byKingston University, London

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A pioneering patient-reported outcome tool, developed by health care 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 inScientific Reports, which examined people with a variety of chronic conditions including type 2 diabetes,cardiovascular diseaseandchronic obstructive pulmonary disease(COPD) and predicted the risk of medication nonadherence and the causes of this behavior.

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 nonadherence risk based on 13 behavioral drivers grouped into four categories: social, psychological, usage and rational. Notably, structural equation modeling 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 nonadherence, further analysis revealed that social and psychological factors, which relate to the patient's identity, societal role, and a reluctance of being told what to do by a prescriber, had a powerful indirect impact on behavior.

"The study has not only demonstrated the predictive value of SPUR to identify nonadherence risk but also identified a novel framework for behavior in terms of the interaction of drivers behind nonadherence, 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 rationalize their nonadherence 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 health care providers who note patients rarely explain nonadherence 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 forpatient careby providing a behavioral 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 nonadherence compared to other widely used patient measures," Dr. Wells explained.

"It can serve as a diagnostic map, guiding health care professionals to understand the nested nature of a patient's behavioral profile. By identifying these deeper layers, providers can choose more targeted behavioral change techniques and a more holistic approach that addresses the patient's discomfort stemming from an interplay of psychological, social and other factors, reducing nonadherence risk in those living with chronic conditions."

Professor Dolgin described how the SPUR tool allowed, for the first time, the opportunity to explore more closely how different factors influenced adherence behavior. "We examined how some of the deeper, more psychological drivers not only directly impact nonadherence 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 behavioral scientists, who know that we rationalize what is otherwise non-rational behavior—both to ourselves and to health care 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 ofchronic conditions.

More information: Kevin Dolgin et al, Predicting and understanding non-adherence in chronic disease: cross-cohort validation and structural equation modeling of the SPUR 6/24 tool, Scientific Reports (2025). DOI: 10.1038/s41598-025-17866-6 Journal information: Scientific Reports

Provided by Kingston University, London