Facilitators of and Barriers to Adherence to Dietary Interventions Perceived by Women With Multiple Sclerosis and Their Support Persons

Cassidy Dean; Samantha Parks; Tyler J Titcomb; Andrea Arthofer; Paul Meirick; Nicole Grogan; Mary A Ehlinger; Babita Bisht; Sara Shuger Fox; Sandra Daack-Hirsch; Linda G Snetselaar; Terry L Wahls

doi:10.7224/1537-2073.2021-051

Facilitators of and Barriers to Adherence to Dietary Interventions Perceived by Women With Multiple Sclerosis and Their Support Persons

Int J MS Care. 2022 Sep-Oct;24(5):235-241. doi: 10.7224/1537-2073.2021-051. Epub 2022 May 26.

Authors

Affiliations

¹ Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA.
² Department of Epidemiology, College of Public Health (TJT, LGS), University of Iowa, Iowa City, IA, USA.
³ The Department of Exercise Science (SSF), Central College, Pella, IA, USA.
⁴ College of Nursing (SD-H), University of Iowa, Iowa City, IA, USA.

Abstract

Background: People with multiple sclerosis (MS) frequently report implementing dietary strategies as part of their personal wellness programs; however, little is known about the perceived themes of healthy behavior change in people with MS.

Methods: Semistructured one-on-one interviews were conducted with 20 women with MS enrolled in 2 different restrictive dietary intervention studies and their 18 self-identified support persons consisting of partners and adult children. Interviews were transcribed, coded, categorized, and then grouped into summative themes. The frequency of issues being mentioned as facilitators of or barriers to diet adherence was evaluated to identify possible differences in perceived experiences between women with MS and their support persons during the studies.

Results: Five qualitative themes were identified: (1) personal motivation, (2) diet components, (3) time, (4) support, and (5) resource access. Major facilitators of dietary adherence were positive support from support persons and study staff, access to resources, symptom improvement, and personal motivation. Major barriers included the novelty of the study diet, lack of cooking skills, no change in or worsening of symptoms, lack of diet knowledge, and food preferences and temptations. Symptom severity was more frequently reported as a barrier to study diet adherence among participants with secondary progressive MS.

Conclusions: Methods to enhance personal motivation and ensure positive support from support persons and study staff may improve study diet adherence. Due to the unique challenges faced by people with MS, future studies should tailor interventions to their unique MS cohort to increase diet adherence.

Keywords: dietary interventions; multiple sclerosis; support person; women with MS.

Grants and funding

FUNDING/SUPPORT: This study was supported in part by the National Multiple Sclerosis Society (grant RG-1506-04312 to Dr Wahls), the Direct-MS Charity of Canada, and University of Iowa institutional funds. The University of Iowa Summer Research Fellowship for Medical Students provided support for Mss Dean, Parks, and Arthofer. Dr Titcomb is a research trainee of the University of Iowa Fraternal Order of Eagles Diabetes Research Center (grant T32DK112751-01) and is supported by the Carter Chapman Shreve Family Foundation and the Carter Chapman Shreve Fellowship Fund for diet and lifestyle research conducted by the Wahls Research Team at the University of Iowa. In-kind support was provided by the University of Iowa College of Public Health Preventive Intervention Center.