A Neutrosophic Framework for Evaluating Peer Education Based on Pender’s Health Promotion Model in Patients with Multiple Sclerosis: A Secondary Mathematical Analysis of Quality of Life, Stress Management, and Self-Efficacy

Background. Multiple sclerosis (MS) is a chronic neurological disease in which physical disability, psychological stress, impaired self-management, and reduced self-efficacy may interact over time. Peer education based on Pender’s Health Promotion Model (PHPM) has been investigated as a strategy for improving quality of life, stress management, and self-efficacy in patients with MS. Classical statistical analyses, however, normally represent observed outcomes by precise numerical summaries and consequently provide limited mathematical language for distinguishing measurement variability from genuine indeterminacy, incomplete information, or conflicting evidence. Objective. The objective of this paper is to develop a neutrosophic framework for representing and analysing clinical outcomes associated with peer education based on Pender’s Health Promotion Model. The framework is applied as a secondary mathematical interpretation of a previously published randomized controlled trial involving 90 patients with multiple sclerosis. Methods. A single-valued neutrosophic representation is developed in which each clinical outcome is characterized by a truth-membership component, an indeterminacy component, and a falsity-membership component. Neutrosophic representations are constructed for quality of life, stress management, and self-efficacy. We introduce neutrosophic change vectors, intervention-effect indices, an indeterminacy-adjusted health-promotion index, and sensitivity procedures. The published summary statistics are retained as the empirical basis; no individual patient-level observations are fabricated. Results. The published clinical study reported significant improvements in quality of life, stress management, and self-efficacy in the intervention group immediately after the educational intervention and at three-month follow-up, whereas corresponding changes in the control group were not statistically significant. The proposed neutrosophic framework preserves these observed directions while explicitly representing uncertainty surrounding the reported aggregate evidence. The resulting formulation makes it possible to distinguish a strong direction of observed change from the degree to which the available evidence remains indeterminate. Conclusions. Neutrosophic modelling provides a flexible mathematical language for clinical education research in which measurements may contain variability, incomplete information, contextual uncertainty, or heterogeneous patient responses. The framework should be regarded as a methodological extension and not as a replacement for conventional randomized-trial statistics. A definitive patient-level neutrosophic reanalysis requires access to the original individual-level dataset.