The SPUR Model: A Framework for Considering Patient Behavior

Abstract

Background

Medication nonadherence is a global problem that requires urgent attention. Roughly half of all drugs that are prescribed for chronic treatments are not taken by the patients in question. Initiatives designed to support patients and help them modify their behavior are enhanced by personalization, and a number of profiling tools exist to help customize such interventions. Most of these tools were originally designed as paper-based questionnaires, but the growth of digital adherence technologies (DATs) illuminate the need for the development of digital profiling systems that can interact with fully automated patient interfaces.

Objective

The objective of this study was to examine existing frameworks from medicine, psychology, sociology, consumer behavior, and economics to elaborate a comprehensive, quantitative profiling approach that can be used to drive the customization of patient support initiatives.

Results

Building primarily on Icek Ajzen’s Theory of Planned Behavior (TPB), the Health Belief Model (HBM) was used to inform the beliefs about behavior posited in the TPB, while incorporating established factors regarding self-efficacy in the “control” elements of the TPB and selected social and psychological factors in the other constituents of the model. The resulting SPUR (Social, Psychological, Usage, Rational) framework represents a holistic, profiling tool with detailed, quantitative outputs that describe a patient’s behavioral risks and the drivers of that risk.

Conclusion

An interactive, digital questionnaire built around SPUR represents a potentially useful tool for those desirous of building interactive digital support programs for patients with chronic diseases.

Keywords:

• adherence
• compliance
• health beliefs
• chronic diseases
• review

Abbreviations

DAT, Digital Adherence Technologies; HBM, Health Belief Model; PAM, Patient Activation Measure; PSP, Patient Support Program, SPUR, Social, Psychological, Usage, Rational; TPB, Theory of Planned Behavior; TTM, Transtheoretical Model; WHO, World Health Organization.

Acknowledgments

The author would like to thank John D. Piette, Reem Kayyali, Marie-Eve Laporte and Benoit Arnould for their input and critical review of the manuscript; Lea Kombargi for her support in preparing the manuscript; Béatrice Tugaut for her support in submitting the manuscript.

Author Contributions

The author contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agrees to be accountable for all aspects of the work.

Ethics Approval and Informed Consent

This study did not require any ethics approval.

Funding

This study was funded by Observia.

Disclosure

Kevin Dolgin is an employee of Observia. The author reports no other conflicts of interest in this work.