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Published on: February 27, 2014
The Dietary Journey in Inflammatory Bowel Disease: A Grounded Theory From Medicalization to Empowerment
Rubina Khullar Mahajan1, Ramit Mahajan2, Ritu Sudhakar3
1Department of Critical Care Medicine, Dayanand Medical College, Ludhiana, Punjab, India.
Background And Aim:
Grounded theory develops theoretical frameworks from systematic analysis of patient experiences. Translational research converts findings into clinical tools. Despite dietary management being crucial in inflammatory bowel disease (IBD), no framework exists for understanding patients' dietary journey phases. We explored how IBD patients psychologically and socially experience dietary changes over time and developed a clinical assessment tool.
Methods:
Using grounded theory methodology with translational tool development, we conducted semi-structured interviews with 25 adult IBD patients (21 ulcerative colitis, 4 Crohn's disease; mean age 38.6 years, 56% male) at a tertiary center in North India. A non-clinical researcher conducted interviews minimizing bias. Data were analyzed using constant comparative analysis with open, axial, and selective coding. Qualitative findings were systematically translated into the IBD Dietary Journey Assessment Tool (IDJAT).
Results:
Three journey phases emerged: (1) medicalization (psychological reconceptualization of food's role)-the transformation of food from nourishment to medicine, with fear-based restrictions and medical dependence for dietary decisions; (2) life disruption and rebuilding-profound emotional and social upheaval requiring adaptation (a psychological adjustment process); (3) empowerment (psychological sense of control and mastery)-understanding triggers, self-management, and helping others. Patients progressed through phases via evolving information navigation and coping (non-linear progression, cycling during flares). The IDJAT comprises quick screening questions, phase identification scales, and phase-specific intervention guidelines.
Conclusions:
This grounded theory study provides the first framework for IBD dietary journey phases. The IDJAT enables clinicians to identify patients' phase and deliver appropriate support, transforming dietary care from generic advice to journey-informed, phase-matched care.
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