A Qualitative Study of Multiple Health Behaviors in Adults with Multiple Sclerosis

Abstract

Background: Evidence regarding inflammatory pathways, elevated cardiovascular risk, and negative effects of secondary conditions on disability progression provide a strong rationale for promoting multiple health behaviors in adults with multiple sclerosis (MS). However, many unanswered questions remain about the best ways to design multiple behavior change interventions for adults with MS. We sought to identify facilitators and barriers to engaging in multiple health behaviors (physical activity, nutrition, and sleep) and to gain further insights into how to develop multiple health behavior change interventions based on preferences of adults with MS. Methods: Focus groups and one-on-one interviews were conducted with 17 participants with MS. Results: Five qualitative themes were identified as either facilitating or hindering engagement in multiple health behaviors: 1) roles, priorities, and preferences; 2) sense of duty; 3) the fatigue and mobility problem; 4) taking control; and 5) resiliency. Participants identified advantages and disadvantages of delivery formats (eg, face-to-face group vs. telephone), frequency of contacts, and intervention strategies based on their individual circumstances and obligations. Participants felt that discussing the benefits of engaging in multiple health behaviors, developing action plans, accommodating preferences, and addressing health problems would be helpful strategies to include in a multiple behavior change intervention. Conclusions: These findings indicate that there may be common facilitators and barriers that can be targeted to promote multiple behavior changes. Future research should explore the best ways to tailor multiple behavior change interventions to preferences, symptoms, psychological traits, and social cognitions. Int J MS Care. 2016;18:248-256. There is now an extensive body of research indicating the need to develop and test multiple health behavior change interventions in people with multiple sclerosis (MS). Research on inflammatory pathways, 1 elevated cardiovascular risks, 2 and negative effects of secondary conditions on disability progression 3 all provide a strong rationale for designing and testing multiple behavior change interventions in adults with MS. Engaging in multiple health behaviors may have cumulative effects on reducing inflammation and secondary conditions. 1,4 Furthermore, expert consensus statements on managing common MS symptoms often make recommendations consistent with engaging in multiple health behaviors. 5,6 However, few studies of people with MS have addressed pertinent questions on how best to promote multiple health behavior changes.Although behavior change interventions have been examined in people with MS, the efficacy and theoretical underpinnings of these interventions to support multiple behavior changes are unclear. Behavior change intervention research in MS has typically focused on self-managing symptoms, promoting wellness, and encouraging physical activity. 7-9 Each of these types of interventions makes implicit assu...

Dietary responses to a multiple sclerosis diagnosis: a qualitative study

“…19 Many participants in our study were focused on symptom management whereas the current treatment strategies for MS focus on reducing disability progression of the disease using DMTs. This need in PwMS to be self-experimenting with diet as a means of being in control of an unpredictable and incurable disease has only been reported in one other general topic qualitative MS study recently, 43 but has been documented in other diseases such as cancer. 44 We applied a number of techniques to ensure rigour, 35 however our findings should be interpreted with caution in light of some limitations.…”

Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

“…While very few studies have examined multimodal lifestyle interventions in MS, Plow et al, assessed barriers and facilitators to healthy eating, exercise and sleep. They reported that participants of a multimodal lifestyle intervention [32] found benefit in the provision of evidence of benefits of healthy behaviors, and in developing an action plan taking into account personal preferences and health problems. Similarly, participants in our study reported that the evidence around benefits to healthy behaviors was useful and increased their motivation for initiating and maintaining health behaviors.…”

Nutrition in Multiple Sclerosis: An integrative review of scientific publications from the last 5 years

“…It was verified that professional support aimed at developing self-care and self-efficiency capabilities may contribute to the adoption of healthy nutritional patterns among MS adult patients 42,44,45 .…”

“…Other nutritional factors were also studied with less frequency, such as food pattern aspects (3.2%; n= 2), intake amounts for different food groups, label reading habits and meal frequency 42,43 , cow milk protein intake contraindication (1.6%; n= 1), due to its molecular mimicry with myelin sheath or gluten auto-antigens 10 (1.6%; n= 1). Also, the risk of developing celiac disease 10 , benefits of individual or group educational programs (3.2%; n= 2) interference in MS 44,45 risk and clinical development, protein supplementation (1.6%; n= 1) for the improvement of the cognitive function in patients with this condition 46 , as well as the influence of excessive salt intake (3.2%; n= 2) in MS 47,48 .…”