An Online Nurse-Led Purpose-Focused Group Program for Adult Women With Multiple Sclerosis: Effects on Meaning and Quality of Life

Living with Multiple Sclerosis (MS) involves complex psychological and existential challenges that may influence well-being, identity, and perceived life direction. PURPOSE-MS is a structured behavioral intervention designed to support meaning-making and purpose exploration among adult women with MS. This study uses a repeated-measures, single-group design to evaluate within-participant change across meaning-related constructs and quality of life over a six-week intervention period.

The study integrates two complementary frameworks. The quantitative portion is grounded in the Purpose and Meaning in Life tradition, which conceptualizes meaning as both an evaluative state (Presence of Meaning) and an active cognitive process (Search for Meaning). These constructs serve as the measurable variables for hypothesis testing.

Parse's Human Becoming Theory provides the philosophical structure for how the intervention is facilitated. Consistent with Parse, the intervention prioritizes participants' interpretations, reflective engagement, and the co-creation of meaning within a relational environment. Parse guides facilitator posture and session flow but does not function as the causal mechanism under evaluation.

A single-arm, quasi-experimental repeated-measures design is used. Participants complete standardized assessments at baseline, midpoint, and post-intervention. This design allows examination of temporal change and feasibility ahead of future controlled trials. The analytic strategy focuses on patterns of change rather than group comparisons.

Informed consent is obtained electronically prior to participation. Eligible individuals receive a secure link to the consent form and meet synchronously with study personnel to review the study purpose, expectations, risks, confidentiality protections, and voluntary nature of participation. Participants have the opportunity to ask questions before signing electronically. They are informed that they may withdraw at any time without penalty, may skip any activity, and that data will be de-identified and stored securely. Consent is documented within the institution's approved electronic record-keeping system. No identifiable health information is collected beyond contact information needed for study communication.

The intervention consists of six weekly synchronous group sessions delivered via a secure videoconferencing platform. Sessions are guided by a facilitator manual that standardizes structure, sequence, and fidelity expectations across all cohorts. Weekly sessions include the following components:

1. Opening Orientation (5-10 minutes): Review of group norms, brief grounding, and a reflective prompt related to meaning, identity, or purpose.
2. Guided Reflective Dialogue (25-30 minutes): Facilitated discussion encouraging participants to articulate interpretations of their lived experiences, explore evolving self-concepts, and consider how MS shapes or interacts with their sense of purpose. Facilitators support engagement without directing content.
3. Integrative Meaning Exercise (15-20 minutes): A structured activity (e.g., brief journaling, values clarification task, narrative framing, or identification of meaningful actions) designed to encourage internalization of insights. Exercises are consistent across cohorts but do not require participants to share personal details unless they choose.
4. Closing Synthesis (5 minutes):

Participants reflect on key takeaways and identify one meaning-related intention for the coming week. No assignments are collected as data.

This structure is consistent across all sessions; however, thematic emphasis naturally evolves as participants deepen their engagement with reflective processes. Facilitators complete fidelity checklists each week.

No counseling, psychotherapy, or clinical decision-making occurs within the sessions. The facilitator's role is strictly reflective, supportive, and protocol guided.

Participants complete electronic surveys at three time points. Measures include:

• Meaning in Life Questionnaire-Search (MLQ-S)
• Meaning in Life Questionnaire-Presence (MLQ-P)
• MSQOL-29 These instruments were selected based on reliability, chronic illness relevance, and suitability for repeated assessments over a short intervention period. Data are linked to a unique study identifier and stored in encrypted institutional systems.

Women comprise the majority of adults living with MS and frequently describe meaning-related disruptions following diagnosis, including changes in identity, purpose, and role engagement. Examining meaning and quality-of-life processes within a women-focused cohort provides foundational evidence for future expansions to more diverse populations and allows exploratory examination of meaning-making patterns within a demographic known to encounter distinct illness experiences.

This is a minimal-risk behavioral study. The primary potential risks involve psychological discomfort during reflective dialogue. Participants may pause or decline participation in any exercise. Privacy expectations and strategies to maintain confidentiality in a virtual group setting are reviewed during consent and reiterated at session onset. Because group participants can see one another, confidentiality among members cannot be guaranteed; however, participants may use alternative names if preferred.

Study data are de-identified and stored in compliance with institutional and regulatory requirements.

Descriptive statistics will summarize demographic characteristics and baseline distributions. Repeated-measures ANOVA or linear mixed models will evaluate change over time for each outcome. Model assumptions will be assessed, and corrective methods (e.g., Greenhouse-Geisser adjustment, mixed-effects modeling) will be applied as needed. Effect sizes will be calculated to estimate magnitude of change. Missing data will be evaluated for patterns, and appropriate handling strategies (e.g., model-based approaches) will be used.

This study provides preliminary evaluation of a theoretically anchored, nurse-facilitated behavioral intervention centered on meaning-making among women with MS. Findings will guide protocol refinement, inform sample size estimates for future trials, and contribute to the development of purpose-building interventions within nursing and chronic illness research.