Recipe: re-engaging participants who fall behind

What you get: a routine for keeping participants on track that mostly runs itself. Participants are nudged automatically while a form is open. If they still miss it, your team hears about it the next morning, in a list that says who is overdue, on what, and by how long. The people who need a personal touch get one, through the study's own messaging, and every contact is written up on their record. On the trial overview you can see whether it's working.

What you need: stages with sensible schedules, reminders on the stages that matter, a behind-schedule alert or follow-up list for whoever does the chasing, and an agreed way of recording contact.

This recipe joins up features that each have their own article. Read those for the details of each setting, then come back here for how they fit together:

How the escalation works

Each step only applies to the participants the step before it didn't reach:

  1. Prevent. Every form has a due date that makes sense for that participant, and reminders while it is open.
  2. Notice. Once a form is overdue, the participant is marked behind schedule and your team is told.
  3. Act. A member of staff contacts the participant personally, and records it.
  4. Review. The trial overview shows whether the number of participants falling behind is going up or down.

Then there are the participants who never start at all. They need a separate check, because Trialflare never marks them behind. See Step 6.

Step 1 — Make "behind" mean something

Chasing is only as good as the due dates it chases against. Before you rely on behind-schedule status, check each stage on its Availability tab:

  • Give each form a due date that belongs to the participant. A stage set only to Available to participants, with no schedule, is due from the day the stage was created, not the day the participant joined. Someone who joins six months in is behind on it immediately. Schedule from the participant instead, with Make available after… another stage, or with an anchor such as a start date.
  • Take optional forms out of it. Tick Exempt from "behind" status on forms nobody should be chased for: an ad-hoc symptom report, an optional feedback survey. (Ad-hoc stages never count anyway.)
  • Decide when "late" starts. By default a form is behind from midnight at the end of the day it was due. Set a Behind cutoff time for a daily diary that must be done by 9pm, so it counts as late the same evening.
  • Close forms that go stale. An Availability window closes a form after a number of hours. A daily diary nobody filled in yesterday isn't worth chasing today: once its window closes, it stops counting as behind and stops being reminded.

If your team completes some of the forms themselves, decide whether those should count too. See Counting forms staff complete.

Step 2 — Remind participants while a form is open

On each stage you want completed, open the Reminders tab and add a reminder: an hour in the participant's local time, the channels to use, and the wording.

A reminder is sent every day the form is open at that hour, until the participant completes it or its availability window closes. So a weekly questionnaire with a 9am reminder nudges on day one, again on day two if it isn't done, and so on. That suits a short-lived form and can wear on a long-lived one. Give a long-lived form an availability window, or keep its wording gentle.

Choose the channels carefully:

  • Push is free, but only reaches participants who have allowed notifications on their phone. The participants table shows a bell icon beside those who can receive them. Send everyone else Setting up push notifications, which is written for participants.
  • Email is free and reaches anyone with an email address on their record.
  • SMS and WhatsApp reach people who ignore the other two, and are charged to your wallet. WhatsApp sends a standard reminder, not your wording.

Add a second reminder at a different hour, such as 7pm, for a form that matters more. Each reminder has its own wording, so the evening one can be firmer.

Step 3 — Tell the team when someone falls behind

Whoever does the chasing needs to hear about it. There are two ways, and most teams want the second.

As it happens. Under Settings > Participation > Email updates, tick Email me when a participant falls behind schedule. You are emailed once when someone falls behind, with the forms they are overdue on, and not again unless they catch up and fall behind once more. Site staff get the same alert for their own site: open the site and tick A participant at this site falls behind schedule on its Notifications tab.

As a daily work list. Tick Email me a follow-up list every morning, or the Monday-only version. At 7am UK time it lists everyone who is behind or has something due in the next 7 days, what for, and by when. It isn't sent when there is nothing to follow up. Site staff can get it for their site from the same Notifications tab.

Choose per person. A coordinator who chases every day wants the morning list. A principal investigator who only needs to know when things slip wants the alert, or the weekly list.

Each person subscribes for themselves. The trial-wide options need permission to manage the trial. The site options need only access to that site's participants.

Step 4 — Work the list

The follow-up list is also on screen:

  • On each site's page, the Follow-ups tab lists the site's overdue and due-soon participants, with how late each form is. Each participant ID opens their record.
  • In the participants table, the Behind schedule and Due soon filters show the same people across the whole study. Combine them with a site or group filter, and save the combination with Saved filters so the coordinator can open it in one click each morning. Sort by Seen to see who hasn't opened the app lately.

"Due soon" is worth working as well as "behind". A message the day before a form is due is friendlier than one the day after.

Step 5 — Contact the participant, and write it down

For a participant who hasn't responded to reminders, open their record and use the Messages box on the Information tab:

  • Send via push, email, SMS or WhatsApp, whichever reaches them. Channels the participant can't receive are greyed out. Every message is kept in the study's conversation with them, whichever channel carried it. Over WhatsApp the participant receives a notice that they have a new message, not the text itself.
  • Schedule a message to send at a later time, such as the morning a form opens.
  • Attach a file, such as a reminder of how to complete a form. Attachments go by email and SMS.

When a phone call is needed, add an Event from the participant's Timeline and assign it to a member of staff. Both the staff member and the participant are reminded before it.

Afterwards, write a Note on the participant's record: when you got in touch, how, and what was agreed. That is the contact log. It gives the next person to pick up the participant the history, and shows a monitor that follow-up happened. @-mention a colleague in a note to hand the participant over.

Step 6 — Catch the ones who never start

A participant is only ever marked behind once they have submitted something themselves. Someone who registers and never opens the app is never behind, and never appears on the follow-up list or the Follow-ups tab. The rule stops data your team enters from making participants look late, but it means non-starters need their own check:

  • In the participants table, the Not joined filter shows who has never opened the study.
  • Create a group named Onboarded, tick Add participants automatically, and choose When they complete their first stage. Participants join it as soon as they have done something. In the participants table, filter for Joined and exclude that group (click it twice in the group filter) to see everyone who has opened the study but not yet completed a form. Save the filter.
  • On the trial overview, the Participant journey panel shows how many have started.

For a welcome that does part of this work for you, add an automatic message under Messages > Automatic with Send when the participant joins the trial: how the study works, what to do first, and how to turn on notifications.

Step 7 — Check that it's working

The trial overview's Participant journey panel is where you see the trend:

  • Behind schedule is how many participants have at least one overdue form.
  • Stalled is how many have started but submitted nothing for 14 days. These are the participants most at risk of dropping out quietly, and reminders aren't reaching them.
  • By group and By site show whether the problem is concentrated somewhere: one site with a stretched coordinator, or one arm with a more demanding schedule.

Review it at your regular study meetings. A behind-schedule count that keeps climbing usually means a schedule problem (Step 1) or a reminder problem (Step 2), not a set of unreliable participants.

Groups for targeted messages

Automatic groups that follow progress let you send messages at the right stage of a participant's journey:

  • Onboarded (When they complete their first stage), for a message once they are under way.
  • Completed (When all their stages are complete), for a thank-you, or the next steps after the study.

A scheduled automatic message can be sent to one group's members only, with Send to participants in the group. Membership is checked when each message is sent, so participants move in and out of the audience as their progress changes.

When to stop chasing

Some participants have left the study without saying so. When a participant has told you they are withdrawing, or your protocol says contact attempts should end, mark them as withdrawn. That stops their stage reminders and automatic messages, takes them out of the behind-schedule figures and follow-up lists, and prevents them submitting anything further. Their existing data is kept, and your team can still message them by hand. See Participant management: Acting on several participants at once.

What this flow will not do for you

Nothing messages a participant because they fell behind. Behind-schedule alerts go to staff only. The nudges participants get are the reminders on each stage, and whatever your team sends them.

Stalled participants can't be listed directly. The overview counts them, but no filter in the participants table selects them. Sort by Seen, and work through the participants who haven't opened the app for a fortnight or more.

Data your team enters doesn't make a participant chaseable. Unless you count overdue staff-only stages, a participant whose only data was entered by your team is never marked behind, however late their own forms are.