Patients’ views on a subsidy card model for gluten-free food access: a qualitative study

Sha’aban, Abubakar ORCID: https://orcid.org/0000-0002-5491-9851, Mazzaschi, Francesca, Doe, Elizabeth, Ingram, Beti-Jane, Jones, Alison ORCID: https://orcid.org/0000-0002-7087-9597, Williams, Emma, O’Sullivan, Heather, Evans, Andrew, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 and Joseph-Williams, Natalie ORCID: https://orcid.org/0000-0002-8944-2969 2025. Patients’ views on a subsidy card model for gluten-free food access: a qualitative study. BMC Health Services Research 25 (1) , 1418. 10.1186/s12913-025-13582-z

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Abstract

Background: Coeliac disease requires strict adherence to a gluten-free diet to prevent health complications. While gluten-free foods (GFF) are traditionally available on the National Health Service (NHS) prescriptions, the cost and limited product range have prompted consideration of alternatives. Wales is exploring replacing prescriptions with a subsidy card scheme, piloted and implemented by the Hywel Dda University Health Board. This study explores potential service users’ views on the advantages and challenges of transitioning to a subsidy card scheme, as well as their priorities as individuals with coeliac disease. Methods: A qualitative study was conducted with 23 participants from six Welsh health boards where the subsidy card scheme has not been implemented. Participants included individuals eligible for GFF prescriptions and carers of eligible individuals. Recruitment was via social media and Coeliac UK’s Wales mailing list, with purposive sampling to ensure diversity. Data were collected through semi-structured interviews (April-July 2024) and analysed thematically using NVivo software. Results: Four themes and 20 subthemes were identified. Participants viewed the subsidy card as offering greater choice, autonomy in dietary management, and convenience compared to prescriptions, with the potential to better align with everyday shopping habits. Concerns centred on the card’s monetary value amid inflation, risks of technical or top-up failures, misuse, and limited retailer participation in rural areas. Sixteen participants expressed a clear interest in switching to the subsidy card system, six were ambivalent, and one expressed no interest. Participants also highlighted six key priorities that they felt were essential to improving GFF access and ensuring better support for people with coeliac disease. These priorities included: ease of access, variety and freedom of choice, a tasty and healthy diet, consistency, cost, and better awareness and education of coeliac disease. Conclusions: The subsidy card model presents a promising, cost-effective, and patient-centred alternative to prescriptions, offering greater dietary autonomy and alignment with consumer practices. However, its success will depend on ensuring equity across geographic areas, addressing infrastructure and retailer participation, safeguarding nutritional adequacy, and maintaining prescription access during transition. Careful implementation will be essential to support diverse patient needs and optimise the scheme’s success.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/, Type: open-access
Publisher:	BioMed Central
Date of First Compliant Deposit:	5 November 2025
Date of Acceptance:	26 September 2025
Last Modified:	05 Nov 2025 09:45
URI:	https://orca.cardiff.ac.uk/id/eprint/182132

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