Adherence Automation: From Nags to Nudges - Part I

In research, adherence has long been treated as a stubborn problem — and, too often, a tolerable one. Across clinical and behavioral studies, participant adherence routinely hovers around 50%. Even interventions designed specifically to improve adherence succeed only about half the time. Over the years, these low numbers have become normalized, almost expected. But every missed survey, skipped check-in, or ignored task erodes data quality, drains resources, and undermines the very purpose of the study.

The good news: low adherence isn’t inevitable. With the right system design, it’s possible to reach and sustain rates far higher than the industry norm.

Moving Beyond Nags

At Alethios, we’ve built an adherence automation system that rethinks reminders from the ground up. The goal isn’t to flood participants with emails until they comply. It’s to create a rhythm they can rely on:  consistent enough to build habit, but never overwhelming.

Here’s how it works:

• Instruments, not isolated tasks. Instead of pinging a participant for every single survey or activity, related tasks are bundled into instruments. A daily check-in survey and an activity questionnaire might arrive together in one notification. This approach reduces inbox clutter and helps participants see tasks as part of a manageable routine.
  
  
• Automated email reminders. Notifications are sent at predictable and consistent times, triggered by the study design. Participants quickly learn to expect them — much like they expect a morning news update or calendar alert.
  
  
• Balance, not burnout. By grouping surveys and avoiding unnecessary repetition, the system prevents “notification fatigue.” Participants stay engaged without feeling nagged.
  
  

The Results

We measure adherence as the number of tasks completed compared to the number of tasks made available. Using this automation framework, our studies consistently achieve around 95% adherence, nearly double the rates that are commonly reported in the field.

Why? Because participants adapt. They come to expect their reminders, they trust the cadence, and they don’t feel overloaded. The system strikes the balance between accountability and respect, turning what could feel like a barrage of emails into a familiar, almost invisible routine.

Why It Matters

• Cleaner data. High adherence means fewer gaps, stronger statistical power, and more credible outcomes.
  
  
• Better participant experience. When reminders feel like support instead of pressure, participants remain engaged and satisfied throughout the study.
  
  
• Scalable systems. Automation eliminates the need for constant manual follow-up, making it feasible to run larger and more complex studies without sacrificing adherence.
  
  

Adherence shouldn’t be the weak point of research design; with thoughtful automation, what many long accepted as an unavoidable cost of running studies becomes a competitive strength.

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Rapoff, M.A., Duncan, C., Karlson, C. (2023). Definitions of Adherence, Types of Adherence Problems, and Adherence Rates. In: Adherence to Pediatric Medical Regimens. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-031-27484-8_1

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