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 Table of Contents  
Year : 2023  |  Volume : 6  |  Issue : 1  |  Page : 1-6

Association between perceived social support and self-management in people with multiple sclerosis: A cross-sectional study

1 Department of Adults Health Nursing, Students Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Adults Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission09-Aug-2022
Date of Decision25-Oct-2022
Date of Acceptance12-Jan-2023
Date of Web Publication10-Feb-2023

Correspondence Address:
Shahla Abolhassani
Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Adults Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/shb.shb_188_22

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Introduction: The physiological and psychological limitations resulting from multiple sclerosis (MS) can decrease social interactions. Furthermore, self-management has become popular in the control of chronic diseases such as MS. The purpose of this study was to determine the relationship between perceived social support and self-management in MS patients. Methods: This cross-sectional study was conducted for the years 2019–2020. Patients were recruited through the MS clinic located in Kashani Hospital, Isfahan, Iran, by convenience sampling. The research was performed on a group of 212 MS patients who completed a Medical outcome study social support scale (MOS-SSS), the MS Self-Management Scale, and basic clinical and demographic data. SPSS 20 software was used to analyze the collected data. Results: The study sample included 57 men and 155 women (73.1%). Examining the relationship between perceived social support and self-management revealed a strong correlation between them (r2 = 0.60, P < 0.001). The results of regression analysis showed that self-management in people with academic education was statistically significantly greater than in those without (b [Standard Error] = 6.83 [2.58], P = 0.009). Furthermore, the amount of perceived social support was increasing significantly for females in comparison to males (b [SE] = 6.04 [1.58], P = 0.03). Moreover, the mean of perceived social support was greater between married (b [SE] = 3.31 [1.56], P = 0.007) people and also between academic (b [SE] = 7.43 [3.56], P = 0.03) MS patients. Conclusion: The results of this study indicated that social support was associated with self-management in MS patients. This understanding should be applied in clinical practice when targeting and designing education, support, and care for MS patients.

Keywords: Multiple sclerosis, self-management, social support

How to cite this article:
Baharian E, Abolhassani S, Alijani M. Association between perceived social support and self-management in people with multiple sclerosis: A cross-sectional study. Asian J Soc Health Behav 2023;6:1-6

How to cite this URL:
Baharian E, Abolhassani S, Alijani M. Association between perceived social support and self-management in people with multiple sclerosis: A cross-sectional study. Asian J Soc Health Behav [serial online] 2023 [cited 2023 Dec 3];6:1-6. Available from: http://www.healthandbehavior.com/text.asp?2023/6/1/1/369556

  Introduction Top

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that has a serious impact on people's lives once it is diagnosed.[1],[2] It is estimated that 2.8 million people (35.9/100,000 population) around the world are affected by MS.[3] Iran is considered a high-risk country for MS, although it is located in a low-risk geographical area.[4] MS symptoms include sensory and motor loss, fatigue, pain, depression, sexual function, optic neuritis, and bladder or bowel function loss.[5]

Poorly managed signs and symptoms can lead to severe and potentially life-threatening problems.[6] People living with chronic diseases self-manage their situation. They decide whether to follow medical routines, participate in social activities and roles, use available health-care resources, and exercise.[7] Self-management is an approach to manage the symptoms associated with MS.[8] It can be described as the individual's ability to manage symptoms, treatment, psychosocial and physical effects, and lifestyle changes accompanied by MS. As a result, MS patients must manage the disease's day-to-day effects on their lives.[6],[9]

Self-management is the process by which individuals learn the skills, strategies, and knowledge needed to manage the physical, psychological, emotional, and social symptoms caused by a chronic illness.[10],[11] Self-management can be affected by several elements. For example, types of treatment methods, age, emotional problems, and deterioration in disease. Because self-management interacts with personal, psychological, and functional variables, these factors cannot be considered separately.[8],[12]

Patients with MS often lose their jobs, social relationships, and economic status due to impairment in physical, psychological, and social aspects.[13] Social support is a term referring to support activities that come from supporting resources such as family, relatives, friends, and health-care providers. The nature of social support lies in the awareness that other people are available to us and are likely to give us help if needed.[14] It plays an important role in every phase of the disease.[1]

Social support may improve the responsibility to control health behavior and contribute to better physical and mental health.[15] Literature concerning MS indicates that there is a positive influence of social support on mental health and psychological symptoms. Increased loneliness, social isolation, and family tension, for example, have been linked to chronic conditions such as MS.[2]

Previous studies revealed that social support has an important role in the quality of life among patients with MS.[13],[16] Social support is correlated with lifestyle self-management behaviors in patients with diabetes.[17] There is a positive relationship between social support and chronic illness self-management in people with asthma, epilepsy, diabetes, and heart failure.[18] In another study, social support is not strongly related to diabetes self-management.[19]

A number of studies have examined the relationship between social support and quality of life, depression, anxiety,[20] pain,[21] fatigue,[22] and self-compassion[23] in MS patients. The existing literature suggests that there is a lack of knowledge around the relationship between social support and self-management specific to the case of patients with MS. Given the nature of the disease and the importance of social support and self-management in the treatment and control of chronic conditions, the purpose of this study was to assess self-management in MS patients and the relationship between this and social support.

  Methods Top

This study was designed as a cross-sectional study. It was approved by the research ethics committee with a code of IR.MUI.RESEARCH.REC.1398.268.


The study sample consists of 212 MS patients who attend Kashani Hospital's MS Clinic and were selected for the study using convenience sampling. To detect a simple correlation r (r = 0.2) between Social Support Scale (MOS-SSS) and MS Self-Management Scale (MSSM) using a two-sided test, 5% significance level test (α = 0.05) with power 80% power (α = 0.2), and considering correlation in formula to 0.2, the required sample size is approximate 194 using a z-test on Fisher z-transformed correlation coefficients using G * Power 3.1 software based on the formula of Negida et al.[24]

Patients with MS were provided with information about the study. Next, followed by signing the informed consent, they participated in the study and completed the questionnaires. The majority of patients completed the questionnaires on their own, with only a few (10 participants) requiring assistance. Patients were assured that the data would be treated as confidential. The researcher returned to the MS clinic several times to complete the required sample size due to an outbreak of COVID-19 disease at the time of sampling and a decrease in patient visits to the MS clinic.

Inclusion criteria were: (1) diagnosis of MS, (2) lack of other comorbidities, and (3) ability to fill the questionnaires. Exclusion criteria, on the other hand, were incomplete filling of the questionnaires. It should be noted that none of the participants were excluded based on these criteria.


The following data collection tools were used:

Self-report with survey items was used to determine sociodemographic variables (age, gender, education level, marital status, monthly income, and employment status) and clinical information (duration of disease and family history).

The MSSM-Revised (MSSM-R) was developed in 2011 by Bishop and Frain. It basically contains 24 items with a 5-point Likert scale (1 – disagree completely, 5 – agree completely). In this instrument, 6 items are related to the health-care provider relationship and communication, 7 items to adherence to treatment and its barriers, 3 to family and community support, 4 to MS knowledge and information, and 4 to health maintenance behavior. The overall score of self-management ranges from 24 to 120, with higher scores corresponding to a higher degree of self-management.[25] Erbay et al. have confirmed the validity and reliability of the scale. The Cronbach's α reliability coefficient was 0.85, indicating high reliability. The test–retest reliability coefficient was 0.84, indicating high consistency.[26] In the Persian version of this MSSM-R questionnaire, Saadat et al. assessed the reliability in terms of internal consistency and corrected item–total correlation. Results showed the internal consistency, as measured by Cronbach's α and test–retest reliability, for the MSSM-R overall (α

= 0.85, r = 0.77) and its reliability was between 0.7 and 0.85 in all subscales.[27]

The Medical Outcome Study Social Support Scale (MOS-SSS) was designed in 1991 by Sherbourne and Stewart. It includes 19 items on a 5-point Likert scale (1 = never to 5 = always), with the lowest score of 19 and the maximum score of 95. To obtain the overall score, all points are summed. In this instrument, 8 items are related to emotional and informational support, 4 items to tangible support, 3 to affectionate support, 3 to positive social interaction, and 1 to additional item. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all alphas >0.91), and are fairly stable over time.[28] Mohammadzadeh et al. (2015) assessed the reliability and validity of the Social Support Scale in its Persian version. The result showed that the Cronbach's alpha coefficient for the Social Support Scale was 0.96. The results of the Social Support Scale and the mental health-related factors overlapped and were capable of evaluating concepts and constructs. The Social Support Scale's various items and overall score have a significant relationship. These coefficients show a significant relationship between the questions and the overall score, indicating convergent validity and internal consistency.[29]

Statistical analysis

First, descriptive analyses of the sample were carried out. Next, the values of quantitative variables in two groups were compared using a t-test, and the values of quantitative variables in three groups were compared using a one-way ANOVA. Then, Pearson correlation was performed to determine the relationship between self-management and perceived social support. Finally, linear regression was performed with self-management and perceived social support as the dependent variables. For all variables under study, the Kolmogorov–Smirnov test has a significance level >0.05. Parametric tests can be used to test the research hypotheses because the distribution of all variables is normal and the test result is not significant for any of the variables. The analysis was carried out using IBM SPSS version 20.0; IBM Corp., (Armonk, NY, USA) software. The results were considered significant at P < 0.05.

  Results Top

A total of 212 people with MS participated in this study. [Table 1] displays the mean scores of self-management and perceived social support in terms of demographic and clinical variables. The sample averaged 37.17 ± 11.25 years old and consisted of 155 (73.1%) women. Most of the participants had a university education, 98 (46.2%), and married 127 (59.9%). The majority of them 132 (62.3%) earn <1 million tomans per month, and 123 (58%) patients are unemployed. About 169 (79.7%) patients had a negative family history of MS, and 121 (57%) participants had been diagnosed for more than a year. Participants' average perceived social support score was 70.7 ± 16.9 and their average self-management score was also 97.7 ± 12.

The result of the Pearson correlation test showed that the relationship between perceived social support and self-management is significant (r2 = 0.60, P < 0.001).
Table 1: The mean scores of self-management and perceived social support in terms of demographic and clinical variables

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Self-management was regressed on the demographic and clinical characteristic variables [Table 2]. According to regression analysis that controlled for the effect of other covariates, people with an academic education had statistically significantly better self-management than those without (b [SE] = 6.83 [2.58], P = 0.009). Furthermore, the amount of perceived social support was increasing significantly for females in comparison to males (b [SE] = 6.04 [1.58], P = 0.03). Married people had a higher mean of perceived social support (b [SE] = 3.31 [1.56], P = 0.007), as did academic MS patients (b [SE] = 7.43 [3.56], P = 0.03) [Table 3].
Table 2: Linear regression analysis: Demographic and clinical variables regressed on self-management

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Table 3: Linear regression analysis on demographic and clinical variables in relation to perceived social support

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  Discussion Top

The current study provided evidence of the level of self-management and social support among a group of MS patients, as well as the association between these variables, and provided insight into elements that may potentially improve self-management and social support. This study found that social support is an important factor affecting self-management in MS patients positively. The results of this study are consistent with those of some other studies that show that social support has a relationship with self-management in different populations of patients, e.g., chronic kidney disease, diabetes, asthma, inflammatory bowel disease, Parkinson's disease, heart failure, and cancer.[17],[30],[31] However, this relationship was not found in some of the studies mentioned.[18],[19] Patients were less comfortable with the assistance they received in the form of personal care, financial help, or diabetes-related self-care.[19] The second noteworthy point is that excessive support from others may increase a patient's dependence on other people. Another issue is that support from those who do not have the correct information can lead to problems.

Several factors can affect the relationship between social support and self-management. However, in general, a person who can build enough social networks according to their needs can more easily manage the disease process. Furthermore, receiving social support may encourage the patient to manage the disease. The participants who had good social support could be caused by the fact that those participants without a high level of social support were less willing to take part in the survey or finish it.[32]

We found that education is associated with self-management, which is similarly supported by previous studies on people with Parkinson's disease[33] and type 2 diabetes.[34] As people's knowledge increases, their level of responsibility and life perception increase as well. Hence, they are expected to manage disease conditions in a better way.

The results of this study showed a relationship between social support and marital status. Being married may provide a good source of social support, and married people feel more secure. This finding is consistent with Thompson's findings regarding perceived social support in African American breast cancer patients.[35]

This study proves several previous studies that showed that gender was correlated with perceived social support.[36],[37] Maybe because they are less willing to ask for assistance or because they are less emotional, men receive less social support than women. In turn, women are more enthusiastic about making different social relations and are emotionally open.

It was found that education is related to social support. This result is in line with the findings of Ozbayir et al., who showed that perceived social support increased along with educational level.[38] Furthermore, educated people may play a more active role in society and make more social connections with other people.


Data were collected in a single city in Iran, which may limit the generalizability of the findings; therefore, future studies with participants from different provinces are suggested. The MOS-SSS is a tool of perceived support availability; it does not provide information about specific sources of support or negative social interaction, which may be an important parameter.[35]

  Conclusion Top

This study showed that social support is associated with self-management in people with MS. The results of the study may have a practical recommendation on the development of the physical and mental health of people with MS. As a result, health-care providers are advised to use this information when targeting and designing education, support, and care for MS patients.


We appreciate all the dear patients who took part in the study despite their illness. Our special thanks to the staff of Kashani Hospital who helped us collect the research group. The vice chancellery for research affairs at the Isfahan University of Medical Sciences provided funding for this research (grant number: 198083).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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