The authors labeled their subject pool a "convenience sample". Participants were recruited with the help of two chapters of the National MS Society in the southwestern United States. One chapter served primarily rural communities and the other large metropolitan areas. Analysis is based on 347 women who responded to a questionnaire at three times: baseline, 18 months and 3 years. Self-reported diagnoses of MS at baseline included 200 relapsing-remitting and 147 chronic progressive subjects. Participants had been diagnosed with MS at least one year prior. Despite the fairly large sample and respectable response rate (86%), the sample has many limitations, including a lack of diversity. The relapsing-remitting and chronic progressive groups identified themselves as 95% and 93% white, respectively. Having subjects that were taken only from the southwestern United States might also affect generalizability. Because analysis was only conducted on women who completed all three questionnaires, it is likely the sample includes those most interested and focused on health promotion practices. An additional limitation of this study is the inherent bias in using self-reported information.