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 during 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 of 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.