Strengths and limitations
ADVERSE EFFECTS, FOUNDERS
One of the strengths of this study was the use of various teaching methods and the combination of face-to-face and virtual training, as well as the random selection of samples.Moreover the design of the educational intervention for increase of adherence drugs in patients with MS was based on a the need assessment (pre-test) and the constructs of the TPB, as well as on following up of the adherence drugs of patients three months after the educational intervention. Another strengths of this study is showed that how theory can be used to inform the design of an effective intervention and to guide its evaluation. However, since the TPB itself is generic and its domains are quite elementary, but it has great potential for developing specific applications for other health behavior support contexts as well.Several limitations in this study should be noted. Firstly limitations of the study were the impact of the COVID-19 outbreak and the virtual delivery of some training due to the susceptibility of MS patients to COVID -19.Secondly, we do not have direct clinical data related to adherence provided by physicians (e.g., medical reasons, therapeutic failure, progressive forms, adverse effects). Therefore in this study does not allow generalization of the results to other groups of MS patients because others factors may not have been fully controlled.Third, the selection of TPB out of a pool of more than 30 theories of behaviour change [Another study limitation was selecting the samples within the limit age range of 20–50 years. Finally, in this study we are using a self-reported questionnaires. This limitation was resolved by allocating sufficient time and explicit expression of the objectives of study, and gathering information along with interviewing. Also, we followed up the patients with MS for 3 months as the longer follow up may lead to more accurate outcomes. In addition based on the recommendation of Ajzen (who is one of the founders of the theory of planned behavior), using the self-report method and relying on individual’s reports rather than direct observation and immediate measurement of the target behavior, due to some problems in obtaining data in the time limits, is an accepted method in TPB studies [Despite these limitations, this study provides an initial approach to the potential variables (construct of TPB) that could affect adherence to treatment in patients with MS and this warrants further study.