1. von Gaudecker, Jane R.

Article Content

In this issue of Journal of Neuroscience Nursing, Erbay and colleagues1 report the findings of a cross-sectional study conducted to examine the factors that influence adherence to medication in patients with multiple sclerosis (MS). This article excellently describes culturally relevant factors related to medication adherence among a Turkish population with MS.



The role of medications for MS is to decrease disease-related disability progression and to improve quality of life of those living with the disease. Early treatment using disease modifying treatment (DMT) reduces recurrence frequency, disability progression, and frequent hospitalization. Patients are most likely to quit treatment in the first 6 months. Improving adherence in this population should be a significant treatment objective, as non-adherence to MS medication leads to negative outcomes and increased costs.



The purpose of the study was to examine adherence to DMT in patients with MS, as well as potential factors that could affect adherence. The study explored the attitudes such as coping, fatigue, and self-efficacy that participants have regarding the disease and treatment, and their possible connection with adherence.



A descriptive cross-sectional study was conducted in the MS clinic of the Faculty of Medicine, Department of Neurology of a university in Izmir, Turkey, between July 2016 and February 2017. Participants (N=198) were 18 years or older, received DMT for at least 1 month, had their last seizure at least 30 days ago, had an expanded disability status scale score of 6.5 or less as assessed by neurologist, and could read, speak, and write in Turkish. Questionnaires used included Individual Identification Form, Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ), Fatigue Severity Scale (FSS), Self-Efficacy Scale and Brief COPE, and missed dose rate (MDR) score.


Data Analysis

Normality of distribution was tested using Kolmogorov-Smirnov test. Group comparisons were examined using Mann-Whitney U test for 2 independent samples with ordinal and interval variables, and with [chi]2 test for nominal variables. Statistical significance was set for p<0.05



The mean age of participants was 44+/-2.4 years, and the majority of them were women (77.8%), 40.4% completed primary school, and 72.2% were married with children. No significant relationship was found between sociodemographic variables and medication adherence, except married patients with children who had lower adherence levels (p<0.05). Using the MDR scores, the self-reported non-adherence rate was 40.4%, and the most common reason for non-adherence was memory problems. Of the 83.8% who had been diagnosed with MS for more than 10 years, 93.4% had relapsing remitting multiple sclerosis, and 35.4% received Copaxone treatment. Factors that contributed to adherence included comorbid chronic disease and satisfaction with treatment (p<0.05). Highest adherence was shown to Avonex, a once a week treatment, and lowest adherence to Betaferon.


The mean FSS score was 4.74 for adherent and 5.17 for non-adherent patients. Of the participants who had a FSS score of 4 and above, 70.4% of the adherent patients and 81.3% of the non-adherent patients reported fatigue. Medication adherence status did not differ by patient's FSS score. The mean Self-Efficacy Scale was 91.0 for adherent and 89.2 for non-adherent patients. No significant difference was found between the mean Brief COPE score and medication adherence.



Having an awareness of culturally-relevant factors can help healthcare professionals caring for diverse patient population to determine appropriate strategies and guide them toward positive health habits. This study discusses factors affecting medication adherence among a Turkish population with MS.




1. Erbay O, Yesilbalkan O, Yuceyar N. Factors affecting the adherence to disease modifying therapy in patients with multiple sclerosis. J Neurosci Nurs. 2018;50(5):291-297. [Context Link]