Retention rate from the beginning of the study until the end.


The Situation 

Vysnova supports a COVID-19 research study at six Universities and Health Systems across the United States. The study design included a cohort of approximately 43,000 participants with:

  • A serology cohort of nearly 25,000 participants, who signed up to complete electronic self-reported daily symptoms survey’s, and to do monthly at-home COVID-19 antibody testing, and
  • Another 18,000 participants regularly completed syndromic surveillance only. 

Serology participants returned dried blood spot samples to the laboratory for analysis and received non-clinical test results without any compensation. Results included a positive or negative for antibody levels above a certain threshold, and if positive for antibodies, a Roche reflex test result indicating whether antibodies were present from natural infection or vaccination

The Problem

Communication Overload: Call centers were experiencing extremely high inbound volume due to infrequent and inconsistent outbound communication with participants. However, the national call center was charged with sending all outbound participant communications, resulting in feedback of resource consumption, an inability to communicate proactively with participants at all six study sites, leading to more resource consumption, etc., without an improvement no matter how many resources were utilized. For example:

  • Participants were not notified of test kit shipments, expectations of when to return test kits, nor provided with a link to helpful YouTube demonstrations.
  • Participants were not aware of when the next test kit would arrive, nor were they reminded to return the current test kit, resulting in many participants holding onto test kits and returning them at random points later in the study.
  • Misperceptions began to fester including but not limited to: getting vaccinated negated the purpose of participating in serology testing, only 1-2 test kits needed to be completed, the results were for the participants’ use only and not part of an ongoing analysis by the study, as COVID-19 numbers subsided in Spring of 2021 the testing was no longer important, etc.


The Solution

Recognizing the impact the above problems were having on the study’s participation rate, leadership took evasive action including:

  1. A marketing expert was hired to assist with recruitment and retention
  2. Oracle Eloqua, a leading marketing automation platform (ranked as “leader” in Gartner Magic Quadrant for 4+ years in a row) was procured to handle bulk email sends, allow for automated/triggered email sends, and manage dynamic email content and lists.
  1. Retention manager migrated all communications into Eloqua, optimized message subject lines, and began a study-long weekly analysis of email metrics, to learn and improve upon results constantly
  2. Supply Chain and Logistics Manager and retention manager developed a cadence for transferring lists of participants scheduled to receive test kits and lists of participants with unreturned kits at specified intervals after receipt.

Call center data chart

Additional Tactics

Recruitment and Retention Manager expanded the frequency and type of email messages to increase participant engagement with outbound communications.  

  • For example, eNewsletters were developed periodically, featuring interviews with principal investigators, participant testimonials, participant FAQs with answers, and study updates with key dates and milestones.  
  • Development of a more cohesive site-specific email program to complement the study-wide email program.  For example:  Thank you emails, study wrap-up emails, test kit deadline emails, re-engagement emails to participants falling behind on kit return schedule, et al.

Retention manager joined chairs of retention committee and led weekly calls with 25-30 internal study members, utilizing each call to gather feedback on email strategy/copy, facilitate study sites’ collaboration on retention tactics (sharing winning strategies for other sites to replicate).  This led to: 

  • Three study sites using raffle drawings to increase syndromic participation,
  • Five town halls with thousands of participants in total attending, and
  • Development of a study-wide tagline:  “Every test kit returned makes a difference in the fight against COVID-19!” 

The retention manager designed a “retention survey” and fielded it to inactive participants in order to understand reasons for participants leaving the study, not returning test kits, and/or becoming inactive.

Using data from survey results, a new test kit email campaign was launched in July which addressed key participant concerns and reasons for non-participation, to retain existing participants who could drop out for similar reasons.

The above tactics utilized Site Wake Forest Baptist Health support for IRB approval of participant messaging. Cooperation of six sites as follows Atrium, Wake Forest Baptist Health, University of Maryland, Medstar, University of Maryland, the University of Mississippi in their effort to include their own data to target their participants Increased retention.  None of the above would have been possible without the cooperation, collaboration and feedback/support of all sites, as the retention manager came into the study with a plethora of marketing experience, but lacked the clinical research knowledge study sites provided on almost a daily basis in support.  


  1. From April through August, the monthly serology kit return rates rose from 60% to 87%.
  2. Call center interactions dropped 75% from their peak in March 2021 through September 2021, indicative of a more informed, independently capable cohort of participants.
  3. Participant base highly engaged with email communications, as indicated by an average open rate of 55%, less than 100 unsubscribes/opt-outs over an 8-month period and only 1 spam complaint. 


Vysnova and their COVID-19 study partners collaborated to generate increasing monthly serology test kit return rates, starting around 60% in April, and reaching 86-87% by August and September. 

This sharp improvement was the result of a combination of factors:

  1. The actions were taken by the retention manager, in collaboration with all six study sites, the supply chain and logistics manager, and the procurement of Oracle Eloqua for automated email marketing.
  2. The “locking” of the CDC serology cohort in late April 2021, and subsequent cadence of test kit distribution logic—in April and May, participants could remain in the cohort provided they returned either kit shipped to them during those months. However, starting in mid-June, the requirement was changed to 30 days, which had the tangible impact of eliminating unengaged participants from the study.  As the study cohort became smaller, the participants remaining were mostly engaged, resulting theoretically in fewer unreturned kits.
  3. The emergence of the delta variant in summer 2021, and the overall resurgence of COVID-19 impacted participants’ work, news/media information feed, and lives in general as infections rose. 

To elaborate on #1, the Retention and Supply Chain/Logistics Managers worked out the automated messaging system and refined targeted personal messages for unique participants groups. The email program expanded the number of messages sent (including frequent reminders to return test kits), added new types of messaging (such as participant eNewsletters), was closely monitored, and employed A/B testing to learn what participants responded best to, and optimize campaigns frequently throughout the study. Health Systems included their site-specific feedback on the participant messages campaigns, and messages were branded/customized for each site to generate familiarity and encourage participants to open emails.

Automation of messages ensured timely outreach of situation-specific messages i.e., return test kit reminders or communicating technical issues. Several emails of appreciation from participants from the Health Systems were received as evidence of the need for timely messaging. Improved communications were also evident from the steep decline in call center interactions for the month of April when compared to the two months prior. This correlates with the launch of Eloqua on April 1, 2021.