Peer-Interaction Group Support in Adolescents With Celiac Disease: A Randomized Controlled Trial
Phase: NA
Conditions: Celiac Disease in Children
Sponsor: Melike Taşdelen Baş

02/01/2018 
 
 
 
STUDY PROTOCOL 
 
 
1. Project Name: EFFECT OF PEER-INTERACTIVE GROUP SUPPORT ON LIFE 
QUALITY, PEER RELATIONS AND COACHING LEVELS IN CELIAC-
DIAGNOSED ADOLESANS 
 
2. Rationale of the Project: Chronic diseases, generally slow progressing, lasting for 3 
months or longer, caused by many risk factors, without medical treatment, reducing the 
degree of the disease, supporting the person in self-care, requiring periodic monitoring 
and life are diseases that affect their quality (1). These diseases expose children to many 
problems in childhood (2). With the developments in the medical world, the life 
expectancy has increased in childhood chronic diseases (3). Therefore, children are 
faced with more psychological and social problems (4). It has been reported that the 
incidence of celiac disease has increased in the last 30 years (5). In the study of Murray 
et al., It is stated that the incidence and prevalence of celiac disease has increased in 
Europe and America in the last 30 years, and the incidence rate was 0.9 in 100,000 in 
the 1950s, and 9 in 100,000 after 2000 (6). The incidence of celiac disease in Denver 
city of Colorado was determined as 1.6%, 2.8% and 3.1% at the age of 5, 10 and 15, 
respectively (7). Its prevalence is accepted as 1% in many countries around the world 
(8-10). While the prevalence of celiac is highest in Finland with 2.4%, it is the lowest in 
Germany with 0.3% (11). There are different studies on the prevalence of celiac disease 
in our country. In a study conducted among children admitted to hospital in Kayseri, the 
prevalence rate of celiac disease was found to be 1% (12). The prevalence of celiac 
disease was found to be 1/158 in a study conducted on 1263 school-age children in 
Erzurum (13). Turkey in 62 provinces, 20190 prevalence rate of celiac disease in studies 
with healthy school children was found to be 0.47% (14). According to the Republic of 
Turkey Ministry of Health data, the incidence of celiac disease ranged between 1% and 
0.3% of celiac patients is estimated between 750 thousand to 250 thousand in Turkey. 
Celiac disease is an immune-based autoimmune disease that affects the small intestine in 
those with a genetic predisposition and develops against gluten (15, 16). Gluten is a 
group of proteins found in grains like wheat, barley, and rye (17). Common symptoms 
of celiac disease due to gluten intolerance are abdominal swelling, abnormal bowel 
movements, weight loss, fatigue, weakness, and vomiting (18). 
 
One year after the diagnosis of celiac disease, psychological problems begin to occur 
and a decrease in the quality of life in patients (19, 20). The disease affects personal 
relationships, social conditions, and the individual's self-confidence (21). Strict 
adherence to a gluten-free diet is vital to achieving optimal quality of life. Adolescents 
who have difficulty in adapting to their diet may face lower quality of life, more 
physical problems, higher disease burden and family problems. It has been reported that 
the feeling of "being sick" is higher in these patients (22). Celiac patients with dietary 
incompatibility may also face complications such as anemia and osteoporosis, 
nutritional retardation, growth retardation, infertility, the development of other 
autoimmune disorders, and malignancy (23). It is important to successfully manage 

celiac disease in medical and psychological terms and to provide psychosocial support 
(22, 24, 25). 
Children who try to adapt to a gluten-free diet experience some psychological 
difficulties (19, 26, 27), experience adaptation problems to social life, and are prone to 
social isolation (19, 26). Children's lifestyles can change radically (28). Studies have 
found that children and adolescents have problems with adaptation in terms of social 
relations (29, 30), difficulty coping with gluten-free diet (30), management of daily life 
(29), and participation in social activities (31). In addition, children with a diagnosis of 
celiac experience social limitations due to stigmatization (32, 33). Studies have found 
that children and adolescents with celiac disease have high levels of depression and 
anxiety (19, 26, 34). Children with chronic illnesses and their parents cope with 
difficulties and restrictions in daily life. Therefore, anxiety, depression, and a decrease 
in quality of life are observed in children diagnosed with chronic diseases (35). 
The degree of adherence to a gluten-free diet has been shown to be the reason for 
consistency in health-related quality of life (36). It has been found that the quality of life 
is impaired in children with celiac disease (5, 37, 38). It has been stated that compliance 
with diet can increase the quality of life (37). White et al. Reported that quality of life in 
adolescents with celiac disease is associated with health-related behaviors such as eating 
out, traveling and socializing with friends (39). 
Lifetime survival of a gluten-free diet is the cornerstone of celiac disease (40). However, 
the biggest challenge in children with celiac disease is the requirement to follow a 
gluten-free diet (41). Especially adolescents with chronic diseases experience difficulties 
in dietary compliance in the management of the disease (42). 
It has been reported that avoiding gluten-containing foods is difficult for adolescents 
(43, 44), and dietary non-compliance is most common in this period (31, 45, 46). 
Adolescents experience difficulties in complying with the diet as a result of social 
pressures, being independent from the family, and adding new responsibilities (41, 47). 
Impaired dietary compliance in adolescents, peer pressure, and inability to access 
gluten-free foods (41), are caused by the difference in the taste of gluten-free foods (31). 
In a study conducted among children and adolescents with a diagnosis of celiac disease, 
it was found that 50% of the participants did not comply with their diet (38). In a study 
conducted with children and adolescents aged 10-18 with celiac disease, they found 
decreased quality of life scores in mental and social areas in patients. It has been 
suggested that support and education should be given to adolescents to help them 
manage and cope (50). In a study conducted with celiac patients in the 5-12 age group, 
impairment was found in the quality of life of children related to social life (51). It has 
been reported that compliance with a gluten-free diet is strongly associated with low 
quality of life (52). It is stated that the establishment of support groups is effective in 
ensuring compliance with treatment and increasing the quality of life in the management 
of chronic diseases. Support groups can be effective in increasing individuals' 
knowledge of disease and social connectedness and decreasing social isolation (53). In 
the training program with group activity, the quality of life of children with asthma (54, 
55), the quality of life of children with diabetes in group intervention, improvement in 
psychosocial functions (56, 57), decrease in the sense of loneliness in children 
diagnosed with cystic fibrosis (58), support with children with chronic diseases It has 
been reported that there is an increase in the level of knowledge and quality of life in the 
group intervention (59). Scholten et al. Stated that informing, relaxation techniques, 
increasing medical knowledge, improving social competence and positive thinking are 
effective in coping with the disease in children with chronic diseases. This support is 
provided to reduce the emotional and behavioral problems of children can reduce (60). 

Healthcare professionals should be aware of the psychological burden of this disease in 
order to support individuals with celiac disease to increase treatment adherence (27). In 
order to increase compliance with the treatment of celiac disease, emerging 
psychological and social problems should be addressed (61). Patients usually need diet 
training and coping strategies that can be applied in daily life (62). In the study of Ring -
Jacobsson et al., The training program for celiac patients, in which issues such as coping 
strategies, knowledge and obstacles in daily life were discussed, increased the 
psychological well-being of the participants (63). Communication of individuals with 
celiac disease with other celiac patients has a positive effect on individuals (62). In 
addition, comprehensive training is recommended for patients with a diagnosis of celiac 
disease in order to increase the quality of life and to increase compliance with diet (38). 
Having peer support enables the adolescent to feel competent and successful, to develop 
their skills and to use effective coping methods (64). Coexistence of peers with similar 
problems can help them discuss problems and learn new coping methods from each 
other (65). Participation in group interactive support programs has become an important 
determinant in the management of chronic diseases and in achieving psychosocial well-
being. In medical treatment for chronic diseases, patient education is emphasized as the 
cornerstone of care (66). In group training, individuals find the opportunity to share their 
experiences with other people in similar situations (67). Comprehensive training and 
expert support contribute positively to the management of the disease (68). It is known 
that participation in support groups in individuals with chronic diseases enables them to 
obtain up-to-date and reliable information and to manage their illnesses better (69). In a 
study conducted by Kyngäs and Rissanen on 300 adolescents with chronic diseases 
diagnosed with asthma, epilepsy, diabetes, juvenile rheumatoid arthritis, they stated that 
the strongest support in terms of support, motivation and compliance with treatment 
came from nurses (70). It is stated that support groups formed under the leadership of 
nurses help adolescents to express problems better and cope with daily or long-term 
problems (71-75). In our country, among the duties and responsibilities of the Child 
Health and Diseases Nurse in the Nursing Regulation published in the Official Gazette 
dated 8/3/2010 and numbered 27515 of the Ministry of Health are teaching the sick 
child and his family the necessary care and skills, guidance and counseling (76). 
 
It has been determined that there are no studies in the literature on peer interactive group 
support on celiac adolescents. In line with this information, it was planned to examine 
the effect of peer interactive group support to be given to adolescents with celiac disease 
in the 13-18 age group on the quality of life, peer relationships and coping levels of 
adolescents. 
 
3. Materials and Methods of the Research: 
 
3.1. Location of the study: The research will be carried out in Afyon Kocatepe 
University Hospital (Afyonkarahisar) Child Health and Diseases Polyclinic. (Institution 
permit certificate is attached.) 
3.2. Time of study: The research will be conducted between June 2018 and December 
2018. 
3.3. The population, sample, and research group of the study: In the province of 
Afyonkarahisar where we planned to study, the incidence rate of the disease was shown 
to be 0.05% according to 2015 data and it was stated that there were 322 patients (77). 
There are 85 patients with a diagnosis of celiac disease in the 0-18 age group who were 
followed up in the Afyon Kocatepe University Pediatric Outpatient Clinic where the 

study will be conducted. There are 36 patients with a diagnosis of celiac disease in the 
13-18 age group. Patients with a diagnosis of celiac disease in the 13-18 age group who 
are followed up in the Child Health and Diseases outpatient clinic of Afyon Kocatepe 
University will constitute the universe of the study. 
Research inclusion criteria; 
• Agree to participate in research 
• Being a patient diagnosed at least a year ago 
• Being a boy or a girl in the 13-18 age group 
• No other chronic illness or psychiatric disorder 
• Not being in the hospital while working 
 
There will be two groups in the study, namely the experimental and the control group. 
While peer interactive group support is applied to the experimental group, no 
intervention will be made to the control group. 
Since the study was experimental, the sample size was determined by power analysis. 
Sample Number Calculation 
In a study conducted in our country, the mean quality of life score in children with 
celiac disease was found to be 69.1 ± 17.1 (49). According to this value, it was 
determined in the study that after the support program, it was aimed to increase the 
effect size of the quality of life scores by 0.8 (increase the quality of life from 69.1 ± 
17.1 points to 82.8), and it was determined that at least 15 people should be included in 
the experimental group in calculating the sample number with 5% alpha error margin 
and 80% power. (G * Power 3.1.9.2). Considering the possible loss of patients, it was 
decided to enroll a total of 36 patients, 18 patients in the experimental group and 18 
patients in the control group, with an excess of 10%. 
Working groups will be assigned to the experimental and control groups by 
randomization by lot method. 
 
1.4. Type of the study: The research was experimentally planned with pre-test, post-test 
control group. 
 
1.5. Required manpower for research: 
Prof. Dr. Hicran Çavuşoğlu: Coordinator of the research (creation of the method, 
follow-up of the application, evaluation of the findings, management of possible 
problems) 
Lecturer . Melike Taşdelen Baş: She will take part in the stages of obtaining institution 
and ethical approvals, implementation, data collection, data entry, interpretation and 
evaluation of study findings. In this process, information will be shared with the 
researcher. 
Assoc. Dr. Ayşegül Bükülmez: She will contribute to the stages of obtaining patient 
records, sharing patient information and directing patients for application. 
 
 
 
 
 
 
 
 
 

 
 
 
1.4. Research method and data collection tools: 
Peer interactive group training will be applied for 3 months, one week apart, and will 
consist of 6 sessions in total. Support group meetings were planned to be held at the 
weekend in order to prevent adolescents' attendance at school. Adolescents will be 
contacted by phone before each session, and will be invited by informing about the date 
and time of the meeting. Each session will continue for 1.5 to 2 hours. 
Adolescents to be included in the control group will be administered an Introductory 
Information Form for Adolescents with a diagnosis of Celiac disease, the Quality of Life 
Scale for Children, the Peer Relations Scale, and the Coping Scale for Adolescents in 
the outpatient clinic in order to compare the effect of education in the hospital routine 
and peer interactive group support. After three months, the Adolescents in the control 
group will be re-administered the Quality of Life Scale for Children, the Peer 
Relationship Scale, and the Adolescent Coping Scale. 
First Session; In this session, adolescents will be provided to share their knowledge of 
the disease. "What is celiac?", "What are the symptoms of celiac?" , "What does the 
celiac treatment include?" questions will be asked. By enabling adolescents to discuss 
among themselves, sharing of information, completing the missing information by the 
researcher and correcting the wrong information will be provided. In this session, 
Introductory Information Form, Children's Quality of Life Scale, Peer Relationship 
Scale, Adolescent Coping Scale will be applied to Adolescents with Celiac Diagnosis. 
Second Session; In this session, to enable adolescents to share their difficulties with the 
disease, group members, 
1- "How do you perceive living with celiac disease?" 
2- "How is it an experience to live with celiac disease?", "How did celiac disease affect 
your life?" 
3- “What are the difficulties you experience in daily life? 
4- "How do you deal with these problems in your daily life?", "What are the areas that 
you have difficulties in coping with the difficulties you experience?" questions will be 
asked. 
Questions directed to the participants will be discussed among the group leader and 
participants. 
The contents of the Third, Fourth, Fifth and Sixth sessions will be created regarding the 
problems identified in the first and second sessions. The determined problem areas will 
be discussed in each session. At the end of the sixth session, the Adolescents will be 
again applied to the Quality of Life Scale for Children, the Peer Relationship Scale, and 
the Adolescent Coping Scale. 
 
After peer interactive group support, celiac patients will be given an educational booklet 
named "Living with Celiacs" to be created by the researcher. 
In the content of the training booklet; 
• What is celiac disease? 
• What are the symptoms of celiac disease? 
Celiac and life 
• What is the treatment for celiac disease? 
• What is gluten? 
• What are edible foods for people with celiac disease? 
• What foods should celiac patients avoid? 

• What should celiac patients pay attention to in their diet? 
Food shopping and reading labels for people with celiac disease 
• Alternative solutions, food suggestions 
• Living gluten-free in school, home and social life will be covered. 
 
After the research is completed, the control group will also be given training on celiac 
disease and a training booklet titled "Living with Celiacs" to be prepared by the 
researcher will be given.. 
 
DATA COLLECTION TOOLS 
 
INTRODUCTORY INFORMATION FORM FOR DIAGNOSED ADOLESCENTS 
The introductory information form for adolescents with a diagnosis of celiac disease 
was created by the researcher. It consists of 14 multiple choice questions in total.  
 QUALITY OF LIFE SCALE FOR CHILDREN 
The quality of life scale for children is a quality of life scale developed in 1999 as a 
result of a 15-year study by Varni et al. In order to measure the health-related quality 
of life of children and adolescents between the ages of 2 and 18 (78). Children's 
health-related quality of life measurement is used to determine the risks of their 
diseases, to evaluate their health status subjectively, to monitor the results of the 
treatment and to make comparisons. The Turkish validity and reliability study of the 
scale for 13-18 years old was carried out by Nursu Çakın Memik et al. In 2005. The 
scale has sub-dimensions consisting of physical health, emotional functionality, social 
functionality and school functionality (79). The quality of life scale for children 
consists of 23 items. Physical health consists of 8 items, emotional functionality 5, 
social functionality 5, and school functionality 5 items. Scoring is done in 3 areas. 
First, the total score of the scale (STP) (23 items), secondly the physical health total 
score (FSTP) (8 items), and the third, the psychosocial health total score (PSTP), 
which consists of calculating the item scores evaluating emotional, social and school 
functionality (15 item) is calculated (80). The Cronbach alpha coefficient of this study 
was 0.82 in the adolescent form. With this study, it was determined that the 13-18 
year-old adolescent forms of the "Children's Quality of Life Scale" are valid and 
reliable in our country and can be used to evaluate the health-related quality of life of 
adolescents (79). 
The most important features of the quality of life scale for children are that it can be 
completed in about 5-10 minutes, and it is easy to apply and score by the researcher. 
This scale questions the last month of adolescents. A Likert-type scale with 5 options 
has been developed for children and adolescents aged 8-18. The lowest score that can 
be obtained from the scale is 0, the highest score is 92. The total score is obtained by 
adding the scores and dividing them by the number of filled items. If there are missing 
items in the scale, the scores of the filled items are added up and divided by the 
number of items marked. If more than 50% of the scale is not filled, the scale is not 
evaluated. In conclusion, the higher the total score of the quality of life scale for 
children, the better perceived health-related quality of life (80).  
 
 
 
 
 
Friendship Qualities Scale   

 
This scale aims to evaluate the quality of the relationships children and adolescents 
have with their best friends. The draft items prepared by Berndt and Perry through 
interviews were made into a scale by Bukowski et al. (1994) (81). The structure of the 
measuring tool, which has a structure of thirty items and six factors, was supported by 
experimental studies, and the structure of the concept was evaluated and reviewed. The 
measurement tool consists of a total of 23 items with five factors. These sub-dimensions 
were named as Solidarity (4 items), Conflict (4 items), Assistance (5 items), Protection 
(5 items) and Proximity (5 items). The Turkish validity and reliability study of the scale 
was conducted by Zeynep Erkan Atik et al in 2014 (82). 
Aiming to evaluate the quality of the adolescent's relationship with his best friend, 
the Friendship Qualities Scale  consists of 22 items and five sub-dimensions 
(Togetherness, Conflict, Help, Protection, Proximity). The scale is scored with a 5-Likert 
(1 = Not Correct, 5 = Completely Correct) type rating. 
The Cronbach alpha internal consistency coefficients of the scale were .66 for the 
Unity subscale, .66 for the Conflict subscale, .86 for the Help subscale, .71 for the 
Protection subscale, .83 for the Proximity subscale, and .85 for the whole scale. has been 
determined. Four items in the scale are scored in reverse. The scores that can be obtained 
from the scale range from 4-20 in the Togetherness, Conflict and Protection sub-
dimensions, and 5-25 in the Assistance and Proximity sub-dimensions. High scores to be 
obtained from both the total score and the subscales from the AIS indicate highly 
positive peer relationships (82).  
 COPING SCALE FOR ADOLESCENTS (KIDCOPE) 
The Adolescent Coping Scale, known as KIDCOPE in the international literature, 
was developed by Spirito et al in 1988 (83). Bedel et al. Conducted the Turkish validity 
and reliability study of the scale in 2014. The scale consists of 11 items in three sub-
dimensions: active coping, avoiding coping, and negative coping. Ratings are made on a 
scale of four from never (0) to always (3). Internal consistency reliability coefficient of 
the EBÇÖ was found to be 0.72 for Active Coping (ABÇ), 0.70 for Avoided Coping 
(ALW) and 0.65 for Adverse Coping (ADW). The test-retest reliability coefficient, 
which was evaluated three weeks apart, was found to be r = 0.66 for Active Coping, r = 
0.61 for Avoided Coping, and r = 0.76 for Adverse Coping. These results show that the 
Turkish form of the three-factor EBÇÖ is a valid and reliable measurement tool that can 
be used to evaluate the coping approaches of adolescents. Each subscale score is 

obtained by summing the relevant items in order. The scores that can be obtained range 
from 0-12 for ABÇ and KBÇ, and 0-9 for ADF. The higher the score, the more frequent 
the related coping approach is used (84).  
 
Collection of Data: The data will be collected face to face by survey method. 
 
1.5. Data analysis: In the evaluation of the data of the study, the number,%, mean and 
standard deviation will be given in descriptive statistics. Compliance of numerical data 
to normal distribution will be evaluated with Kolmogorow-Smirnow test. The 
homogeneity of the descriptive characteristics of the experimental and control groups 
will be evaluated with the Chi-square test for categorical variables, and parametric or 
nonparametric tests according to the normal distribution in numerical variables. In 
comparison of the scale scores (dependent variable results) of the two groups, dependent 
groups t test or Mann Whitney U test will be used according to the normal distribution 
feature. The scale scores of the groups before and after the intervention will be compared 
with the dependent sample t test or the wilcoxon test. Significance level will be accepted 
as p <.05. 
 
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 STATISTICAL ANALYSIS  
Sample Number Calculation  
In a study conducted in our country, the mean quality of life score in children with celiac 
disease was found to be 69.1 ± 17.1. According to this value, it was aimed to increase the 
quality of life scores by 0.8 (effect size) level (increase the quality of life from 69.1 ± 17.1 
points to 82.8) after peer-interactive group support, and to calculate the sample size with an 
alpha error margin of 5% and power of 80%, the research group was It was determined that 
people should be taken (G * Power 3.1.9.2).  
The list of adolescents with celiac disease, which was created in accordance with the inclusion 
criteria in the study, was created by an education nurse working in the hospital. 
Randomization was performed using the simple random sampling method (lottery method), in 
which equal participation of each patient was possible. All patients were assigned a sequence 
number between 1 and 36 in computer environment and assigned to the research and control 
groups of the study in the Excel program.  
Considering the possible loss of patients, it was decided to enroll a total of 36 patients, 18 
patients in the study group and 18 patients in the control group, with an increase of 10%. 
When the study was planned, all 36 patients in the 13-18 age group who were followed in 
Afyonkarahisar Health Sciences University Faculty of Medicine and constitute the population 
of the study were included in the sample. The study was conducted on two groups as research 
and control groups. While peer interactive group support was applied to the research group, 
no intervention was made to the control group.  
Independent Variables: Sociodemographic characteristics (gender, age, place of residence, 
family type, number of people in the home, education level, family income level, age of 
diagnosis) Dependent Variables: The Quality of Life Scale for Children, Friendship Qualities 
Scale, Coping Scale for Adolescents are the total points.  
Statistical analyzes were performed using a package program called SPSS (IBM SPSS 
Statistics 24). Frequency tables and descriptive statistics were used in the interpretation of the 
findings. In the analysis of all tests, p value <0.05 was considered statistically significant. The 
homogeneity of variances was evaluated by the "Levene test" and the conformity of the study 
data to normal distribution was evaluated by the "Shapiro-Wilk" test. According to this; 
"frequency distributions (number and percentage)" are given for independent variables.  
"Independent Sample-t" test (t-table value) for comparing two independent groups for 
normally distributed data; “Paired Sample” test (t-table value) statistics were used in the 
comparison of two dependent groups. "Mann-Whitney U" test (Z-table value) in comparison 
of two independent groups for data that do not show normal distribution; "Wilcoxon" test (Z-
table value) statistics were used to compare two dependent groups.  
"Pearson correlation" analysis was used to examine the relationship between the mean scale 
of the two groups. Correlation coefficient; It has been accepted that there is a high relation 
between 0.70-1.00, a medium relation between 0.70-0.30, and a low level between 0.30-0.00 
 
 
 
 
 
 
 
 

 
Informed Consent Forms 
 
 
FOR ADOLESCENTS AGED 13-15  
(Study group)  
Dear;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effect of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents with Celiac Diagnosis”. Dr. Ayşegül 
Bükülmez, Associate Professor of Pediatrics Department of Afyon Kocatepe University 
Ahmet Necdet Sezer Application and Research Hospital, who is responsible for the study. We 
will talk to them about the illness and share our knowledge. The meetings will take place 
every two weeks and we will meet with our friends for a total of six meetings. Our fellow will 
attend the meeting six times in total. We will be about 18 people at each meeting. You will 
have the opportunity to meet all friends. Before we invited you to this investigation, we made 
a lottery. As a result of the lottery, we invited you because it is your name. If you do research, 
you will not be charged or paid. If you do not agree to participate in the research, you will not 
be charged a fee. Our request from you regarding this research is that you should come to the 
Afyon Kocatepe University Ahmet Necdet Sezer Application and Research Hospital, where 
the meeting will be held on the day and date we call you or when we reach your guardian. 
Because the place where we will organize all the meetings is Afyon Kocatepe University 
Ahmet Necdet Sezer Application and Research Hospital Pediatric Health and Diseases 
Polyclinic. Your participation in this research is at your discretion. You can leave your study 
whenever you want without facing penalty. If you participate in this research, information 
about you will not be shared with anyone. Even if the research results are published in 
scientific journals, identity information will not be shared with anyone or an institution. Some 
institutions following the research can access your information by signing this form, but this 
information will be kept confidential. I'll tell you when there are innovations in research. To 
get information about the research, 24 hours a day, Inst. See. Melike Baş (Tel: 0 505 705 84 
99) and Assoc. Dr. You can reach Ayşegül Bükülmez (Tel: 0505 266 45 44). If you are 
hospitalized during the research period or if you move out of the province, you can leave the 
study by informing us.  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose is stated above, was given to me 
by the physician and researcher named below. I know that I have participated in the research 
voluntarily and that I can leave the research with or without justification whenever I want.  
 
 
 
 
 
 
 
 
 
 
 
 

FOR ADOLESCENTS AGED 13-15  
(Control Group)  
Dear;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effects of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents with Celiac Diagnosis.” My advisor, 
Hacettepe University Nursing Faculty Child Health and Diseases Nursing Faculty Member 
Prof. Dr. Hicran Çavuşoğlu and the research Ayşegül Bükülmez, Associate Professor of 
Pediatrics Department of the Department of Child Health and Diseases of Afyon Kocatepe 
University Ahmet Necdet Sezer Application and Research Hospital, who is in charge of our 
study. Our study was planned as a research. Our aim is to examine the changes in their lives 
with the meetings we will hold with adolescents with celiac disease. With this research, we 
will learn how regular support meetings affect the lives of adolescents with celiac disease The 
research will be conducted in Afyon Kocatepe University Child Health and Diseases 
Outpatient Clinic. We will conduct a survey twice, including ten. After the research is over, 
we will organize a training meeting (with about 18 people) with your friends who are 
conducting the survey like you. You will not be charged any fees for participating in this 
study. No additional payment will be made to you for participating in the study. We will 
publish these research results in scientific journals, but we will not say your name.  
Our request from you about this research is that you need to come to the place where the 
surveys will be conducted on the day and date we specified when we call you or reach your 
guardian. Surveys will be collected in Afyon Kocatepe University Child Health and Diseases 
Polyclinic. Your participation in this research is at your discretion. There is no penalty for 
quitting work. If you participate in this research, information regarding your identity 
information will be kept confidential. Even if the research results are published in scientific 
journals, we will not reveal credentials to anyone. Some institutions can access your 
information by signing this form, but this information will be kept confidential. As we learn 
new things about research, we will share them with you. To get information about the 
research, 24 hours a day, Inst. See. Melike Baş (Tel: 0 505 705 84 99) and Assoc. Dr. You can 
reach Ayşegül Bükülmez (Tel: 0505 266 45 44). If you are hospitalized during the research 
period or if you move out of the province, you can leave the study by informing us.  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose is stated above, was given to me 
by the physician and researcher named below. I know that I have participated in the research 
voluntarily and that I can leave the research with or without justification whenever I want.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
FOR ADOLESCENTS 16-18 AGE AGES  
(Study group)  
My dear friend;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effect of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents with Celiac Diagnosis”. Our study was 
planned as a study. The meetings held during the research will last three months and will be 
held every two weeks. We will have a total of six meetings. Phone you before the meeting to 
inform you of the date and time of the study. I will reach with. A participant friend will attend 
the meeting six times in total. We think there will be approximately 18 people in each 
meeting. Within the scope of the research, your participation in the meeting was determined 
by lot. If you participate in the research, you will not be charged or paid. If you do not agree 
to participate in the research, you will not be charged a fee. Our request from you regarding 
this research is that you should come to the Afyon Kocatepe University Ahmet Necdet Sezer 
Application and Research Hospital, where the meeting will be held on the day and date we 
call you or when we reach your guardian. Because the place where we will organize all the 
meetings is Afyon Kocatepe University Ahmet Necdet Sezer Application and Research 
Hospital Pediatric Health and Diseases Polyclinic. You must attend a total of six meetings that 
will be held within the scope of the research. Your participation in this research is at your 
discretion. You can leave your study at any time without incurring a penalty. If you 
participate in this research, information regarding your identity information will be kept 
confidential. Even if the research results are published in scientific journals, identity 
information will not be shared with anyone or an institution. Some institutions following the 
research can access your information by signing this form, but this information will be kept 
confidential. When new information about the research becomes available, this information 
will be shared with the volunteers. To get information about the research, 24 hours a day, Inst. 
See. Melike Baş (Tel: 0 505 705 84 99) and Assoc. Dr. You can reach Ayşegül Bükülmez 
(Tel: 0505 266 45 44). If you are hospitalized during the research period or if you move out of 
the province, you can leave the study by informing us.  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose is stated above, was given to me 
by the physician and researcher named below. I know that I have participated in the research 
voluntarily and that I can leave the research with or without justification whenever I want.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
FOR ADOLESCENTS 16-18 AGE AGES  
(Control Group)  
My dear friend;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effects of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents with Celiac Diagnosis.” My advisor, 
Hacettepe University Nursing Faculty Child Health and Diseases Nursing Faculty Member 
Prof. Dr. Hicran Çavuşoğlu and the research Ayşegül Bükülmez, Associate Professor of 
Pediatrics Department of the Department of Child Health and Diseases of Afyon Kocatepe 
University Ahmet Necdet Sezer Application and Research Hospital, who is in charge of our 
study. Our study is planned as a research. Our aim is to meet with adolescents with celiac 
disease, quality of life, peer With this research, we will learn how regular support meetings 
affect the lives of adolescents with celiac disease. We will conduct surveys twice, at the 
beginning and at the end. After the research is over, we will organize a training meeting (with 
about 18 people) with your friends who are conducting the survey like you. You will not be 
charged any fees for participating in this study. No additional payment will be made to you 
for participating in the study. We will publish these research results in scientific journals, but 
we will not say your name.  
Our request from you regarding this research is that you should come to the Afyon Kocatepe 
University Ahmet Necdet Sezer Application and Research Hospital, where the surveys will be 
conducted on the day and date we call you or when we reach your guardian. Your 
participation in this research is at your discretion. You can leave your study at any time 
without incurring a penalty. If you participate in this research, information regarding your 
identity information will be kept confidential. Even if the research results are published in 
scientific journals, identity information will not be shared with anyone or an institution. Some 
institutions following the research can access your information by signing this form, but this 
information will be kept confidential. When new information about the research becomes 
available, this information will be shared with the volunteers. To get information about the 
research, 24 hours a day, Inst. See. Melike Baş (Tel: 0 505 705 84 99) and Assoc. Dr. You can 
reach Ayşegül Bükülmez (Tel: 0505 266 45 44). If you are hospitalized during the research 
period or if you move out of the province, you can leave the study by informing us.  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose is stated above, was given to me 
by the physician and researcher named below. I know that I have participated in the research 
voluntarily and that I can leave the research with or without justification whenever I want.  
 
 
 
 
 
 
 
 
 
 
 
 
 

FOR PARENT OR GUARDIAN  
(Study group)  
Dear Parent;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effect of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents Diagnosed with Celiac”. Dr. Ayşegül 
Bükülmez, Associate Professor of Pediatrics Department of Afyon Kocatepe University 
Ahmet Necdet Sezer Application and Research Hospital, who is responsible of the study, was 
planned as a study. The study was planned as a study in meetings where adolescents 
diagnosed with celiac disease came together. We draw a lottery among adolescents with a 
diagnosis of celiac disease between the ages of 13-18 and have determined that they will 
participate in the study. will happen with up. Before organizing meetings, we will call you 
and your child to let you know the time of day of the meeting. If you accept the research, you 
will not be paid or charged. If you do not accept the research, you will not be charged. Our 
request from you is to be present with your child at the meeting place on the day and date 
specified when we call you. Participation in the research is at your discretion. If you 
participate in the research, your child's information will be kept confidential. Even if the 
research results are published in scientific journals, identity information will not be shared 
with anyone or an institution. Some institutions that follow the research can access your 
child's information by signing this form, but this information will be kept confidential. When 
new information about the research becomes available, this information will be shared with 
the volunteers. To get information about the research, 24 hours a day, Inst. See. Melike Baş 
(Tel: 0 505 705 84 99) and Assoc. Dr. You can reach Ayşegül Bükülmez (Tel: 0505 266 45 
44). If your child is hospitalized during the research period or if you move out of the province, 
you can leave the study by informing us.  
"Your child will be informed about this research in a way that he / she understands and his / 
her consent to participate in the research will be obtained."  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose was stated above, was given to me 
by the physician named below. I know that I have participated in the research voluntarily and 
that I can leave the research with or without justification at any time.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

FOR PARENT OR GUARDIAN  
(Control Group)  
Dear Parent;  
I am a student of Hacettepe University Health Sciences Institute Child Health and Disease 
Nursing Doctorate Program. My name is Melike Baş. The name of this research, which is my 
doctoral dissertation, is “The Effect of Peer Interactive Group Support on Quality of Life, 
Peer Relationships and Coping Levels in Adolescents with Celiac Diagnosis”. Our study was 
planned as a study. It was planned to provide support to each other. A training meeting about 
Celiac Disease will be organized for the children who fill up. You have to come to the 
hospital (Afyon Kocatepe University Child Health and Diseases Polyclinic) to fill the 
questionnaires. We will call you and your child to let you know the time of day of the 
meeting. If you accept the research, you will not be paid or charged. If you do not accept the 
research, you will not be charged. We request you to be at the hospital with your child on the 
day and date specified when we call you. Participation in the research is at your discretion. If 
you participate in the research, your child's information will be kept confidential. Even if the 
research results are published in scientific journals, identity information will not be shared 
with anyone or an institution. Some institutions that follow the research can access your 
child's information by signing this form, but this information will be kept confidential. When 
new information about the research becomes available, this information will be shared with 
the volunteers. To get information about the research, 24 hours a day, Inst. See. Melike Baş 
(Tel: 0 505 705 84 99) and Assoc. Dr. You can reach Ayşegül Bükülmez (Tel: 0505 266 45 
44). If your child is hospitalized during the research period or if you move out of the province, 
you can leave the study by informing us.  
"Your child will be informed about this research in a way that he / she understands and his / 
her consent to participate in the research will be obtained."  
“I have read all the explanations on the informed consent form. Written and verbal 
explanation about the research, whose subject and purpose was stated above, was given to me 
by the physician named below. I know that I have voluntarily participated in the research and 
that I can leave the research with or without justification at any time.