Psychological and societal factors can be reasons why people living with type 2 diabetes do not respond to medication
A new tool can uncover why people living with chronic health conditions may not follow recommended to medical treatments.
Researchers have developed a tool that can uncover some of the deep psychological and societal factors for not following recommended medication treatment plans in people living with chronic health conditions.
Researchers used a pioneering patient-reported outcome tool, developed by healthcare company Observia with the support of Kingston University, to predict the risk of a patient with chronic conditions not following their treatment plan.
The results of the study recently published in the Nature journal Scientific Reports showed significant promise in uncovering the deep psychological and social reasons driving the patient’s decision making.
Researchers now hope the results of their study can be used to help healthcare workers develop tailored interventions for patients to prevent not following recommended medication treatment plans.
The refined SPUR 6/24 tool was used during the study, which examined people with a variety of chronic health conditions including type 2 diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD).
The study included figures from 1,800 patients collected from five different cohorts in three countries over a period four years.
The research was conducted by Kingston University academics Professor Reem Kayyali, Dr Chao Wang, Dr Josh Wells, and Co-Founder of Observia, Professor Kevin Dolgin.
Researchers used the tool to predict the risk of not following recommended medication treatment plans and the causes of this behaviour based on 13 behavioural drivers grouped into four categories: social, psychological, usage and rational.
The results found that patients often cited practical reasons like forgetting a dosage (usage) or doubting a medicine’s effectiveness (rational) to explain why they were not taking medication.
However, further analysis revealed that social and psychological factors, which relate to patient’s identity, societal role, and a reluctance of being told what to do by a prescriber, had a powerful indirect impact on behaviour.
Dr Wells said: “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.
“We have also demonstrated that a patient’s underlying sense of self or an aversion to external instruction may lead them to rationalise their non-adherence by claiming the drug isn’t working or that it’s too much of a financial burden.
“This echoes the common experience of healthcare providers who note patients rarely explain non-adherence by simply stating ‘I don’t want to follow instructions’.”Researchers were concerned that providing education to address a patient’s stated rational or usage concerns could be ineffective if a deeper, understated psychological factor was the true underlying cause.
Therefore, the results of the study have direct implications for patient care by providing a behavioural framework for the development of targeted interventions, which could be tailored to each patient.
Dr Wells added: “Our findings have validated the SPUR 6/24 tool as a robust predictor of non-adherence compared to other widely used patient measures.
“It can serve as a diagnostic map, guiding healthcare professionals to understand the nested nature of a patient’s behavioural profile. 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.”
Professor Dolgin said: “We examined how some of the deeper, more psychological drivers not only directly impact non-adherence but also strongly influence some of the more practical and rational drivers. We found that issues surrounding societal identity theory impact the perceived severity of the disease, while psychological reactance affects issues with the treatment, such as side effects.
“This is not surprising to psychologists and behavioural scientists, who know that we rationalise what is otherwise non-rational behaviour – both to ourselves and to healthcare professionals – but here we have demonstrated this in a concrete and quantitative way.”
Future research is planned to assess the SPUR tool’s effectiveness across a wider range of chronic health conditions.
Read the report in the Nature journal Scientific Reports
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