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Medically reviewed by Dr. Samuel Sarmiento, M.D., MPH on August 3, 2023

An educational intervention based on the theory of planned behavior enhances treatment adherence in multiple sclerosis patients.

Disease-modifying drugs (DMDs) effectively control the course of multiple sclerosis (MS). Adherence to these medications is crucial for a successful therapeutic response. Patient education is an important factor in improving medication adherence. A study in the journal BMC Public Health assessed the effect of an educational intervention based on the theory of planned behavior (TPB) on treatment adherence in MS patients receiving injectable DMDs.

Patient Characteristics

In this randomized controlled trial, 100 patients were equally randomized to the intervention and control groups. Both groups were comparable regarding demographic and disease-related characteristics. Patients were predominantly female, with a mean age of 33.82 and 33.24 years for the intervention and control groups, respectively.

Evaluation of Intervention

On comparing the baseline mean scores, no significant differences were observed in knowledge, subjective norm, perceived behavior control, behavioral intention, or treatment adherence drugs (TAD) between the two groups.

Control Group Showed a Not Statistically Significant Difference in Knowledge Scores and Theory of Planned Behavior Construct

There was no significant difference in the pre-test and post-test knowledge scores. The pre-test–post-test mean differences of TPB constructs were also insignificant in the control group, except for the subjective norm, which showed a significant difference by the study’s completion.

Significant Knowledge Score Improvement in the Intervention Group

A statistically significant difference was observed between pre-intervention and post-intervention mean knowledge scores, with the mean knowledge score of TAD being 56.25 pre-intervention and 78.31 post-intervention. The intervention group also showed higher post-intervention scores on the health belief TPB subscales than pre-intervention.

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Statistically significant differences were observed in the mean scores of knowledge, attitude, subjective norm, behavioral control, behavioral intention, and patients’ performance concerning drug adherence 3 months post-intervention.

Significant Attitude Score Improvement in the Intervention Group

The greatest increase was noted in the attitude scores, which increased from 70.4 pre-intervention to 93 post-intervention.

Significant Improvement in Treatment Adherence Drugs Performance and Knowledge Post-Intervention

The performance of TAD increased from 56.22 (pre-intervention) to 71.62 (post-intervention). Only 34% of the intervention group participants had good knowledge regarding TAD before the intervention, which significantly increased to 76% after the intervention. Concerning the gender difference regarding TAD in the intervention group, the adherence scores of males and females significantly increased after the intervention; among female patients, in particular, it increased from 57 to 70.94.

The TPB-based educational intervention in the study proved to be very effective at enhancing drug adherence in MS patients. This effect was achieved by improving patients’ perceived abilities and attitudes toward medication adherence outcomes and utilizing the effect of subjective norms along with active follow-up.


Hamtaeigashti, S., Shamsi, M., Sahraian, M. A., Soltani, R., & Almasi-Hashiani, A. (2023). 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. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-15910-6