Introduction

Multiple sclerosis (MS) is a neurodegenerative condition that primarily affects the central nervous system [1], and the prevalence of MS has increased worldwide since 2013 [2]. People with MS (PwMS) report high levels of anxiety, depression, fatigue and stress due to disease unpredictability and an overall chronic disease burden [3,4]. While drug treatments may provide some relief, studies show that they may also be counterproductive due to their common side effects including increased fatigue, cognitive impairment and disability [5]. Psychological interventions (also known as psychological therapies) such as cognitive behavioural therapy, support groups and mindfulness-based interventions provide a safe and alternative treatment option for PwMS, and there is emerging evidence related to their efficacy and use in this population [6–8].

Previous systematic reviews have investigated the efficacy of various psychological therapies for PwMS [9–11]. The authors concluded that these types of interventions may improve physical (e.g., fatigue) and psychological (e.g., anxiety) symptoms, contributing to an improvement of overall quality of life for this population [9]. While previous research has outlined implementation considerations from different perspectives in the context of mindfulness-based interventions for PwMS [12,13], there remains a need to examine implementation strategies more broadly. In addition to evaluating the efficacy of psychological interventions for this population, it is also crucial to investigate how these interventions are implemented in practice to support their uptake and sustainability. This scoping review protocol outlines proposed steps to address this gap.

Implementation of healthcare interventions involves translating evidence-based interventions from research into routine clinical care [14]. More specifically, implementation strategies are methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice [15]. A useful framework to categorize and assess implementation strategies is the Expert Recommendations for Implementing Change (ERIC) framework [15]. Strategies identified in ERIC highlight drivers for implementation success across multiple contexts. This scoping review protocol draws upon this framework as it provides useful guidance to identify key implementation strategies that influence the uptake and impact of an intervention.. Components such as patient engagement, training and clinical integration and infrastructure support [14] need to be explored to contextualize efficacy, assess impact and inform future programs to maximize benefits for PwMS.

Furthermore, one persistent gap in the field of implementation science is the lack of equity, diversity, inclusion and accessibility (EDIA) considerations when developing and implementing new healthcare interventions [16]. Incorporating EDIA considerations, particularly through an intersectional lens, can improve accessibility of healthcare interventions for marginalized and underserviced groups [16]. As Fahim and colleagues note, this approach recognizes how overlapping social identities (e.g., race, gender, socioeconomic status) and structural inequities shape individuals’ experiences and influence the implementation process [17]. Specifically, an understanding of these factors is required to investigate potential barriers and facilitators to implementation, associated implementation strategies, and sustainability of these programs [17] for all PwMS. This lens is particularly important as the rates of MS continue to rise globally (e.g., Iran, Western Europe etc) [2]. An investigation into the implementation and sustainability of psychological interventions will provide policymakers and healthcare professionals with a better understanding of the effectiveness, scalability and adoption of these services in practice. This scoping review protocol integrates considerations for investigating EDIA factors in this context, as it can provide important insight into implementation strategies that promote EDIA factors at the outset. These are crucial elements to ensure that these interventions are both accessible and focused on the needs of PwMS, which can ultimately maximize their mental health and overall wellbeing.

The objective of this paper is to standardize a scoping review protocol for completion of a scoping review. The aims of the proposed scoping review are to: 1) determine the extent of the literature on which implementation strategies have been used to develop, deliver, and sustain psychological interventions for PwMS and 2) investigate how EDIA considerations are embedded within these implementation strategies and psychological interventions more broadly.

Methods

A scoping review was chosen to allow for a broad and comprehensive investigation of the existing literature. It will allow for the identification of both the sources and types of evidence available in this research area. A scoping review methodology will facilitate the inclusion of a variety of study designs (i.e., RCT, mixed methodology, observational, etc.). The research objectives do not focus on assessing intervention efficacy but will rather explore the evidence available to determine what has been done. A scoping review will provide an overview of the existing literature, map the existing implementation strategies that have been developed or used in the literature and highlight future areas of research in this context.

The Joanna Briggs Institute (JBI) scoping review methodology guidance [18] will be used to conduct this scoping review. The reporting of this protocol follows PRISMA-P [19] (S1 File), and The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [20] will be used as a guideline for reporting our scoping review findings. A PRISMA-ScR flow diagram will provide a visual presentation and breakdown of the studies that were screened, excluded and included into the final review. The diagram will identify the number of articles retrieved from the relevant sources and reasons for exclusion at the full text stage.

Discussion

This scoping review will provide novel insights into strategies used to implement psychological interventions for PwMS. These strategies can be used to optimize the implementation of psychological interventions in the future and in diverse contexts as well as inform the development of a toolkit of implementation strategies to optimize implementation. The identification of implementation strategies used across these interventions can further highlight important gaps in current implementation practices such as lack of standardization and underutilized strategies. This review further seeks to identify EDIA considerations embedded within psychological intervention development and implementation strategies to inform future programs to continuously evaluate implications for marginalized and underserviced groups. It will also highlight implementation strategies that integrate and promote EDIA considerations.

Findings from this scoping review will be disseminated through traditional knowledge mobilization channels such as conferences (e.g., endMS conference) and publication in a peer-reviewed academic journal (e.g., Disability and Rehabilitation Journal). Key knowledge users such as policy makers, clinicians and groups who are involved with building psychological interventions can use findings from the review to maximize the development, and implementation of future interventions with considerations related to EDIA characteristics.

This review will have several strengths. The search strategy will be developed with an academic research librarian and peer reviewed using PRESS [19], ensuring a rigorous approach to identifying relevant studies. The use of comprehensive frameworks such as ERIC and PROGRESS-Plus will systematically categorize implementation and EDIA characteristics, contextualized within existing literature and highlighting critical gaps. The review team will include individuals with clinical and academic backgrounds with expertise in scoping reviews and implementation science, ensuring relevancy and applicability to diverse contexts.

Some limitations of this scoping review are anticipated. First, implementation science includes a broad scope of evidence and conceptualizations vary in healthcare literature. The inherent heterogeneity of the term ‘implementation’ makes identifying relevant studies challenging. For example, the term ‘implementation’ may not be included in studies, even though aspects of implementation such as training and staffing considerations were included. To mitigate this, the search strategy included broad terms related to implementation science based on previous literature in the field. Due to feasibility constraints, this review will not include a scope of the grey literature, which may result in the exclusion of implementation literature outside of peer-reviewed contexts.

Supporting information