Development of the SPUR tool: a profiling instrument for patient treatment behavior

Abstract

Background Long-term treatment adherence is a worldwide concern, with nonadherence resulting from a complex interplay of behaviors and health beliefs. Determining an individual’s risk of nonadherence and identifying the drivers of that risk are crucial for the development of successful interventions for improving adherence. Here, we describe the development of a new tool assessing a comprehensive set of characteristics predictive of patients’ treatment adherence based on the Social, Psychological, Usage and Rational (SPUR) adherence framework. Concepts from existing self-reporting tools of adherence-related behaviors were identified following a targeted MEDLINE literature review and a subset of these concepts were then selected for inclusion in the new tool. SPUR tool items, simultaneously generated in US English and in French, were tested iteratively through two rounds of cognitive interviews with US and French patients taking long-term treatments for chronic diseases. The pilot SPUR tool, resulting from the qualitative analysis of patients’ responses, was then adapted to other cultural settings (China and the UK) and subjected to further rounds of cognitive testing. Results The literature review identified 27 relevant instruments, from which 49 concepts were included in the SPUR tool (Social: 6, Psychological: 13, Usage: 11, Rational: 19). Feedback from US and French patients suffering from diabetes, multiple sclerosis, or breast cancer (n = 14 for the first round; n = 16 for the second round) indicated that the SPUR tool was well accepted and consistently understood. Minor modifications were implemented, resulting in the retention of 45 items (Social: 5, Psychological: 14, Usage: 10, Rational: 16). Results from the cognitive interviews conducted in China (15 patients per round suffering from diabetes, breast cancer or chronic obstructive pulmonary disease) and the UK (15 patients suffering from diabetes) confirmed the validity of the tool content, with no notable differences being identified across countries or chronic conditions. Conclusion Our qualitative analyses indicated that the pilot SPUR tool is a promising model that may help clinicians and health systems to predict patient treatment behavior. Further steps using quantitative methods are needed to confirm its predictive validity and other psychometric properties.

SPUR: A Patient-Reported Medication Adherence Model as a Predictor of Admission and Early Readmission in Patients Living with Type 2 Diabetes

“…Through the design and delivery of an international multi-arm series of studies in line with the COSMIN criteria, the SPUR tool has been developed as a holistic PROM to assess medication adherence behaviour in patients with long-term conditions. The proposed SPUR model framework 31 and initial model development 32 process have been reported previously. Furthermore, psychometric properties for populations based in the US 33 and France 34 have been reported, in addition to a UK-based cohort of patients living with type 2 diabetes (VMATT2) 35 that produced a more concise SPUR tool – SPUR-27.…”

SPUR-27 – Psychometric Properties of a Patient-Reported Outcome Measure of Medication Adherence in Chronic Obstructive Pulmonary Disease

“…The initial model to holistically address four key drivers of MA, known as SPUR, was developed by Observia, an e-health organisation based in Paris. 19,20 The four key domains of MA termed Social, Psychographic, Usage, and Rational comprise the 45-item measure and can be used to evaluate individual factors and behaviours related to non-adherence. 21,22 Recently, a shorter 27-item version of the SPUR tool (SPUR-27) was validated for patients living with type 2 diabetes in a UK study by Wells et al 23 The revised 27-item model demonstrated greater reliability than the original SPUR-45 tool as well as significant correlations with objective and PROMs of MA in addition to socio-clinical factors such as body mass index (BMI) and income.…”