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.

Keywords: Cognitive test; Compliance; Health beliefs; Interview; Literature review; Translation.

Fig. 1

Development steps of the SPUR tool. SPUR Social, Psychological, Usage, Rationale

Fig. 2

Selection process of the targeted literature review. *Not related to any of the concepts of interest (i.e., treatment and treatment adherence)

Fig. 3

Evolution of the SPUR tool versions (US English and French). SPUR Social, Psychological, Usage, Rationale, n number of items. *Example of rewording (US English version): SPUR-Test 1: “Medications should only be taken when needed”; SPUR-Test 2: “I believe I can stop taking my treatment for my [health problem] when I feel better.”; SPUR-Pilot: “I believe I can stop my treatment for my [health problem] when I feel better”