When discussions about diversity in clinical trials occur, recruitment is often the primary focus. That’s because researchers, healthcare providers, and advocacy organizations have spent years working to increase participation among historically underrepresented populations, including the Black community, to help ensure clinical trials better reflect the populations that will ultimately use these treatments. While enrollment is an important part of a successful clinical trial, it is only one part of conducting successful clinical research.
Equally important is retention — the ability to keep participants engaged in a study from enrollment through completion. When participants leave a trial early, researchers may lose valuable data, making it more difficult to evaluate how a treatment performs across different populations.
And as clinical trials continue to prioritize diversity and inclusion, retention has emerged as a critical factor in ensuring research produces meaningful and representative results. This is especially important given that, on average, 25 percent to 30 percent of participants drop out of clinical trials before completion, which can delay timelines, increase costs, and affect data quality.
As time progresses, healthcare organizations and pharmaceutical companies continue to work to improve diversity in clinical trials, noting that success should not be measured solely by enrollment numbers. While increasing participants is important, ensuring participants remain engaged throughout a study is equally critical to producing reliable and representative research.
Retention refers to the percentage of participants who remain enrolled in a clinical trial and complete the study in accordance with the research protocol. Though recruitment determines who enters a study, retention determines whether researchers can collect enough data to answer important scientific questions.
When participant retention is low, studies may experience missing data, smaller sample sizes, and challenges in interpreting results. Researchers may lose important information about treatment effectiveness, safety outcomes, and long-term health impacts, making it more difficult to determine how different populations respond to an intervention.
Participant loss can also increase research costs. Sponsors may need to recruit additional participants, extend study time, or invest more resources to achieve enrollment targets and statistical goals. For large-scale studies, even small declines in retention can affect both operational efficiency and overall study outcomes.
According to Joyce H.N. Nortey, MPH, MSBH, Sr. Director, Clinical Research & Operations at Evidation Health and Research Advisor for the Fibroid Foundation, retention is often framed as a participant problem when it should be viewed as a reflection of the participant experience. Nortey says long-term engagement is influenced by whether participants feel valued, respected, and connected to the research’s purpose from the beginning.
As awareness of retention challenges continues to grow, many research teams are implementing strategies designed to improve the participant experience.
A study identified several strategies that may improve participant retention, including flexible scheduling, follow-ups to ensure patients remember their appointments, transportation assistance, regular communication, and newsletters that inform them of the importance of research or offer daily tips on their condition.
Together, these strategies can help improve the participant experience and reduce barriers that may lead participants to leave a study before it is completed. As time goes on, researchers increasingly recognize that retention cannot be addressed after enrollment. Instead, it requires thoughtful planning from the beginning to the end of the study.
Recruitment remains a critical component of clinical research, particularly as the industry continues working to improve representation among historically underserved populations. By focusing on both recruitment and retention, research teams can help ensure studies generate data, improve participant experiences, and contribute to more equitable healthcare outcomes.
Nortey explained, “People are more likely to stay engaged when they see themselves as contributors to something meaningful rather than simply sources of data.”
For many Black patients, hesitation around clinical trial participation is understandable. Historical injustices and negative experiences within the healthcare system have contributed to concerns about research and medical institutions. Nortey said trust cannot be assumed; it must be earned through transparency, respect, and consistent communication. When participants feel heard, respected, and supported throughout the research process, trust is more likely to develop over time.
As researchers continue working to improve both recruitment and retention, many studies are placing greater emphasis on participant support, including clear education about the research process, regular communication, and resources to reduce barriers to participation.
Although participation in a clinical trial is a personal decision, understanding how clinical research works can help patients make informed choices about their healthcare. Clinical trials play an important role in advancing treatments and improving health outcomes. When participants remain engaged throughout a study, researchers are better able to gather the information needed to understand how treatments perform across diverse communities.
Overall, retention is not just about keeping participants enrolled. It’s about creating research experiences where people feel informed, respected, and valued every step of the way. By investing in participant-centered research, providers and research teams can strengthen trust, improve retention, and generate findings that better reflect the communities they serve.
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