Guest Column | January 31, 2025

How "Atomic Habits" Can Help Optimize Patient Recruitment

By Ross Jackson, consultant

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As I tend to do, I’ve again drawn inspiration from business and self-help books to help deliver effective patient recruitment and retention solutions. This is now the third article in the series “Inspired Patient Recruitment — Taking Inspiration from Business Advice Bestsellers.”

This time, I’ve drawn on the techniques recommended in James Clear’s book, Atomic Habits. The book outlines a series of life hacks people can implement to make incremental changes in their own behavior. When compounded together, these can make a significant difference in helping people break out of bad routines and move forward with good ones.

I’ve again imagined two candidates for the role — one of whom wishes to implement the kind of strategies found in the book Atomic Habits, the other entrenched in the same old way of doing things. I always find an inverted approach can help highlight bad practices.

Candidate Interviews: Inspiring Habits Or Sticking To The Same Old Routine?

Could you break down the patient recruitment process into smaller, manageable actions that might feel less overwhelming to potential participants?

Candidate One: I should think that potential participants are more likely to engage if we can simplify the onboarding process. Instead of overwhelming them with all the details at once, I’d like to start with a brief, simple explanation of the trial in layperson's terms. The first touchpoint with the potential participant is often a short phone call or a concise email, followed by easy-to-understand prescreening questions. Each subsequent communication should build on the last, gradually introducing more information as the patient moves through the process. I should think this step-by-step approach would significantly reduce dropout during recruitment.

Candidate Two: I believe in providing all the information upfront. During recruitment, I usually hand participants a large packet filled with all the relevant information they need, including the medical jargon, consent forms, and technical trial details. I feel it’s better to give everything at once, to avoid confusion later. While it’s true that I have seen how this level of detail can sometimes overwhelm patients, I think it's important they understand every aspect of what they’re getting into from the outset.

Is there a core identity or belief your trial could appeal to in order to recruit patients? For instance, could you help make participation become part of their identity as someone who values health, science, or community?

Candidate One: In my current role, I’ve started framing trial participation as a way for patients to take control of their health and contribute to the greater good. The messaging highlights the role participants play in advancing science, plus potentially helping others with similar conditions. I’ve found that patients who see themselves as “health-conscious” or “community-minded” are more likely to participate if we can tap into those identity traits. A good technique has been to use testimonials from previous participants to help reinforce this messaging.

Candidate Two: I wouldn’t say we really need to think too much about aligning participation interest with a patient’s identity. Our focus is on the data we need to collect for the trial, so it would really be a waste of time crafting messages around who the patients are or what they value. I’ve always believed people should want to join because it’s a clinical trial that can help further research — why would their identity matter?

Have you thought about applying the 1% improvement approach to recruitment and retention? If so, what are the small, consistent changes you might implement to make the process easier and more appealing?

Candidate One: I’m always looking for ways to improve the recruitment and retention process incrementally. For example, for a previous trial, I started refining our consent process to make it clearer and more user-friendly. By adjusting the wording, using plain language, plus offering visual aids, we saw a 15% increase in signed consents. We also refined our follow-up strategies with more personalized communications, and I’d certainly say that these small adjustments resulted in higher retention rates.

Candidate Two: To maintain a level of consistency and not confuse the people working on the trial, I’ve rarely tweaked our recruitment or retention processes. Once I’ve set something up, it’s best to stick to it, as changing things even a little is such a hassle. I believe in keeping things simple and sticking to an existing method, and I’m not concerned with making small improvements, as I don’t believe the benefits would be worth the effort.

What environments do you think potential participants are navigating, and how could you design those environments to make trial participation the obvious and easy choice?

Candidate One: I’d really like to redesign our clinical environments to be more welcoming and less clinical — for example, trial sites could offer more comfortable waiting areas and wellness resources. I’d also look to expand access by using decentralized trial methods, allowing participants to join from home by using technologies such as telemedicine. These approaches reduce travel barriers, which can make participation far easier. In digital environments, I’d look to streamline the onboarding process so patients can enroll with just a few clicks and offer relevant immediate support if they get stuck.

Candidate Two: Given how regulated this industry is, participants should adapt to our environment, not the other way around. Our clinic locations are set, and we would expect them to travel for appointments. In my experience, it’s the ones who are not committed that are the least reliable, so I’m not sure we want them in the trial anyway. As for digital tools, again, participants need to show their commitment by learning how we do things, which underlines their suitability to fit in with our methods.

What existing habits might your potential participants already have, and how could you stack clinical trial activities onto those habits?

Candidate One: I’d love to start working closely with participants to understand their daily routines and identify where trial activities could fit in seamlessly. For example, we could encourage participants to complete trial-related tasks, like logging data or taking medication, right after their morning coffee or before getting into their evening routine. We could also sync reminders with health apps or wearables they might already be using (such as a Fitbit or Apple Health), so trial activities could naturally integrate with their established habits.

Candidate Two: I wouldn’t have time to concern myself with participants’ existing habits. Once they’ve been sent a list of trial-related activities, it’s up to them to make time for it. If they can’t fit it into their day, they’re probably not right for us. Given how busy we all are when working on a trial, I certainly couldn’t see how it would be possible to work around participants’ schedules or routines.

Are the tasks you’re asking participants to complete within the “Goldilocks Zone”? That is – challenging enough to keep them engaged, but not so difficult that they feel overwhelmed?

Candidate One: I’d regularly assess the difficulty of tasks we’d be asking participants to complete. For example, if logging daily symptoms feels too burdensome, we could reduce the frequency or make it easier to log the data via a voice-activated or simplified app. On the other hand, it might be fun to include a few engagement challenges, such as tracking fitness goals, to help keep participants motivated. Hopefully, we could strike the right balance to keep participants engaged without it becoming too much for them.

Candidate Two: When managing a clinical trial, it’s essential to ask for as much data as possible, regardless of how difficult or time-consuming it might be. If participants can’t keep up with the requirements, they may not be serious enough about their health. Simplifying tasks just isn’t a priority for us. In keeping with the spirit of the industry, we’d rather get too much information than too little.

How can you make progress visible and motivating to participants? What progress indicators could you introduce to help them see the impact of their involvement over time?

Candidate One: I’d look to introduce visual progress trackers in our patient portal. Participants would be able to see how far they’ve come and, more importantly for motivation, how their involvement contributes to the overall success of the trial. For example, we could show them aggregate data on how the trial is progressing (e.g., 50% of participants have completed this stage). Regular updates on the trial’s impact, such as how their participation is influencing outcomes, should help encourage patients to continue, especially through long trial phases where progress might not feel immediate.

Candidate Two: I don’t believe participants are all that interested in being updated on their progress through the trial. They’ll find out how things went once the trial is over anyway. Regular feedback or visual progress trackers seem an unnecessary extra complication — not to mention being time-consuming and expensive to set up. I don’t really see how that would motivate anyone. The right kind of participants should stay committed without ongoing updates that distract study staff from their core operations.

How might you balance the need for patient engagement with the ease of participating? Could you make things easy enough for participants to get started, while also engaging enough to keep them motivated throughout?

Candidate One: I’d be very keen to simplify the trial enrollment and participation process, such that our forms would be short, easy to understand, and available digitally. At the same time, I’d also make sure to offer meaningful interactions by providing participants with health insights or information about how the trial is advancing medical science. This balance of convenience and value should help reduce barriers to participation while keeping people interested and motivated.

Candidate Two: Once the trial requirements are set, in order to provide valid data, participants need to adjust to them. I feel that simplifying the process would compromise the integrity of the study. If people aren’t willing to put in the work, they’re probably not the right fit for the kind of rigorous, science-based clinical trials I like to be a part of.

A Clear Winner For Better Patient Recruitment And Retention?

While it’s likely that Candidate Two is a committed and dedicated professional, with the best interests of clinical research at heart, I would suggest that the approach adopted by Candidate One — based on the principles outlined in Atomic Habits — will be a more successful one for recruiting and retaining trial participants.

Hopefully, you’ll be able to pick up some tips from the above article, and the book, for improving your own results.

About The Author:

Ross Jackson is a patient recruitment specialist and author of the industry standard books The Patient Recruitment Conundrum and Patient Recruitment for Clinical Trials using Facebook Ads.

Having started with digital marketing in 1998, Ross quickly developed a specialty in the healthcare niche, evolving into a focus on clinical trials and the problems of patient recruitment and retention.

Over the years Ross branched out from the purely digital and now operates in an advisory capacity helping sponsors, CROs, sites, solutions providers, and others in the industry to improve their patient recruitment and retention capabilities – having advised and consulted on over 100 successful projects.