-free foods for adults with coeliac disease following their withdrawal on prescription in England: A qualitative study

BackgroundChanges to prescribing policies in England have restricted or stopped access to gluten-free food on prescription for people with coeliac disease in some geographical areas. The present study aimed to explore the impact of these changes on the affordability and obtainability of gluten-free foods for adults with coeliac disease.MethodsSemi-structured qualitative interviews (n = 24) were conducted with people with coeliac disease living in areas where prescriptions for gluten-free foods were no longer available, were restricted or followed national guidelines. Interviews explored the impact of gluten-free prescribing changes on the affordability and obtainability of gluten-free food, as well as dietary adherence.ResultsAll participants considered gluten-free substitute foods to be expensive. Participants felt the availability of gluten-free foods has improved over time, also acknowledging some challenges remain, such as limited local availability. For most, the withdrawal of prescriptions had minimal impact requiring small adjustments such as reducing the quantity of foods obtained. However, greater challenges were faced by those less mobile, permanently sick or disabled and/or on lower incomes.ConclusionsThe majority of participants affected by the withdrawal of prescriptions were able to adapt to cope with these changes. However, participants with mobility issues, who are permanently sick or disabled and/or on lower incomes were struggling to afford and obtain gluten-free substitute foods from elsewhere. The withdrawal of prescriptions may further widen health inequalities. Further research should focus on the long-term impacts of prescription withdrawal for the vulnerable groups identified. Changes to prescribing policies in parts of England mean that some adults with coeliac disease no longer have access to prescriptions for gluten-free substitute foods. Although the majority were able to adapt to these changes, some groups were struggling to afford and obtain gluten-free foods from elsewhere.image Prescriptions for gluten-free substitute foods have been restricted or withdrawn in some areas of England, but the impact of these changes on people with coeliac disease is unknown.The present study found that the majority of people with coeliac disease were able to adapt to cope with prescribing changes, but certain groups (people with mobility issues, who are permanently sick or disabled and/or on lower incomes) were struggling to afford and obtain gluten-free foods.Future research should focus on the longer-term impacts of no access or restricted access to gluten-free substitute foods on prescription, with specific focus on the groups identified above.