The 2024 Nudges in Health Care Symposium will take place September 26–27 in Philadelphia. Learn more and register

Recruitment Strategies to Promote Ongoing Participation in a Diabetes Self-Management Intervention

Recruitment Strategies to Promote Ongoing Participation in a Diabetes Self-Management Intervention

Project status

Pilot/study with results


Jaya Aysola, MD, DTMH, MPH 

Andrea Troxel, ScD 

Innovation leads


National Institute on Aging


An opt-in approach in studies often recruits only 5 to 15 percent of the target population, reducing representativeness and thereby the ability of the trial to reflect how well participants might do in practice if they receive a given intervention. Opt-out defaults may increase enrollment but also include less motivated individuals and result in lower overall participant engagement and follow-up. Examining these potential trade-offs and the implications can yield useful insights for designing clinical trials of behavioral interventions to improve health outcomes. 


A team of researchers at the University of Pennsylvania leveraged Way to Health to conduct a randomized controlled trial comparing opt-in versus opt-out default recruitment methods on enrollment rates and ongoing participation in a diabetes self-management intervention among patients with poorly controlled diabetes.  

Participants received wireless glucometers and blood pressure monitors and were instructed to monitor their glucose and blood pressure daily and transmit the readings for six months. For the first three months, adherent participants were eligible for a daily lottery incentive. 


Of patients who were given the opportunity to opt-in to the study, only 13 percent signed up. But when the introductory letter framed the program as standard care but allowed patients to opt-out if they wished, enrollment rates nearly tripled to 38 percent.   

Glucometer and blood pressure adherence rates were substantially higher in the opt-in arm and declined in both arms over time. In addition, participants in both arms experienced a decrease in mean HbA1c levels, but there was no significant difference between arms.  

Results from this study demonstrate that opt-out defaults, where clinically appropriate, can significantly improve participation rates. 

Way to Health Specs

Learn more about the platform
Activity monitoring
Arms and randomization
Criteria-based rules
Dashboard view
Device integration
EHR integration
Multiple languages
Patient portal messaging
Patient-reported outcomes capture
Photo messaging
Remote patient monitoring
Schedule-based rules
Survey administration
Two-way texting
Vitals monitoring