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Patients’ risk of not adhering to medication plans can be predicted by the ‘Social, Psychological, Usage and Rational’ (SPUR) tool, which can also help understand social and psychological factors behind non-adherence, leading to more personalised interventions, according to a study.
In the study, published in Nature Scientific Reports on 26 September 2025, researchers retrospectively examined 1,800 patients with chronic conditions, over four years across three countries: the UK, US and France — more than half of which had type 2 diabetes mellitus (T2DM).
Researchers used the SPUR tool, which measures non-adherence risk by looking at the drivers behind non-adherence and places those drivers into four categories: social, psychological, usage and rational.
In this study, researchers used a SPUR 6/24 model, which features six initial questions followed by a further 24 questions. Researchers analysed the reasons why people with long-term illness may not take their medicine as directed.
Study authors said that while people often cite rational reasons, such as simply forgetting or the cost or perceived lack of effectiveness of the medicine, there are very often deeper reasons, such as a patient’s feelings about how their illness and its treatment affect their social interactions, or how they feel their illness influences their role in society.
Support for non-adherent patients may not be effective if there is a deeper, underlying reason behind the patient’s reluctance — especially if those reasons are more related to social or psychological factors, the authors said.
However, the authors noted that a potential limitation of the study was a high representation of people with T2DM, which could have led to an overrepresentation of the behavioural, psychological and social dynamics specific to this condition.
“Diabetes, particularly T2DM, is well-documented to involve a complex interplay of psychological constructs, such as identity conflict, health-related distress and social stigma, which may accentuate the role of psychological and social factors in adherence behaviour,” they said.
In a press release published on 4 November 2025, study author Joshua Wells, honorary lecturer at Kingston University, commented: “The study has not only demonstrated the predictive value of SPUR to identify non-adherence risk but also identified a novel framework for behaviour in terms of the interaction of drivers behind non-adherence, which had not previously been described.
“By identifying these deeper layers, providers can choose more targeted behavioural change techniques and a more holistic approach that addresses the patient’s discomfort stemming from an interplay of psychological, social and other factors, reducing non-adherence risk in those living with chronic conditions.”
Commenting on the study, Stefan Ecks, senior lecturer in social anthropology at the University of Edinburgh said: “Taking medicines long-term can quietly reshape how people see themselves. When daily treatment becomes part of life, it can blur the line between ‘being ill’ and ‘being a person’, and that can make adherence emotionally difficult.
“Some begin to feel that the medicine defines them, others resist it because it reminds them of a vulnerability they’d rather forget. Helping them means recognising that non-adherence is often not about forgetfulness or misunderstanding, but about the struggle to stay whole while living with a medical label. What helps most is not more instruction, but genuine conversation: making space for people to express what the medicine means to them.
“Pharmacists can play a key role here, not just by explaining treatment, but by listening for these quiet tensions and helping patients find a way to live with their medicines rather than under them.”
Read more: ‘How do we solve a problem like medicines adherence?’
- This article was amended on 17 November 2025 to include additional independent comment
