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The aim of this study is to evaluate the effects of face-to-face and distance nursing education, based on Pender's Health Promotion Model, on fatigue, pain, sleep, and urinary tract infections in MS patients who applied to the Multiple Sclerosis Outpatient Clinics of Sakarya Training and Research Hospital. With this research, the researcher aims to reduce MS symptoms and severity, prevent secondary problems, and improve quality of life.
Education is a crucial aspect of disease management in MS patients. A strategy aimed at improving patients' health and health behaviors, education provides benefits such as increasing their quality of life, self-efficacy, and confidence in ongoing care, reducing anxiety and stress, decreasing the frequency of disease symptoms, increasing patient participation in care plans, and improving their autonomy and self-management. Selecting the appropriate educational model is the first step in educational planning, and one of the most comprehensive and widely used models offered by nurses for patient education is Pender's Health Promotion Model.
Introduced by Pender in 1982, Pender's Health Promotion Model (HPLP) focuses on enabling people to achieve higher levels of well-being. The model encompasses six areas of health promotion, including nutrition, physical activity (exercise), health responsibility, stress management, interpersonal relationships, and self-actualization, as well as the factors that influence these areas.
Telenursing is a method that allows nurses to receive training to improve nursing services and enhance patient well-being. Telenursing is considered a component of telemedicine and, by definition, enables nurses to meet patients' healthcare needs through information and communication technologies. Telenursing offers a tool for providing continuous care to patients with chronic illnesses. This allows patients to receive the care they need without the need for long journeys, at a low cost, and in a way that positively impacts their recovery process.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Education through telenursing services | Experimental | TELENURSING GROUP: EDUCATION AND SYMPTOM MANAGEMENT PROVIDED ACCORDING TO PENDER'S HEALTH PROMOTION MODEL THROUGH TELENURSING |
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| face-to-face education | Experimental | FACE-TO-FACE GROUP: EDUCATION AND SYMPTOM MANAGEMENT PROVIDED ACCORDING TO PENDER'S HEALTH PROMOTION MODEL THROUGH FACE-TO-FACE EDUCATION |
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| control group | Experimental | CONTROL GROUP |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| telenursing | Other | The nurse researcher developed training modules for MS symptoms (pain, fatigue, sleep, and urinary tract infections) in consultation with experts. These training modules were then presented via an online application (e.g., WhatsApp software or internet access address creation) with the approval and support of training and IT experts. In this context, volunteer patients who met the study criteria received training three days a week for six weeks via telenursing. Furthermore, as part of the telenursing program, patients were given the opportunity to call the researcher for 10-15 minutes from 8 a.m. to 8 p.m. on weekdays if they needed telephone consultation (Dehghani et al., 2023). |
| Measure | Description | Time Frame |
|---|---|---|
| TELENURSING EDUCATION | Based on Pender's Health Enhancement Model, telenursing provides education to MS patients, reducing patient fatigue, pain intensity, and urinary tract infections, while improving patient sleep quality. 1. The total score obtained from the application of fatigue technology (FSS) is reduced as it decreases; a higher score indicates increased fatigue. | Up to the 12th week after educational interventions |
| TELENURSING EDUCATION | 2. Pain is determined using a visual analog scale (VAS) with marking on a 10 cm ruler, indicator marking (0 = no pain, 10 = unbearable pain). | Up to the 12th week after educational interventions |
| TELENURSING EDUCATION | 3. Urinary tract is used according to presence or absence. 1 point is given if present, 0 points if absent. | Up to the 12th week after educational interventions |
| TELENURSING EDUCATION | 4. Epworth sleep performance state (ESS) uses 0, 1, 2, and 3-wire systems; higher scores indicate increased daytime sleepiness. A total score between 0 and 24 can be obtained from the scale. | Up to the 12th week after educational interventions |
| Measure | Description | Time Frame |
|---|---|---|
| FACE TO FACE EDUCATION | Pender's face-to-face patent training, based on his health improvement model, reduces pain, pain crying, and exhaustion in MS patients while also improving sleep quality. 1. The total score obtained from the application of fatigue technology (FSS) is reduced as it decreases; a higher score indicates increased fatigue. | Up to the 12th week after educational interventions |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sakarya University Institute of Health Sciences | Sakarya | Serdivan | 54050 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Demir, G., & Kesgin, M. T. (2020),Lise Öğrencilerinde Gündüz Uykululuk Durumu Ve İlişkili Risk Etmenleri, Journal Of Turkish Sleep Medicine-Turk Uyku Tibbi Dergisi. | ||
| Result | Rujnan, T., Çaykara, B., Sağlam, Z., & Pençe, H. H. (2019), Sigara Bağımlılarında Depresyon, Anksiyete, Uykululuk Ve Uyku Kalitesi Düzeyleri Arasındaki İlişkinin Belirlenmesi, Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, (4), 609-615. | ||
| Result | Pekçetin, S., Irmak, D. E., İnal Ö., Özkan, H., Kehaya, S., & Kayıhan, H. (2019), Multipl Skleroz Hastalarında Algılanan Yorgunluğun Aktivite-Rol Yeterliliği İle İlişkisi, Ergoterapi Ve Rehabilitasyon Dergisi, 7(2), 79-84. | ||
| Result | Kaya, T., Karatepe, A. G., Demirhan, A., Günaydın, R., Gedizlioğlu, M., & Çe, P. (2009), Multipl Sklerozlu Hastalarda Yorgunluk ve İlişkili Faktörler, Journal of Neurological Sciences, 26(2). | ||
| Result | Arslan, M., Albaş, S., Küçükerdem, H. S., Pamuk, G., & Can, H. (2016),Vizüel Analog Skala İle Kanser Hastalarında Palyatif Ağrı Tedavisinin Etkinliğinin Değerlendirilmesi, Family Practice & Palliative Care, 1(1), 5-8. | ||
| Result | Güven, Ş. Ş., Özcan, D. S., Aras, M., Köseoğlu, B. F., & Ak, F. (2016), Multipl Sklerozlu Hastalarda Ağrının Değerlendirilmesi Ve Yaşam Kalitesi, Yorgunluk Ve Depresyon İle İlişkisi,Turkish Journal Of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip Ve Rehabilitasyon Dergisi, 62(2). |
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Based on patient rights and the principle of confidentiality of personal data, I want my data to remain confidential.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Nov 17, 2025 | Jan 2, 2026 |
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The study population will consist of patients diagnosed with MS who present to the Multiple Sclerosis Outpatient Clinics of the Department of Neurology at Sakarya Education and Research Hospital. A total of 3,552 patients have been admitted to the Multiple Sclerosis Outpatient Clinics in the last year. Participants will be assigned to the intervention and control groups according to their order of presentation to the clinic, using computer-assisted block randomization to ensure an equal and homogeneous number of participants in each group. Considering the possibility of participants who did not meet the study criteria withdrawing from the study, 90 randomly selected participants from the population will be randomly assigned to the experimental and control groups (Group 1, Group 2, and Group 3), each consisting of 30 patients with MS.
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Because participants and researchers are aware of the assigned groups, double-blinding is not possible. However, study evaluation and scale scoring will be masked wherever possible. The MS medical support team who assisted with survey completion and the statistician who evaluated the data are blinded to the study. (Both groups will be blinded.) Data will be analyzed after the study is completed to support blinding.
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| face to face education | Other | A focus group training program was planned for patients who met the study inclusion criteria during the MS Outpatient Clinic Days (Tuesday-Thursday, 9:00-16:00) at Sakarya Training and Research Hospital. The training, prepared according to Pender's Health Promotion Model , was provided by the research nurse. The literature suggests that the ideal number of focus group interviews should be 4-10 people, and that the number of groups should not exceed 10 to facilitate group dynamics and interaction. In our study, a total of 3-5 focus group training sessions were conducted (Öner and Karabudak, 2021; Çokluk et al., 2011). |
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| Control arm | Other | The control group received no intervention, and patients continued to receive their routine treatments. At the end of the study, volunteers in the control group received an Pender's Health Promotion Model-based education program prepared by the research nurse, either face-to-face or via telenursing, at their request. |
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| FACE TO FACE EDUCATION | 2. Pain is determined using a visual analog scale (VAS) with marking on a 10 cm ruler, indicator marking (0 = no pain, 10 = unbearable pain). | Up to the 12th week after educational interventions |
| FACE TO FACE EDUCATION | 3. Urinary tract is used according to presence or absence. 1 point is given if present, 0 points if absent. | Up to the 12th week after educational interventions |
| FACE TO FACE EDUCATION | 4. Epworth sleep performance state (ESS) uses 0, 1, 2, and 3-wire systems; higher scores indicate increased daytime sleepiness. A total score between 0 and 24 can be obtained from the scale. | Up to the 12th week after educational interventions |
| 37580788 | Result | Alonso-Martinez AM, Legarra-Gorgonon G, Garcia-Alonso Y, Ramirez-Velez R, Alonso-Martinez L, Erice-Echegaray B, Izquierdo M. Gamified family-based health exercise intervention to improve adherence to 24-h movement behaviors recommendations in children: "3, 2, 1 Move on Study". Trials. 2023 Aug 14;24(1):531. doi: 10.1186/s13063-023-07494-8. |
| 34852793 | Result | Chu-Ko F, Chong ML, Chung CJ, Chang CC, Liu HY, Huang LC. Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status. BMC Public Health. 2021 Dec 1;21(1):2196. doi: 10.1186/s12889-021-12239-w. |
| 32158276 | Result | Jalili Bahabadi F, Estebsari F, Rohani C, Rahimi Khalifeh Kandi Z, Sefidkar R, Mostafaei D. Predictors of Health-Promoting Lifestyle in Pregnant Women Based on Pender's Health Promotion Model. Int J Womens Health. 2020 Feb 24;12:71-77. doi: 10.2147/IJWH.S235169. eCollection 2020. |
| 33062730 | Result | Masoudi R, Lotfizade M, Gheysarieha MR, Rabiei L. Evaluating the effect of Pender's health promotion model on self-efficacy and treatment adherence behaviors among patients undergoing hemodialysis. J Educ Health Promot. 2020 Aug 31;9:197. doi: 10.4103/jehp.jehp_747_19. eCollection 2020. |
| Result | Ghoulami-Shilsari, F., & Bandboni, M. E. (2019). Tele-Nursing In Chronic Disease Care: A Systematic Review. Jundishapur Journal Of Chronic Disease Care, 8(2). |
| Result | Eren, F. (2018). Koroner Arter Bypass Greft Ameliyatı Geçiren Hastalara Taburculuk Sonrası Tele-Hemşirelik Hizmeti İle Verilen Danışmanlığın, Depresyon Anksiyete Ve Stres Düzeyine Etkisi. T.C. Akdeniz Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı, Yüksek Lisans Tezi |
| 36682241 | Result | Dehghani A, Pourfarid Y, Hojat M. The effect of telenursing education of self-care on health-promoting behaviors in patients with multiple sclerosis during the COVID-19 pandemic: A clinical trial study. Mult Scler Relat Disord. 2023 Feb;70:104507. doi: 10.1016/j.msard.2023.104507. Epub 2023 Jan 5. |
| 34610821 | Result | Habibzadeh H, Shariati A, Mohammadi F, Babayi S. The effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure: an experimental study. BMC Cardiovasc Disord. 2021 Oct 5;21(1):478. doi: 10.1186/s12872-021-02294-x. |
| 35436876 | Result | Bijani M, Niknam M, Karimi S, Naderi Z, Dehghan A. The effect of peer education based on Pender's health promotion model on quality of life, stress management and self-efficacy of patients with multiple sclerosis: a randomized controlled clinical trial. BMC Neurol. 2022 Apr 18;22(1):144. doi: 10.1186/s12883-022-02671-9. |
| Prot_000.pdf |
| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D005221 | Fatigue |
| D010146 | Pain |
| D014552 | Urinary Tract Infections |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |
| D007239 | Infections |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
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| ID | Term |
|---|---|
| D055817 | Telenursing |
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D009729 | Nursing |
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
| D017216 | Telemedicine |
| D003695 | Delivery of Health Care |
| D010346 | Patient Care Management |
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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