Questions | 1 | 2 | 3 | 4 | 5 |
Have you been bothered by low energy level during the past 4 weeks? | None of the time | A little of the time | Some of the time | Most of the time | All of the time |
Have you been bothered by headaches during the past 4 weeks? | None of the time | A little of the time | Some of the time | Most of the time | All of the time |
I am able to follow a gluten-free diet when dining outside my home | Strongly agree | Somewhat agree | Neither agree nor disagree | Somewhat disagree | Strongly disagree |
Before I do something I carefully consider the consequences | Strongly agree | Somewhat agree | Neither agree nor disagree | Somewhat disagree | Strongly disagree |
I do not consider myself a failure | Strongly agree | Somewhat agree | Neither agree nor disagree | Somewhat disagree | Strongly disagree |
How important to your health are accidental gluten exposures? | Very important | Somewhat important | Neutral/unsure | A little important | Not at all important |
Over the past 4 weeks, how many times have you eaten foods containing gluten on purpose? | 0–never | 1–2 | 3–5 | 6–10 | >10 |
The sum of the numeric values provide a score ranging from 7 to 35; lower scores reflect better adherence to a GFD.