Research applications

Introduction: SPUR, a Valuable Tool for Research

SPUR is a dynamic and predictive self-assessment questionnaire. Over the past 4 years, several tens of thousands of patients have tested SPUR, and our international research protocol validated the tool with the input of 2,500 patients globally. SPUR reliably detects a patient's risk of non-adherence and accurately articulates the reasons for his/her health behavior along four over-arching dimensions: Social, Psychological, Usage and Rational (the initials form the name SPUR).

SPUR is unique insofar as it allows researchers to:

  • Understand chronic patients’ behavior holistically,
  • Accurately detect the risk of non-adherence, even for naïve patients,
  • Limit bias through usage of Likert scale and non-judgmental question phrasing, and
  • Adapt suggestions for patient support.

Theoretical Frameworks behind SPUR

SPUR™ aggregates and distills decades of proven theories and models in behavioral science into a single validated digital tool. SPUR’s building blocks were informed by the following theories and models,

  • the Health Model Belief, established in the 1950s, which posits that a patient's beliefs in both the threat represented by the illness and the efficacy of the recommended treatment will determine his/her adherence to the recommended behavior,
  • the Theory of Planned Behavior, developed in the 1980s, which posits that behavior change requires active decision and planning, and that intentions to perform behaviors of different kinds can be predicted accurately from attitudes toward the behavior, subjective norms, and perceived behavioral control,
  • the COM-B model, developed in early 2000s, which identifies three factors that need to be present for any behavior to occur: capability, opportunity and motivation, and
  • the Transtheoretical Model of Change, developed in the 1970s, which lays out six stages of intentional change within health behavior change.

Various profiling approaches have built on the successes and addressed the shortcomings of their predecessors. One of the innovations of SPUR is its focus on the motivational dimension, through the evaluation of psychological drivers with demonstrated influence on adherence in chronic patients: rejection of identity as a patient, reactance and discounting of future benefits.

Health Behavior in Four Dimensions

Within the four over-arching dimensions of health behavior, SPUR calculates a score for 13 individual drivers:

These drivers relate to how patients behave according to their perceived role in society.

S1: IMMEDIATE - The degree to which a patient's beliefs about their role and social standing in their entourage are affected by their pathology.
S2: SOCIETAL - The degree to which a patient’s beliefs and attitudes about social norms and their potential impact on behavior are affected by their pathology.


These drivers relate to the psychological attitudes that impede patients’ ability to act on planned behavior.

P1: IDENTITY - The degree to which the idea of being a “patient” is traumatic, leading some to reject this identity.
P2: REACTANCE - The degree to which the patients has a negative responses to authority, namely the authority represented by their HCP.
P3: TIME - The degree to which a patient discounts future benefits.


These drivers relate to the patients' ability to access and follow treatment.

U1: SELF-EFFICACY - The degree to which the patient is capable, physically, or mentally, of following the treatment.
U2: FORGETFULNESS - The degree to which the patient will remember to take the treatment.
U3: AVAILABILITY - The degree to which the the patient will have trouble obtaining the treatment.
U4: FINANCIAL - The degree to which the the patient lacks the financial or practical resources to follow treatment.


These drivers refer to cognitive and educational elements impacting behavior or the capacity of the patient to project the benefits/risk balance of the treatment or disease on their life.

R1: DISEASE GRAVITY - The degree to which the patient underestimates the severity of the disease or its future complications.
R2: DISEASE SUSCEPTIBILITY - The degree to which the patient underestimates the danger of disease progression to them.
R3: TREATMENT BENEFIT - The degree to which the patient is convinced of the importance of the treatment.
R4: TREATMENT RISK - The degree to which the patient is concerned about obstacles to the treatment, such as side effects.

 

 

Use cases

The use cases for researchers for SPUR include,

  1. Impact of attitudes for naive patients or those undergoing treatment on behavior in a certain pathology/geography,
  2. Health economics: Longitudinal studies of impact of interventions to improve adherence,
  3. Study of the SPUR tool itself, as a newly validated tool, in more pathologies/geographies/languages.

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SPUR is free for funded and unfunded academics

You may immediately download a guide with the questionnaire to start to envision the integration of SPUR into your research protocol.

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