Probst, YasmineStefoska-Needham, AnitaAllogmanny, Shoroog Mohammad A2026-04-022025Allogmanny et al., 2025https://hdl.handle.net/20.500.14154/78558Co-developed digital nutrition educational resources to support integration of nutrition and metabolic comorbidity management into routine MS clinical care.Although multiple sclerosis (MS) has no cure, nutrition has the potential to delay MS-related disability progression and improve quality-of-life for people living with MS (plwMS) by managing metabolic comorbidities, some symptoms and malnutrition. Current evidence-based nutrition approaches for MS align with national dietary guidelines. However, plwMS often encounter contradictory, non-evidence-based nutrition advice, creating confusion and nutritional risk without clear guidance from healthcare professionals (HCPs). Routine MS care offers an ideal setting for supporting nutrition care, defined as practices by HCPs to improve nutritional status through screening, advice, or referral. Effective implementation requires sufficient knowledge, skills and educational resources. However, the educational resources available for HCPs remain unclear, and there is a paucity of evidence investigating the perspectives and needs of key stakeholders, namely HCPs and plwMS, regarding the integration of nutrition into routine MS care. This PhD research aimed to co-develop nutrition education resources with key stakeholders and evaluate their usability to support the integration of nutrition into routine MS care. Four interrelated studies were undertaken, guided by the Design Thinking framework (Empathising, Defining, Ideating, Prototyping, and Testing) and underpinned by principles of Participatory Action Research. It was hypothesised that nutrition-related care should be integrated into routine MS care to empower plwMS to improve their health, thereby mitigating some MS-related complications (e.g., metabolic comorbidities). Nutrition education resources may be required to support HCPs in facilitating this integration. Study 1, a scoping review of peer-reviewed (n = 7) and grey literature (n = 32), identified a scarcity of evidence-based, MS-specific nutrition education resources. Of the 13 resources addressing nutrition, only two were HCP training programs and two were patient education materials (PEMs); none were co-developed with key stakeholders. These findings informed subsequent studies. Study 2 surveyed 35 dietitians and 66 non-dietitian HCPs to examine current practices, perceptions, confidence, and resource needs related to MS nutrition care. While 73.3% reported providing nutrition advice, only 28.7% routinely screened for malnutrition. Dietitians reported significantly higher perceptions of role importance, relevance of nutrition management for MS and its symptoms, and confidence in providing nutrition advice compared with non-dietitian HCPs, though dietitians’ median confidence scores were not “very confident”. Nearly all respondents expressed a need for MS-specific nutrition education resources. Study 3 involved six focus groups with 25 plwMS to explore their experiences and needs. Qualitative analysis generated three key themes and seven subthemes: (1) nutrition guidance is overlooked in routine MS care due to HCPs prioritising medication over nutrition, resulting in the perception that plwMS are their own nutrition educators; (2) routine nutrition guidance is needed, highlighting the desire to receive meaningful MS-related nutrition information from HCPs with nutrition knowledge for MS; and (3) person-centred care is a priority, highlighting the importance of acknowledging that no one-size-fits-all approach exists for plwMS, and supporting a holistic approach to the coordination of nutrition care. Studies 1–3 informed Study 4, structured in three phases. Phase 1 included two workshops (n = 9 HCPs; n = 14 plwMS) and ten HCP interviews to understand the problem and ideate solutions. Four themes were generated: (1) addressing healthcare barriers to providing nutrition education in MS care; (2) supporting person centred nutrition communication; (3) fostering equity through accessible and inclusive MS-specific educational resources, such as an online website hosting downloadable PEMs and HCP learning materials; and (4) the integral role of the dietitian in MS care. Phase 2 developed prototypes, a clinician guide, a screening tool, and PEMs, hosted on a central website. Phase 3 tested prototype usability via interviews (18 HCPs; 15 plwMS), generating four themes: (1) clear, targeted messaging; (2) visually engaging and informative design; (3) lived experiences informing choices; and (4) trust, credibility and connection. Feedback guided resource refinements to support their adoption into MS care. Overall, this PhD research found that nutrition is overlooked in routine MS care, highlighting a clear need for its integration through nutrition education resources. Effective nutrition care for plwMS requires an individualised, person-centred approach supported by a multidisciplinary healthcare team to empower informed nutrition choices and address MS management, including metabolic comorbidities. This research led to the co-development of MS-specific, evidence-based, digitally accessible nutrition educational resources.306enClinical nutritionNutrition and dieteticsMultiple sclerosisNeurological diseasesMetabolic comorbiditiesClinical careProfessional education and trainingEducational counsellingThesis