When participants don't want an app

Some participants simply do not want another app on their phone. Not because they are disengaged, but because they do not like notifications, have limited storage, feel uncomfortable about data use, or have accessibility needs that make apps impractical.

Forcing everyone into a mobile app experience is not always the right approach, and there's genuine survey evidence behind just how varied preferences actually are. A study of 55 participants with chronic health conditions found a clear split by relationship: when communicating with friends and family, most preferred a messaging service (69.6%) or text (80.4%). When communicating with a healthcare provider, the preference flipped, with 72.7% favouring a phone call instead. For reporting symptoms specifically, the largest groups preferred a phone or video call (50.9%) or a touchscreen on their own device (47.3%), and a meaningful minority (36 to 42%) were genuinely interested in having questions read aloud and answering verbally, a channel most study designs don't even offer as an option. Here are alternatives that still allow studies to collect quality data without asking participants to install anything.

Option 1: Web-based access

A secure website that participants can reach through any browser, on any device, with no installation required. Easily updated without participant action, it works across phones, tablets, and laptops.

Best suited for:

• Simple diary entries and symptom logs
• Surveys and questionnaires
• Reviewing consent or study documents

Make sure the experience is mobile-optimised and uses secure logins or magic links to reduce the barrier to entry. Notably, 72.7% of respondents in the study above preferred to report symptoms using their own phone rather than a study-provided one, which is a point in favour of a browser-based approach that works on whatever device someone already carries.

Option 2: SMS

Text messages with instructions or questions, with participants responding by reply. Familiar, requires no internet, and minimal technical support to maintain.

Works well for:

• Daily medication or supplement reminders
• Short symptom check-ins with limited question sets
• Visit confirmations and scheduling

Not suitable for complex question logic, branching, or anything involving sensitive data that should not travel over standard SMS.

Option 3: Phone calls

Scheduled or on-demand voice calls for data collection, reminders, or welfare checks. Takes more staff time than other channels, but provides a personal quality that can meaningfully reduce dropouts in populations less comfortable with digital tools. The preference data above supports this directly: when it came to their healthcare relationship specifically, phone contact was the clear favourite, at a rate that dwarfed every other channel tested.

Particularly useful when:

• Participants have low digital literacy
• Access to devices or internet is inconsistent
• The study population includes older adults or those with cognitive or visual needs

Option 4: Paper with remote support

A physical diary or logbook posted to participants, with SMS or phone support alongside. In some studies, the physical act of logging is itself meaningful to the participant or part of the intervention. Hybrid setups also work: a paper backup for participants who hesitate about the app, while the rest use digital tools.

A fifth option worth watching

The research above surfaced a channel that barely features in most trial technology today: voice interaction, where a device reads out questions and the participant answers verbally rather than typing or tapping. A meaningful minority of participants expressed real interest in this, which is worth noting as voice assistants and conversational interfaces become more capable and more familiar in everyday life. It's not yet a mainstream option for most trial technology stacks, but it's a genuine signal of where participant comfort may be heading next, not a niche preference to dismiss.

The goal is not to convince a reluctant participant that the app is actually fine. It is to find a method that suits how they prefer to engage and keeps them in the study. The best tool is the one they will actually use, and the evidence increasingly suggests that "one tool for everyone" was never the right target to begin with.

Offering a genuine choice at onboarding, rather than defaulting everyone into the same channel and treating requests for an alternative as exceptions to be handled case by case, is a small design decision with an outsized effect on who actually stays engaged through the length of a study.