People with multiple sclerosis (MS) frequently seek dietary advice; however, online nutrition information is often conflicting and not evidence-based. In people with MS, co-design is particularly important due to the variability of symptoms, the complexity of dietary information available, and the strong interest in lifestyle management strategies(1). To address this, our team developed Eating Well with MS, a co-designed 6-week digital program providing evidence-based nutrition education and behaviour change support for people with MS in Australia(2). A feasibility study (n = 70) showed that the program was acceptable and feasible, with preliminary data suggesting improvements in diet quality, food literacy, and nutrition literacy(2). Building on these findings, this study aimed to further co-design, optimise, and digitally redevelop Eating Well with MS to strengthen its content, behaviour change support, accessibility, and delivery in preparation for evaluation in a large-scale randomised controlled trial (RCT).
A multiphase participatory design process involving people with MS and carers was undertaken between 2023–2026 to inform redevelopment of Eating Well with MS within Platform O, a digital delivery platform with interactive features including user tracking, videos, audios, discussion boards, and other digital resources. The co-design process included: a) semi-structured interviews with prior program participants (n = 16)(3); b) stakeholder (e.g., clinicians and MS dietitians) focus groups (n = 31) and online workshops (n = 9); and c) two Lived Experience Advisory Panel meetings (n = 9). Participants and stakeholders provided feedback on program content, relevance to MS-related needs, behaviour change support, usability, accessibility, digital delivery, and recruitment pathways.
Following this process, key refinements included: a) restructuring of the program content and introduction of a 3-month refresher module, incorporating additional goal-setting and fatigue planning activities to strengthen longer-term behaviour change; b) updated evidence and resources to reflect the latest research; c) new content on different life stages such as pregnancy and menopause; d) integration of audiovisual accessibility features, including text-to-audio narration; e) improved navigation, delivery, and engagement tracking via Platform O, enabling automated module release, embedded analytics, and participant dashboard tracking; and f) expanded recruitment reach and pathways informed by stakeholder consultation.
The Eating Well with MS program was further co-designed, optimised, and digitally redeveloped to support accessible, larger-scale digital delivery and RCT evaluation among people with MS in Australia. Integration of stakeholder and lived-experience perspectives enhanced the program’s relevance, accessibility, and behavioural support prior to evaluating its effectiveness with an RCT.
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