Discussion
phobia, Costello et al., unnecessary dependence, PBC, depression, memory disorders
DISEASE COMPLICATION, DISEASE PROGRESSION, DISORDERS, PBC, DISEASE, MOHR, HAND PRESENTATION, HANSEN
The results of this an educational randomized controlled trial study showed that an improvement of patients in medication adherence was due to the use of theory-based education methods combined with active follow-up.After the educational intervention, patients' knowledge of medication adherence increased significantly. Education on a better understanding of the medication adherence program, the proper amount and timing of medication use, symptoms of underuse or overuse of medication, as well as the provision of materials in the form of brochures and health messages, could prove effective in increasing patient awareness.The study by Zimmer et al. on the effect of the nurses’ education program for MS patients increased their awareness of fingolimod treatment [The improvement in the attitude of patients in the intervention group regarding medication adherence outcomes was due to the educational intervention programs. With emphasis 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. Educational videos, pictures, and presentation of patients' experiences in the form of group discussions were used to improve patients' attitudes. In a study on medication adherence and clinical outcomes from MS, it was shown that patients with complete medication adherence had a lower rate of hospitalization for MS [In the current study, to improve subjective norms, the influential role of other people who influence patients' decisions, such as physicians, nurses, and family members, was used. In addition, physicians and nurses participated in the educational sessions to educate patients, and educational materials in the form of brochures, booklets, and educational videos were also provided to family members; therefore, all these factors improved the subjective norm of the patients. Moreover, Burke et al. suggested that MS nurses, as trained healthcare professionals, played an important role in educating patients about the nature of the disease and increasing medication adherence [One of the most important parameters for medication adherence in MS patients is to empower them and increase their PBC. In the present study, patients' PBC was promoted by emphasizing factors such as a better understanding of the nature of the disease by the patient to ensure adherence to treatment instructions, creating internal motivation independent of external incentives, and adherence to medication under conditions of travel or preoccupation.In the study of Mohr et al. on MS patients who had just started interferon treatment, it was revealed that the inability of patients to inject themselves with the drug was directly related to discontinuation of the drug during the first 6 months of treatment [When a medication regimen requires frequent injections, empowering patients to self-inject reduces unnecessary dependence on others or the need to visit the clinic frequently to receive medications and increases medication adherence. According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychological Association, phobia (fear) of injections is one of the main problems of MS patients and causes them not to adhere to the medication [In a review study showed that the most frequent cause of stopping treatment is perceived lack of efficacy, and that most withdrawals from treatment occurred during the first year [By educating patients and improving awareness, attitude, and PBC, a positive intention to adherence to medication is formed in patients. When patients have the necessary injection capabilities and skills, intention becomes behavior. In a study, patients' intention was found to be important in behaviors about stress management in MS patients [Costello et al. in a study showed that patients with MS require education that clearly explains the facts regarding the possible course and nature of the disease, its symptoms, and the importance of diagnostic tests [In our study adherence in baseline in intervention and control group was 36% and 42% respectively. Our results were superior to those described by Hansen et al. [The improvement in patient performance on medication adherence was due to the improvement in other constructs of the TPB. In this regard, the educational intervention program emphasized teaching patients about adherence to dosage, timing of injections, and taking medications with them when traveling, as well as following the recommendations of treatment staff through educational videos and hands-on demonstrations.Regarding the need for medication adherence in MS patients, clinical trials have demonstrated that interferons with high doses and more frequent injections (e.g., Rebif with thrice-weekly injections) are more effective than interferons with less frequent injections (e.g., Avonex with once-weekly injections), and the same repeat of injection increases the importance of medication adherence in these patients [In the present study, adherence drugs was reported significant difference based on the gender, marital status, level of education and memory disorders after an intervention. So it seems that beside educational program based on TPB at the same time during outbreak Covid-19 patients are sensitive to their health and the rate of their participation in health programs and their acceptance and practice of health behaviors such as treatment adherence drugs.In addition to the role of education for behavioral change, environmental factors should be considered. For example, patients' limited mobility and living alone can not to access medicine and visits to doctors and clinics, forgetting to take medicines and not being reminded by others in patients who live alone, or lack of help in injecting medicine by others. This factors can be effective on the level low of treatment adherence drugs in MS patients. In a study Treadway and et al. showed that the most common reason MS patients for missing injection was that they simply forgot to administer the medication, hope, depression, and support were also assessed in relation to adherence [In a clinical trial study, self-care training was suggested as a useful and effective intervention to improve the performance of MS patients [Furthermore, Jones et al. found that the role of support services and patient follow-up influenced medication adherence [