While many have identified medication adherence as a critical part of therapy success and recognize that most therapies have adherence rates that are too low, few successful solutions to improve adherence have emerged. The palette of potential adherence interventions continues to grow, but the literature does not provide a general understanding of what works and what doesn’t. Instead, many papers describe adherence problems within a single condition, therapy, or patient population or assess traditional interventions: support phone calls, informational literature, reminder text messages. Furthermore, the specifics of adherence approaches tested are not typically discussed in the literature.  One can imagine multiple telephonic “support” experiences, some of which motivate and truly support patients, and others which may annoy them. The missing piece is an approach to adherence that considers design. A more careful consideration of the details of the design will open new possibilities for effective adherence intervention systems. Understanding the broader context of design: the particular condition, therapy, and patient population, will help ensure that those details are most appropriate. The combined focus on details with sensitivity to context creates a foundation for innovation that can be both customized to the particular problem and generalizable for other researchers and designers.