# Design and implementation of a social cognitive theory-based medication adherence coaching intervention

> **NIH NIH K08** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $193,976

## Abstract

ABSTRACT
Dr. Benyam Muluneh’s long-term career goal is to become a leading clinician-researcher in oncology by leveraging health
behavior theories and implementation science methods to promote adherence, access, and equitable cancer care. This K08
Mentored Research Career Development award (PAR-21-299) is an initial step toward developing his research program as
an NIH-funded independent investigator; with this award, he will follow a structured plan, receive expert mentorship, and
conduct research in an ideal environment. Oral anticancer (OAC) agents revolutionized treatment of once-fatal
malignancies by extending survival and delaying progression; however, success often requires a medication adherence
rate >90%. Medication adherence drops from >80-90% in clinical trials (where patients receive adherence support,
proactive symptom management, and the study drug is provided free of charge) to ~40% in clinical practice,
compromising clinical outcomes. The National Cancer Institute (NCI) recommends cancer centers design and implement
health promotion programs (e.g. adherence interventions) guided by health behavior theories, models, and frameworks.
Most published adherence interventions lack NCI’s theory-guided approach: they address known barriers (eg. patient
education and symptom management) without addressing critical moderators of health behavior (eg. social support, self-
efficacy), compromising effectiveness and long-term sustainability. Additionally, many of the existing interventions were
piloted in well-resourced academic medical centers and were not adapted to rural and underserved settings. Our team
piloted an adherence coaching intervention—consisting of tailored education and barrier mitigation—which increased
adherence rates from 48% to 60% in chronic leukemia patients; however, similar to other adherence programs designed
by clinicians, our intervention was not optimally effective (adherence <90%) or sustainable beyond the pilot phase. The
objective of this proposed study is to enhance the effectiveness and sustainability of our adherence coaching intervention
in both urban/academic and rural setting, by integrating social cognitive theory (SCT)—a proven behavioral theory that
conceptualizes health behavior through cognitive, environmental, and behavioral influences —with a well-tested planning
framework called intervention mapping (IM). We will identify cognitive, behavioral, and environmental determinants of
adherence to OACs in both academic/urban and rural settings (aim 1); conduct focus group discussions to adapt our
adherence coaching intervention for local contexts (aim 2); and test the refined adherence coaching intervention in a Type
I Hybrid Effectiveness-Implementation study (aim 3). Through the following training objectives, Dr. Muluneh will
acquire the skills to complete the research aims: gain training and experience in intervention design using health behavior
theories (objective 1); gain training and experience desig...

## Key facts

- **NIH application ID:** 10899647
- **Project number:** 5K08CA279500-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Benyam Muluneh
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $193,976
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10899647

## Citation

> US National Institutes of Health, RePORTER application 10899647, Design and implementation of a social cognitive theory-based medication adherence coaching intervention (5K08CA279500-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10899647. Licensed CC0.

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