Education found to help with MS treatment adherence in Iran

An educational intervention program was found to help improve treatment adherence among people with multiple sclerosis (MS) receiving injectable therapies in a clinical trial in Iran.

The program was designed based on the theory of planned behavior — a psychological premise that assumes people act rationally according to their attitudes, subjective norms, and perceived behavioral control. As such, it aims to modify these three factors to create intention and improve behavior toward a certain beneficial task, such as taking medications as prescribed.

According to researchers, it worked — and in just three months’ time.

“Applying [this] model proved … very effective in developing an educational program for patients with MS, to enhance treatment adherence drugs,” the team wrote, noting that, “besides such programs, follow-up education for controlling and monitoring are highly recommended.”

The study, “Effect of an educational intervention based on the theory of planned behavior on improving medication adherence in patients with multiple sclerosis treated with injectable disease-modifying drugs: randomized controlled trial,” was published in BMC Public Health.

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MS is a neurodegenerative disease that causes problems with how messages are sent between the brain and the rest of the body. This can lead to a variety of symptoms, from difficulty walking and problems with coordination and balance to fatigue and numbness or tingling in the limbs.

While there are treatments available to help manage the disorder, there is no cure. For some patients, the disease’s complexity and the long-term nature of MS can make adherence difficult.

The theory of planned behavior believes that individuals’ behaviors are shaped by their beliefs about an action’s consequences, what society expects from them — known as subjective norms — and the extent to which they believe a behavior is under their active control; this is called perceived behavioral control.

Together, these three factors can create a behavioral intention, which may be used to transform a person’s behavior toward adhering to treatment.

Now, researchers from the MS clinic of Sina Hospital, in Tehran, sought to investigate the impact of an educational program focusing on improving treatment adherence behaviors. To that end, they conducted a clinical trial (IRCT20210808052109N1) involving 100 patients, ages 20 to 50.

All patients had relapsing-remitting MS and were on treatment with Rebif (interferon beta-1a), an under-the-skin or subcutaneous injection therapy that’s given three times per week, for at least one year.

Participants were randomly assigned to an intervention — the education program — or to a control group that did not receive any educational programming.

The education program was delivered in four weekly sessions, each lasting 1-2 hours. Questionnaire data were collected at entry to the study and again three months later.

The first session was based on knowledge about MS and treatment adherence, while the second focused on the consequences of poor treatment adherence and how this is viewed by others. The third provided tools to empower patients to adhere to treatment, and the fourth focused on the practical aspects of the injection.

The level of knowledge of treatment adherence drugs was moderate at the study’s start in both groups. But after three months, patients in the intervention group showed significant improvements in such knowledge (from 56.25 to 78.31 points). In the control group, there was no significant difference between the two assessments.

Performance of treatment adherence also improved significantly — from moderate to good, with an increase from 56.22 to 71.62 points, in the intervention group. No such changes were seen in the control group.

It is essential to implement efforts to improve treatment adherence, disease care, and patients’ quality of life and to reduce public health costs for MS patients.

“The improvement in the attitude of patients in the intervention group regarding medication adherence outcomes was due to the educational intervention programs,” the researchers wrote, noting that program’s focus was on “factors such as the increase in treatment costs and the occurrence of disease complications, disease progression, hospitalization, and the increase in disease flare-ups.”

The intervention made use of educational videos, pictures, and group discussions that described patient experiences.

“It is essential to implement efforts to improve treatment adherence, disease care, and patients’ quality of life and to reduce public health costs for MS patients,” the team concluded.