Exploring self-management of bladder dysfunction among people with multiple sclerosis in the Republic of Ireland

Bladder dysfunction is one of the most distressing symptoms of Multiple Sclerosis (MS) and affects several important life domains. It can affect up to 75% of people with MS. As there is no cure for MS, effective symptom management is the goal of rehabilitation. Given the sensitive nature of bladder dysfunction, facilitating strategies that can be used independently may be an optimal approach to managing this disruptive symptom. The overall aim of this thesis is to inform the development of a self-management resource to enable people with MS to self-manage bladder dysfunction. The literature review provided the background to the topic by examining current research on the prevalence, impact, current service provision, management—including self-management—of bladder dysfunction. This review demonstrated that a wide range of bladder symptoms exist among people with MS and a lack of clarity remains around current service provision for people with MS with bladder dysfunction in the Republic of Ireland. A mixed methods approach was employed in this project involving three distinct but interlinked research strands. Each strand was built sequentially on the preceding one. Nineteen people with MS were interviewed in Strand 1. Findings demonstrated how bladder symptoms interfered with quality of life for people with MS and identified the existing barriers to accessing services. These findings informed the questioning route for a qualitative exploration of perspectives of healthcare professionals (n=14) in Strand 2. This study provided a novel insight into how the underlying beliefs of healthcare professionals may influence clinical practice and how challenging these beliefs are important in relation to bladder dysfunction. Findings from Strand 1 and 2 both guided the development of the online questionnaire (n=213) used in the final strand of the thesis. This final strand compared current approaches to assessment and management of bladder dysfunction between both people with MS and healthcare professionals. The challenges and needs around facilitating self-management of bladder dysfunction were also explored. This project demonstrated important outcomes for people with MS, healthcare professionals and policy-makers in the Republic of Ireland. Education is needed for both people with MS and healthcare professionals to address their lack of knowledge in relation to management strategies. This research provides an evidence and theory base to inform the development of an educational resource to facilitate the self-management of bladder dysfunction among people with MS.