De-medicalising gluten-free products through a subsidy card scheme: a qualitative study of service users

IntroductionCoeliac disease requires a strict gluten-free diet to prevent complications. In the late 1960s, Gluten free foods (GFF) became available on prescription to support adherence when these foods were scarce in shops. Today, gluten-free foods are more accessible in large supermarkets, making it easier for patients to obtain them without prescriptions. In 2019, Hywel Dda University Health Board introduced the GFF subsidy card as an alternative to prescriptions, a method still used by other health boards in Wales. AimsThis study aimed to explore individuals perspectives on a new subsidy card scheme for GFF, identify key barriers and facilitators, and provide recommendations to enhance the schemes implementation and effectiveness. MethodA qualitative approach was employed, involving in-depth interviews with coeliac patients and parents of coeliac children. Participants included current users of the subsidy card, those relying on prescriptions, and individuals who opted out of the card scheme. ResultsParticipants using the subsidy card valued its flexibility, variety of products, and convenience over the prescription system. Challenges included managing card balances, limited retailer acceptance, and geographical disparities. Non-users appreciated the potential for increased choice and mostly showed interest in switching but some raised concerns about inflation, misuse, and the additional burden on taxpayers. ConclusionMost participants view the subsidy card as an acceptable alternative to GFF prescriptions. To improve the subsidy card uptake, recommendations include enhancing digital tools for balance management, card value reviews, expanding retailer partnerships, promoting safer food practices, targeted communication, and ensuring prescription continuity for those who prefer it. These measures can optimize the schemes impact and better support individuals with coeliac disease.