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Push Notifications: Push for Success

Push Notifications in Digital Health: Definition

Health care technologies are transforming medical research and routine clinical care at a rapid pace. Sponsors, medical providers, and IT specialists have embraced the use of mobile solutions to deliver interventions and improve interoperability. Smartphones, for instance, are an integrated part of digital health – with social network services, GPS systems, and camera capabilities improving access to medical information and support (Kim, Kim & Kang, 2016). Consequently, push notifications have also become essential tools in today’s health care industry.

Push or remote notifications are defined as pop-up messages that appear on a connected device. Such prompts originate from a server or a cloud service; when touched, they lead the user to a programmed page (Bidargaddi et al., 2018). Interestingly, data delivery occurs even when an app is not running.  Push notifications rely on sophisticated tailored and sensor-driven capabilities to target certain populations at certain times. In comparison, local notifications are alerts already built within an app and scheduled by developers. The main aim of push notifications in medical research and practice is to boost user engagement and patient health outcomes at the same time.

Benefits of Push Notifications and Tailoring Strategies:

Push notifications have the potential to transform health care practices across the globe. From emergency care to medical education, push notifications can benefit users, providers, and pharmaceutical businesses. Relevant information and engaging content can improve user acquisition. One of the main advantages of remote notifications is their potential to increase user engagement and health outcomes. Prompt alerts and frequent messages, on the other hand, can improve retention, which is a paramount feature in medication adherence. Whether it’s reminders about upcoming appointments or transaction messages, push notifications also facilitate doctor-patient communication and interoperability. Access to reliable and relevant data in real time, 24/7 can only benefit medical interventions and research.

To take advantage of the full capabilities of push notifications and smart devices, though targeting strategies become vital. Push notifications employ a unique device identification, so the server can deliver messages to a given app on a given device. Effective remote notification strategies should include personalized messages based on certain segments and demographics (e.g., subjects who exercise on a daily basis). Note that A/B testing and mHealth app analytics can help specialists tailor notifications and improve desired outcomes. Interesting health facts and welcome messages, for instance, can attract new users.

Push Notifications, User Acquisition, Engagement, and Retention: Factors to Consider

With the newest advances in analytics and technologies, there’s no doubt that push notifications can transform current practices at a rapid pace. While both remote and local notifications provide valuable medical information, remote notifications do not solely send a generic message to a user’s device. As explained above, identification codes and targeting strategies improve data delivery. In addition, when developing and employing push notifications, the following factors should be considered:

Intelligent and sensor-driven notifications: Smartphones, app, and wearables integrate artificial intelligence, learning algorithms, and sensor-driven data to improve health care practices worldwide. GPS settings are among the most beneficial features of any smart device. Thus, effective push notifications should integrate geolocation-based settings to assess a patient’s location and target messages. A recent study (n=77) showed that intelligent sensor-driven machine learning models might improve the timing and frequency of notification delivery (Morrison et al., 2017). By considering a user’s location, Morrison and colleagues explored the effects of three types of notifications on user engagement: intelligent, daily with pre-defined frames (one notification in a 24-hour period with a customized time range), and occasional notifications (one notification in a 72-hour period). Stats showed that intelligent messages (based on location and movement), as well as daily notifications with pre-defined frames, have numerous advantages over generic and occasional notifications. Yet, when it comes to real-world settings, too many intelligent and sensor-driven notifications can be perceived by users as random and invasive.

Timing and scheduling techniques: Push notifications are tailored messages sent at certain programmed times, often in non-working hours. Morrison and colleagues, for instance, chose to send notifications to participants between 17.00h and 20.00h, as previous research had shown that people engaged more actively with apps in their free time (Morrison et al., 2017). Note that messages should not interfere with users’ daily activities; users have the right to define given time frames in which to receive notifications. In addition, people’s daily routines are not always consistent, so participants must have some control over the notifications they receive. Users must have the option to enable or disable push notifications. After all, people often get up to 50 notifications a day, in different formats (e.g., SMS, email) and from different apps – an alarming phenomenon which leads to low engagement rates. Since more and more users across the globe own a smartphone with a data plan, timing and scheduling should also consider local time zones.

Content tailoring and personalized messages: In a world where users are active participants in decision-making and shift companies towards success, it’s not surprising that generic notifications are no longer effective marketing strategies. Therefore, push notifications and content should be engaging, motivating, and tailored based on certain characteristics (e.g., gender). In addition, with the impressive capabilities of today’s mHealth apps, deep content tailoring becomes essential. Note that deep content tailoring is usually based on previous data and engagement (Bidargaddi et al., 2018). Such content can include insights into self-monitored information and suggestions based on previously collected data. In a recent study (n=1414), the effects of insights and suggestions were analyzed. Bidargaddi and colleagues showed that tailored suggestions were more effective in encouraging the self-monitoring of vital aspects, such as sleep, will power, creativity, eating, and activity. At the same time, the research team revealed that among frequent users, push notifications with insights can lead to higher rates of self-monitoring. Most of all, content needs to be engaging and motivational in order to promote optimal user engagement. When it comes to wellness apps, for instance, notifications should never be demanding or degrading. Note that character limit and visuals also matter. Attractive or game-based notifications show to be effective.

Incentives and real-world settings: Motivation is one of the main components for success. Previous research has shown that incentives can improve users’ external motivation and improve outcomes. In clinical trials, for instance, incentives can increase recruitment. From loyalty programs to monetary prizes, incentives can lead to positive behavioral changes in real-world settings. In a recent campaign, a health app was designed to improve the knowledge about influenza vaccines (Dale et al., 2018). The initiative targeted a large number of users (n = 80,229) at the beginning of the influenza season (November-April). Users who completed the initial influenza quiz received 25 points or $0.25. Subjects who enabled the GPS options on their devices received push notifications regarding pharmacies that provided influenza vaccines. Eligible users who clicked on a map to see the location of those pharmacies received an additional bonus. Incentives throughout the study revealed both high enrollment and retention rates. Most of all, the study team showed that incentives could promote healthy behaviors in real-world settings.

Opt-in request and privacy: Although push notifications can benefit medical research and routine clinical care, experts must consider some challenges associated with increased smartphone use. Research shows that push notifications delivered on a daily basis, despite a user’s needs, may increase the chances of developing a smartphone addiction (Kim, Kim & Kang, 2016). A recent study examined brainwaves associated with push notifications and showed that remote alerts could decrease task performance, concertation, and cognition. Kim and colleagues presented 14 participants with a Go-Nogo task: various figures on a screen with a white background. The subjects were asked to press 1 when the figure was yellow, and press nothing when the figure was green (148 Go trials and 38 Nogo trials). In addition, during the task, all participants were presented with push notifications sent by a device behind them. Some participants, especially those who reported smartphone overuse, showed lower levels of concentration after hearing the push notification. Therefore, researchers claim that some notifications can be distracting, so an opt-in request is vital. Opt-in requests are initial permission boxes asking users to either deny or allow notifications. The remote server can obtain information if a person has enabled the notification settings of their phone, which can actually lead to better spam control. When it comes to electronic transfer of sensitive data, privacy also becomes crucial. When downloading an app and registering for an intervention, users must be informed about data collection, analysis, and storage.

Call-to-action plan and support: Research and real-world evidence show that sending random and disruptive messages is not a promising technique. Note that qualitative research (e.g., interviews) can help specialists understand what users need. Valuable feedback and comments can help experts improve their services and support centers. Push notifications must be informative, relevant, and motivating. Also, users should have some control over their devices and personal data. Thus, call-to-action plans and on-the-go interventions are needed to optimize user engagement (e.g., buying proteins). Call-to-action buttons, in particular, can help users access a page of interest or other relevant support platforms. Support, especially in weight loss apps and programs, is vital. Note that studies show that obese participants who self-monitor their weight and body mass frequently often achieve desired results. Last but not least, push notifications can facilitate routine clinical care and save lives. Digital solutions can benefit both patients and health professionals. To set an example, practitioners can receive push notifications about their patients and provide immediate support in real time and at no cost.

Push Notifications in Digital Health: Conclusion

In an era where health technologies, smartphones, and mHealth apps can reshape digital health practices, push notifications have become an integrated part of people’s lives. In fact, users are exposed to a large number of push and local notifications on a daily basis. Push notifications, in particular, can improve user engagement and retention and lead to positive behavioral changes. To set an example, research shows that people with depression benefit from increased rates of monitoring of depressive symptoms. By delivering a short and attractive message at programmed times, remote notifications ensure immediate transfer of information and access to support.

Push notifications must be personal, relevant, and engaging. Content should be based on insights and suggestions which can trigger actual action plans. Visuals and Help buttons are also vital to optimize data delivery. To ensure high rates of engagement and responses to prompts, push notifications should not only meet users’ needs but allow people to exercise control over their own mobile devices.

References

  1. Bidargaddi, N., Pituch, T., Maaieh, H., Short, C., & Stretcher, V. (2018). Predicting which Type of Push Notification Content Motivates Users to Engage in a Self-monitoring App. Predicting which Type of Push Notification Content Motivates Users to Engage in a Self-monitoring App. Preventive Medicine Reports, 11, p. 267-273.
  2. Dale, L., White, L., Mitchell, M., & Faulkner, G. (2018). Smartphone App Uses Loyalty Point Incentives and Push Notifications to Encourage Influenza Vaccine Uptake.
  3. Kim, S., Kim, S., & Kang, H. (2016). An Analysis of the Effects of Smartphone Push Notifications on Task Performance with regard to Smartphone Overuse Using ERP. Computational Intelligence and Neuroscience.
  4. Morrison, L., Hargood, C., Pejovic, V., Geraghty, A., Lloyd, S., Goodman, N., et al. (2017). The Effect of Timing and Frequency of Push Notifications on Usage of a Smartphone-Based Stress Management Intervention: An Exploratory Trial. The Effect of Timing and Frequency of Push Notifications on Usage of a Smartphone-Based Stress Management Intervention: An Exploratory Trial. PLoS ONE, 12 (1).
  5. Morrison LG, Hargood C, Pejovic V, Geraghty AWA, Lloyd S, Goodman N, et al. (2018). Correction: The Effect of Timing and Frequency of Push Notifications on Usage of a Smartphone-Based Stress Management Intervention: An Exploratory Trial. PLoS ONE, 13 (5).