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Adherence isn't a single number you tally at the end of a study — it's earned week by week. Milestones let researchers break a study into checkpoints, each with its own adherence criteria and compensation, so participants always know what they're working toward and researchers always know who's on track.
In Part 1 of this series, we covered how bundled reminders turn nags into nudges. In Part 2, we introduced the Stoplight — the color-coded status that tells participants exactly where they stand. Part 3 is about structure: how researchers define where adherence gets measured, and what participants earn when they hit the mark.
In most studies, adherence is treated as one long tally that gets settled at the very end. That creates two problems. Participants in a 12-week study wait months for any recognition of their effort — a long time to stay motivated with nothing along the way. And researchers get no natural checkpoints to review who's on track, approve compensation, or catch problems before they compound.
We recently launched a solution to solve both problems - milestone-based adherence and compensation.
A milestone is a checkpoint in the study. For each one, you set three things: when it falls, how adherence is evaluated, and what compensation participants earn for meeting it.
Milestones can be placed on any day of the study you choose, counted from each participant's enrollment start. That means you can anchor them to the moments that matter most — a kit return, the end of an intervention period, a mid-study check — rather than an arbitrary calendar. And because decentralized studies enroll on a rolling basis, every participant hits their milestones on their own clock, and Alethios tracks it all automatically.
One of the most consequential choices in milestone design is the evaluation mode:
Per Period evaluation pairs naturally with what we discussed in Part 2: missed tasks tend to snowball, and the "I already slipped, so why try?" trap is one of the biggest drivers of dropout. When a rough first week can't drag down the whole study, participants have a real reason to re-engage at every checkpoint — a recoverable blip stays a blip.
Not every checkpoint is about survey completion. Alethios supports two types of milestone criteria:
In practice, most studies mix both. A gut health study might use a custom milestone at Day 7 for returning blood spot and stool test kits, a task-based milestone at Day 28 requiring ≥80% adherence, and a final task-based milestone at study completion.
Each task-based milestone carries adherence thresholds — the same green, yellow, and red bands that power the participant Stoplight. The upper threshold is the milestone's target; each participant's adherence shows as a green, yellow, or red status against it.
These thresholds work in both directions. For participants, they set transparent expectations during the study — no surprises about what "on track" means. For researchers, they inform the decision to approve or reject compensation when the milestone arrives.
Just as important: none of this is hidden machinery. Participants see their milestones, their adherence status, and the compensation attached to each checkpoint right on their Alethios dashboard. They always know what's coming next, how they're tracking against it, and what they've earned — which is exactly what keeps people engaged through a long study.
Every milestone can carry compensation:
You also set a distribution window: the number of days after each milestone within which you'll review participants and approve or reject compensation. Participants know when to expect a decision, and your team has a defined review cadence instead of an open-ended backlog.
When participants reach a milestone, they appear in the Compensation Distribution dashboard — a single queue for reviewing everyone who's due for a decision. You can filter by milestone, by study arm, or by enrollment ID, and see each participant's adherence and status at a glance before approving or rejecting.
Privacy is the default: participants appear by de-identified enrollment ID, with identifying details hidden behind a deliberate toggle. Review happens on the data that matters — adherence against the criteria you set — and pending, distributed, and rejected decisions are tracked in one place for a clean audit trail.
Adherence isn't one number you tally at the end of a study. It's earned week by week, and it should be recognized the same way.
Milestones give researchers the structure to measure adherence where it matters, reward it promptly, and review it efficiently — while participants get clear expectations, regular checkpoints, and compensation that tracks their actual effort.
Combined with automated nudges and the Stoplight, milestones complete the picture: a system where staying adherent is the path of least resistance. That's what adherence automation looks like — and it's exactly what Alethios was built to deliver.
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Whether you're a researcher or participant, Alethios makes health research effortless and impactful.
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