Pioneering tool developed with Kingston University's help unmasks deep psychological and societal factors for medication non-adherence

A pioneering patient-reported outcome tool, developed by healthcare company Observia with the support of Kingston University, has shown significant promise in predicting the risk of a patient with chronic conditions not following their treatment plan, while also uncovering the deep psychological and social reasons driving the patient’s decision making.

The refined SPUR 6/24 tool was used during a study, published in Nature’s Scientific Reports journal, which examined people with a variety of chronic conditions including Type 2 diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD) and predicted the risk of medication non-adherence and the causes of this behaviour.

The study, conducted by Kingston University academics Professor Reem Kayyali, Dr Chao Wang, Dr Josh Wells, and Co-Founder of Observia, Professor Kevin Dolgin, reflects a cumulative analysis of data from over 1,800 patients collected from five different cohorts in three countries over a period four years.

The SPUR tool used during the study measures non-adherence risk based on 13 behavioural drivers grouped into four categories: social, psychological, usage and rational. Notably, structural equation modelling was used to map the influence of drivers on each other, helping to identify causal links within the model for the first time. 

The results found that while patients often cited practical reasons like forgetting a dosage (usage) or doubting a medicine’s effectiveness (rational) to explain their non-adherence, further analysis revealed that social and psychological factors, which relate to patient’s identity, societal role, and a reluctance of being told what to do by a prescriber, had a powerful indirect impact on behaviour.

“The study has not only demonstrated the predictive value of SPUR to identify non-adherence risk but also identified a novel framework for behaviour in terms of the interaction of drivers behind non-adherence, which had not previously been described” Dr Wells said.

“We have also demonstrated that a patient’s underlying sense of self or an aversion to external instruction may lead them to rationalise their non-adherence by claiming the drug isn’t working or that it’s too much of a financial burden,” Dr Wells said. “This echoes the common experience of healthcare providers who note patients rarely explain non-adherence by simply stating ‘I don’t want to follow instructions’”, he added.

Merely providing education to address a patient’s stated rational or usage concerns may be ineffective if a deeper, understated psychological factor is the true underlying cause. Therefore, the results of the study have direct implications for patient care by providing a behavioural framework for the development of targeted interventions, which can be tailored to each patient. 

“Our findings have validated the SPUR 6/24 tool as a robust predictor of non-adherence compared to other widely used patient measures,” Dr Wells explained. “It can serve as a diagnostic map, guiding healthcare professionals to understand the nested nature of a patient’s behavioural profile. By identifying these deeper layers, providers can choose more targeted behavioural change techniques and a more holistic approach that addresses the patient’s discomfort stemming from an interplay of psychological, social and other factors, reducing non-adherence risk in those living with chronic conditions.”

Professor Dolgin described how SPUR tool allowed, for the first time, the opportunity to explore more closely how different factors influenced adherence behaviour. “We examined how some of the deeper, more psychological drivers not only directly impact non-adherence but also strongly influence some of the more practical and rational drivers. We found that issues surrounding societal identity theory impact the perceived severity of the disease, while psychological reactance affects issues with the treatment, such as side effects,” he said.

 “This is not surprising to psychologists and behavioural scientists, who know that we rationalise what is otherwise non-rational behaviour - both to ourselves and to healthcare professionals - but here we have demonstrated this in a concrete and quantitative way,” he added.

Following the success of the study, future research is planned to confirm the SPUR tool’s effectiveness across an even wider range of chronic conditions.

• Read the study in full in Nature’s Scientific Reports journal.
• Find out more about research at Kingston University.