More than just a diet: occupational performance and participation challenges in university students with celiac disease

Abstract

Introduction: Celiac disease (CeD) necessitates lifelong adherence to a gluten-free diet, which can affect daily occupations beyond dietary habits. These challenges extend to both occupational performance (task execution) and occupational participation (involvement in life situations), particularly in socially embedded contexts. Despite this, the occupational performance and participation experiences of university students with celiac disease are underrepresented in occupational therapy literature. Objectives: To explore the occupational performance and participation challenges experienced by university students with CeD, with particular attention to the relationship between performance, satisfaction, and participation restrictions. Method: Nine university students diagnosed with CeD and without other chronic nutrition-related conditions participated voluntarily. The Canadian Occupational Performance Measure (COPM) was used to identify perceived difficulties in self-care, productivity, and leisure. Participants rated their performance and satisfaction with their most prioritized activities. Performance–satisfaction discrepancies were also calculated to better understand perceived occupational challenges. Results: Findings revealed that occupational challenges were evident across all domains, with leisure being the most frequently affected in terms of participation restrictions, particularly in social activities such as dining out and attending gatherings. Productivity showed the largest discrepancy between performance and satisfaction, indicating unmet expectations in academic and daily role responsibilities. Self-care issues such as managing finances and transporting gluten-free food also emerged, though with relatively lower discrepancy levels. While individuals may maintain performance in certain tasks, participation is more substantially constrained by environmental and social factors. Conclusion: Interventions should particularly target domains with higher performance–satisfaction discrepancies and support engagement in socially meaningful occupations. Supporting university students with CeD through tailored occupational therapy may enhance their daily functioning and participation.