TELESM-edu.Nursing: a Personalised Nursing Intervention for People With Multiple Sclerosis

Change in Navigational Health Literacy (Ability to Navigate Health Systems and Services) Assessed by the HLS19-NAV Instrument From Baseline to 6-Month Follow-up

Navigational Health Literacy will be assessed using the Italian version of the HLS19-NAV Instrument for measuring Navigational Health Literacy. The HLS19-NAV includes 12 items assessing the ability to find, understand, appraise, and apply information needed to navigate health systems and services. Items are rated on a 4-point Likert scale, where 1 = very difficult and 4 = very easy. The total HLS19-NAV score will be calculated as the percentage of positive responses ("easy" or "very easy") among valid responses, provided that at least 80% of items are completed. Scores range from 0 to 100 percentage points, with higher scores indicating better navigational health literacy. Unit of Measure: Percentage points on the HLS19-NAV score, range 0-100.

Change in Health Literacy Level Assessed by the Single-Item Literacy Screener (SILS) From Baseline to 6-Month Follow-up

Health literacy level will be assessed using the Italian version of the Single-Item Literacy Screener (SILS). The SILS consists of a single item assessing how often an individual requires assistance when reading and understanding health-related information. Responses are rated on a 5-point Likert scale ranging from 1 (never) to 5 (always). Scores range from 1 to 5, with higher scores indicating lower health literacy. Based on established SILS cut-offs, participants will be classified as having low health literacy (SILS score ≥3) or adequate health literacy (SILS score \<3). Unit of Measure: Number or percentage of participants classified as having low or adequate health literacy.

Change in Patient Satisfaction With Current Therapy Assessed by a Single-Item Satisfaction Measure From Baseline to 6-Month Follow-up

Patient satisfaction with current therapy will be assessed using a single-item measure. Participants will be asked to indicate their level of satisfaction with their current therapy using three response categories: very satisfied, moderately satisfied, or little satisfied. Participants reporting dissatisfaction will also be asked to indicate the main reason(s) for dissatisfaction, including mode or frequency of administration, side effects, or symptom worsening. Unit of Measure: Patient satisfaction category (very satisfied, moderately satisfied, or little satisfied).

Change in Beliefs About the Necessity of Prescribed Medicines Assessed by the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) Necessity Subscale From Baseline to 6-Month Follow-up

Beliefs about the necessity of prescribed medicines will be assessed using the Necessity subscale of the Italian version of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). The Necessity subscale comprises 5 items rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 5 to 25, with higher scores indicating stronger beliefs in the necessity of prescribed medications. Unit of Measure: BMQ-Specific Necessity subscale score (5-25 points).

Feasibility of the TELESM-edu.nursing Programme Assessed by Participant Retention and Adherence Rates Over the 6-Month Study Period

Feasibility of the TELESM-edu.nursing programme will be assessed in the intervention group by evaluating participant retention, adherence, and dropout rates at 3 months and 6 months. The intervention will be considered feasible if at least 80% of enrolled participants continue to participate in the Telenursing programme at each assessment time point. A dropout rate of 20% or greater will be considered indicative of potential feasibility concerns. Unit of Measure: Percentage of enrolled participants retained in and adhering to the intervention; dropout rate (%).

Acceptability of the TELESM-edu.nursing Intervention Assessed by a TFA-Based Questionnaire at 6-Month Follow-up

Acceptability of the TELESM-edu.nursing intervention will be assessed using five items adapted from the Generic TFA-Based Questionnaire. The items assess five Theoretical Framework of Acceptability (TFA) constructs: Affective Attitude, Burden, Ethicality, Self-efficacy, and Opportunity Costs. Items are rated on a 5-point Likert scale. Burden and Opportunity Costs items will be reverse-scored so that higher values indicate greater acceptability. The overall acceptability score will be calculated as the mean of the five TFA construct items, with higher scores indicating greater intervention acceptability. Unit of Measure: Acceptability score (1-5).

Usability of the TELESM-edu.nursing Intervention Assessed by a Single-Item Measure at 6-Month Follow-up

Usability of the TELESM-edu.nursing intervention will be assessed using a single-item measure developed by the research team to evaluate the perceived ease of use of and participation in the educational programme. Responses are rated on a 5-point Likert scale, with higher scores indicating greater perceived usability. Unit of Measure: Usability score (1-5).

Satisfaction With the TELESM-edu.nursing Intervention Assessed by a Single-Item Measure at 6-Month Follow-up

Overall satisfaction with the TELESM-edu.nursing intervention will be assessed using a single-item measure developed by the research team. Responses are rated on a 5-point Likert scale, with higher scores indicating greater satisfaction with the intervention. Unit of Measure: Satisfaction score (1-5).