The refined SPUR 6/24 tool was used during a study, published in Scientific Reports, which examined people with a variety of chronic conditions including type 2 diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD) and predicted the risk of medication nonadherence and the causes of this behavior.

The study, conducted by Kingston University academics Professor Reem Kayyali, Dr. Chao Wang, Dr. Josh Wells, and Co-Founder of Observia, Professor Kevin Dolgin, reflects a cumulative analysis of data from over 1,800 patients collected from five different cohorts in three countries over a period four years.

The SPUR tool used during the study measures nonadherence risk based on 13 behavioral drivers grouped into four categories: social, psychological, usage and rational. Notably, structural equation modeling was used to map the influence of drivers on each other, helping to identify causal links within the model for the first time.