Introduction

Self-awareness in people with MS has been defined as a realistic examination of one’s beliefs, values, feelings, and abilities and their use in controlling negative emotions and increasing positive emotions (21). In self-awareness, a person with MS is well informed about their physical and psychological states and characteristics and uses them to grow and overcome the disease (22).

Researchers have shown that exercise training has positive effects on the level of self-awareness (23) and mindfulness (24) as well as psychological health (25) of patients with MS (26). On the other hand, researchers in the field of central nervous system injuries have shown in their studies that one of the cognitive variables that undergoes significant negative changes in patients with MS is visual-spatial development (27), such that affected individuals, due to physical injuries that are mainly psychological in origin, become involved in psychosomatic diseases (28) and experience many problems in terms of visual-spatial perception (29). Visual-spatial development is one of the most important foundations of development that plays the role of the primary function of all learning and communication and forms mental representations about the outside world (30), which unfortunately is severely disrupted in patients with MS (31). Research has shown that people with visual-spatial processing problems often have difficulty understanding the larger picture (31) and are easily lost in details, and they also have difficulty understanding complex designs and assembling pieces (32). Research has also shown that deficits in visual ability and perception are directly related to reduced visuomotor function in patients with MS, such that the lower the level of visual ability and perception in a person with MS, the lower the visuomotor performance and perception will be (33).

Some studies have shown that patients with MS have poor perceived physical fitness (34), such that they evaluate their social, emotional, and physical abilities at a lower level than healthy individuals (8)(35). In addition, other studies have reached interesting and, of course, different results, such that the self-control construct mediates the relationship between influential and predictive variables of self-awareness such as visuospatial development, perceived physical fitness, and sports mindfulness in patients with MS (36-37-38). Researchers have recently highlighted the importance of mental balance in the process of performing mindfulness techniques to accelerate the psychological health of patients with MS (39). Therefore, considering the stated issues and the study gaps that exist in previous research and considering the importance of addressing the psychological health of patients with MS, the aim of the present study was to present self-awareness in patients with MS is based on visual-spatial development, sports mindfulness, and perceived physical fitness with the mediating role of mental balance.

Method: The research method was as follows: after obtaining the necessary permits, the researchers went to a comprehensive health center in Boroujerd that was dedicated to providing services to patients with MS. At the beginning of the work, a list of all patients with MS was provided to the researchers. Then, the researchers selected 300 people from that list using a convenience method. In the next step, they were contacted based on their psychiatric and medical records, which included their ID card details, address, and phone number. After the contact was made, a full explanation of the study objectives was provided and their consent was obtained, and the process of presenting and filling out the instruments used in the present study began. The questionnaires were filled out in two ways: in person and virtually via email or ETA and SHAD messengers. Seven people withdrew from cooperation with the researchers for personal reasons and did not return the questionnaires, which the researchers considered as missing data. In the analysis of statistical findings, data related to 293 people were analyzed. In the present study, descriptive statistics (mean, standard deviation, and Pearson correlation coefficients) and inferential statistics (confirmatory factor analysis and path analysis) were used to analyze the collected data using SPSS24 and AMOS24 software.

Results: As Table 4 shows, the standard coefficients of the path of visual-spatial development to self-control (P<0.001, β=0.54), the standard coefficients of the path of visual-spatial development to mental balance (P<0.001, β=0.60), the standard coefficients of the path of visual-spatial development to self-awareness (P<0.001, β=0.67), the standard coefficients of the path of perceived physical fitness to self-control (P<0.001, β=0.59), the standard coefficients of the path of perceived physical fitness to mental balance (P<0.001, β=0.46), the standard coefficients of the path of perceived physical fitness to self-awareness (P<0.001, β=0.52), the standard coefficients of the path of sports mindfulness to self-control (P<0.001, β=0.50), the standard coefficients of the path of The standardized coefficients of the path of sports mindfulness to mental balance (P < 0.001, β = 0.59), the standardized coefficients of the path of sports mindfulness to self-awareness (P < 0.001, β = 0.51), the standardized coefficients of the path of self-control to self-awareness (P < 0.001, β = 0.47), the standardized coefficients of the path of mental balance to self-awareness (P < 0.001, β = 0.57), and the standardized coefficients of the path of mental balance to self-control (P < 0.001, β = 0.63) are significant.

Conclusion: The results showed that the direct effect of visual-spatial development on mental balance is significant. This result is consistent with the findings of studies (14-18-22-23). ​​In these studies, the emphasis on visual-spatial development of the individual causes the affected person to have better and higher mental balance due to the peace of mind and inner satisfaction he has. Therefore, it is because higher visual-spatial development and perception increase the level of mental balance in the person with MS. Another reason for explaining this finding is that in the concept of visual-spatial development there is a subcomponent called awareness and body sensation, which makes the person have a better understanding of his mental and physical conditions. On the other hand, in the concept of mental balance there is a subcomponent of perceptual and sensory acceptance, which makes the person accept his negative feelings and emotions and try to change them into positive emotions. Therefore, it can be said that the reason why visual-spatial transformation can have a positive and significant effect on mental balance is the existence of a common concept and sub-component called body perception and awareness. The results showed that the direct effect of visual-spatial transformation on self-control is significant. This finding is consistent with the results of studies (26-31). The self-control construct in Clinton et al.'s theory means controlling arousal levels in order to perform maximally in difficult situations and refrain from destructive responses such as anger. Also, the concept of self-control is generally understood as the ability to change or adapt oneself to the surrounding world so that better compatibility between the individual and the world arises. On the other hand, the concept of visual-spatial transformation has an important sub-component called the relationship of the individual with the environment. Therefore, one of the important reasons for explaining why the direct effect of visuospatial development on self-control was significant is the existence of a common element of trying to optimally connect the individual with the environment, which exists in both the concept of visuospatial development and the construct of self-control, and therefore this issue is also consistent with theoretical foundations. These findings can be said to indicate that visuospatial development makes the individual feel empowered, which creates the basis for creating and increasing self-awareness. On the other hand, since mental balance also improves the level of visuospatial development and increases self-awareness in people with MS, we conclude that mental balance plays a mediating role between visuospatial development and self-awareness. On the other hand, people who have higher perceived physical fitness and better visuospatial development also have higher self-awareness because high perceived physical fitness and higher visuospatial development allow people to better control their emotions and have more optimal arousal levels. So, in general, and based on theoretical and empirical foundations, it can be said that the existence of common elements in the concepts of perceived physical fitness, visuospatial development, and mental balance has caused them to have a mediating and positive role in the relationship between perceived physical fitness and visuospatial development with self-awareness.

Keywords: Mental Balance, Perceived Physical Fitness, Self-Awareness, Sports Mindfulness, Visual-Spatial Development.

Ethical Considerations

Compliance with ethical guidelines

Ethical considerations have been taken into account in carrying out this research in accordance with the guidelines of the Ethics Committee of Islamic Azad University.

Funding

This study was extracted from the Ph.D. thesis of first author at Department of Sport Psychology of University.

Authors' contribution

All authors contributed equally to the conceptualization of the article and writing of the original and subsequent drafts.

Conflict of interest

The authors declared no conflict of interest.

Acknowledgements

The researcher considers it his duty to acknowledge and appreciate the cooperation of all participants in this study who provided the necessary cooperation in carrying out this research.