Topic 03
Engagement is not benefit
Why opening an app more often is not proof that it helps.
Notifications reliably make people open an app. Whether they change what people actually do is a different question, and in a large 2026 trial they did not.
Most people stop opening wellbeing apps within weeks. For anyone judging such an app, the useful question is whether it led to something you did, not how often you opened it.
8 sources
What this topic rests on
- 2018Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior SupportNahum-Shani I, Smith SN, Spring BJ, Collins LM, Witkiewitz K, Tewari A, Murphy SA · Annals of Behavioral Medicine 52(6):446–462University of Michigan · Northwestern University · Pennsylvania State University · University of New MexicoDesign framework
- 2026Just-in-Time Adaptive Interventions: Where Are We Now and What Is Next?Nahum-Shani I, Murphy SA · Annual Review of Psychology 77:679–703University of Michigan · Harvard UniversityReview
- 2018Real-world large-scale study on adaptive notification scheduling on smartphonesOkoshi T, Tsubouchi K, Tokuda H · Pervasive and Mobile Computing 50:1–24Keio University · Yahoo Japan CorporationLarge-scale deployment in a commercial app
- 2019Efficacy of Contextually Tailored Suggestions for Physical Activity: A Micro-randomized Optimization Trial of HeartStepsKlasnja P, Smith S, Seewald NJ, Lee A, Hall K, Luers B, Hekler EB, Murphy SA · Annals of Behavioral Medicine 53(6):573–582University of Michigan · University of California, San Diego · Harvard UniversityMicro-randomized trial
- 2018To Prompt or Not to Prompt? A Microrandomized Trial of Time-Varying Push Notifications to Increase Proximal Engagement With a Mobile Health AppBidargaddi N, Almirall D, Murphy S, Nahum-Shani I, Kovalcik M, Pituch T, Maaieh H, Strecher V · JMIR mHealth and uHealth 6(11):e10123Flinders University · University of Michigan · Harvard UniversityMicro-randomized trial
- 2026Impact of Push Notifications on Physical Activity and Sodium Intake Among Patients with Hypertension: Microrandomized Trial of a Just-in-Time Adaptive InterventionGolbus JR, Dorsch MP, Chen Y, Basu T, Luff E, Klasnja P, Newman MW, Skolarus LE, Dempsey W, Nallamothu BK · Journal of Medical Internet Research 28:e78218University of MichiganMicro-randomized trial within a 6-month randomized trial
- 2023How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized TrialBell L, Garnett C, Bao Y, Cheng Z, Qian T, Perski O, Potts HWW, Williamson E · JMIR mHealth and uHealth 11:e38342London School of Hygiene & Tropical Medicine · University College London · Harvard UniversityMicro-randomized trial
- 2019Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage AnalysisBaumel A, Muench F, Edan S, Kane JM · Journal of Medical Internet Research 21(9):e14567University of Haifa · Partnership for Drug-Free Kids · Northwell HealthUsage analysis of real-world panel data
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