Unconditional Incentives Research Articles

Does it Pay to Send Multiple Pre-Paid Incentives? Evidence from a Randomized Experiment

To encourage survey participation and improve sample representativeness, the Survey of Consumer Finances (SCF) offers an unconditional pre-paid monetary incentive and separate post-paid incentive upon survey completion. We conducted a pre-registered between-subject randomized control experiment within the 2022 SCF, with at least 1,200 households per experimental group, to examine whether changing the pre-paid incentive structure affects survey outcomes. We assess the effects of: (1) altering the total dollar value of the pre-paid incentive (“incentive effect”), (2) giving two identical pre-paid incentives holding the total dollar value fixed (“reminder effect”), and (3) offering multiple pre-paid incentives of different amounts holding the total dollar value fixed (“slope effect”) on survey response rates, interviewer burden, and data quality. Our evidence indicates that a single $15 pre-paid incentive increases response rates and maintains similar levels of interviewer burden and data quality, relative to a single $5 pre-paid incentive. Splitting the $15 into two pre-paid incentives of different amounts increases interviewer burden though lengthening time in the field without improving response rates, reducing the number of contact attempts needed for a response, or improving data quality, regardless of whether the first pre-paid is larger or smaller than the second.

Methods, strategies, and incentives to increase response to mental health surveys among adolescents: a systematic review

BackgroundThis systematic review aimed to identify effective methods to increase adolescents’ response to surveys about mental health and substance use, to improve the quality of survey information.MethodsWe followed a protocol and searched for studies that compared different survey delivery modes to adolescents. Eligible studies reported response rates, mental health score variation per survey mode and participant variations in mental health scores. We searched CENTRAL, PsycINFO, MEDLINE and Scopus in May 2022, and conducted citation searches in June 2022. Two reviewers independently undertook study selection, data extraction, and risk of bias assessments. Following the assessment of heterogeneity, some studies were pooled using meta-analysis.ResultsFifteen studies were identified, reporting six comparisons related to survey methods and strategies. Results indicate that response rates do not differ between survey modes (e.g., web versus paper-and-pencil) delivered in classroom settings. However, web surveys may yield higher response rates outside classroom settings. The largest effects on response rates were achieved using unconditional monetary incentives and obtaining passive parental consent. Survey mode influenced mental health scores in certain comparisons.ConclusionsDespite the mixed quality of the studies, the low volume for some comparisons and the limit to studies in high income countries, several effective methods and strategies to improve adolescents’ response rates to mental health surveys were identified.

Increasing the Acceptance of Smartphone-Based Data Collection.

To study human behavior, social scientists are increasingly collecting data from mobile apps and sensors embedded in smartphones. A major challenge of studies implemented on general population samples, however, is that participation rates are rather low. While previous research has started to investigate the factors affecting individuals' decision to participate in such studies, less is known about features of the study design which are under the researcher's control and can increase the acceptance of smartphone-based data collection methods. Guided by the Technology Acceptance Model, we varied study characteristics in a vignette experiment to examine their effect on individuals' willingness to download a research app on their smartphone. Data were collected from 1,876 members of the NORC AmeriSpeak Panel, a probability-based panel of the general population aged 18+ in the United States. Respondents were randomly assigned to eight vignettes and, after each vignette, were asked to rate their willingness to participate in the described hypothetical study. The results show that individuals are more willing to participate in smartphone-based studies where they have some control over the data collection process, by having the option either to temporarily switch off the data collection or to review the data before submission. Furthermore, they are more willing to participate in research to which they are invited via postal letter rather than receiving a postal letter plus a phone call from an interviewer who walks them through the app installation. Finally, unconditional incentives increase their willingness to engage with smartphone-based data collection over conditional incentives.

Impact of different financial incentive structures on a web-based health survey: do timing and amount matter?

Financial incentives improve response to electronic health surveys, yet little is known about how unconditional incentives (guaranteed regardless of survey completion), conditional incentives, and various combinations of incentives influence response rates. We compared electronic health survey completion with two different financial incentive structures. We invited women aged 30-64 years enrolled in a U.S. healthcare system and overdue for Pap screening to complete a web-based survey after receiving a mailed human papillomavirus (HPV) self-sampling kit in a pragmatic trial. HPV kit returners (n = 272) and non-returners (n = 1,083) were allocated to one of two different incentive structures: (1) Unconditional: $5 pre-incentive only (n = 653); (2) Combined: $2 pre-incentive plus $10 post-incentive conditional on completion (n = 702). Chi-square tests evaluated whether survey completion differed by incentive structure within kit return groups or was modified by kit return status. For each incentive-by-kit status group, the cost-per-survey response was calculated as: ([number invited*pre-incentive amount] + [number responses*post-incentive amount]) / number responses. Overall, survey response was higher in kit returners vs. kit non-returners (42.6% vs. 11.0%, P < 0.01), and survey response was higher in the combined (20.1%) vs. unconditional (14.4%) incentive group (P = 0.01). Kit return status did not modify the association between incentive type and survey response (P = 0.52). Among respondents, time to survey completion did not differ by incentive type among either kit returners or non-returners. Among returners, the cost-per-survey response was similar between groups ($13.57 unconditional; $14.15 combined); among non-returners, the cost was greater in the unconditional ($57.78) versus the combined ($25.22) group. A combined incentive can be cost-effective for increasing survey response in health services research, particularly in hard-to-reach populations.

Impact of different unconditional monetary incentives on survey response rates in men with prostate cancer: a 2-arm randomised trial

BackgroundMen are often viewed as a difficult group to recruit for psychological research, including in psycho-oncology. Whilst research has demonstrated the effectiveness of small monetary incentives for encouraging research participation, little research has examined different large unconditional incentive amounts. Larger unconditional incentives may result in increased participation of men in psychological research. This randomised study within a case–control trial of men diagnosed with early-stage prostate cancer aimed to investigate whether (a) response rates to a 30-min questionnaire completed via mail, online, or phone would vary with different unconditional incentive amounts, and (b) demographics would vary in those who responded within the different incentive groups.MethodsWe conducted this randomised study within a case–control cross-sectional study aiming to identify the social-ecological factors influencing treatment discontinuation in prostate cancer patients. A total of 238 participants from the cross-sectional study were randomised to receive one of two unconditional incentives (n = 121 received AUD$10, n = 117 received AUD$20) with the study materials (consent form and survey).ResultsOverall, 113 (47%) responded; n = 61/121 (50.4%) in the AUD$10 group, and n = 52/117 (44.4%) in the AUD$20 group. No evidence of a difference was found in response rates by incentive group (odds ratio 1.27, 95% CI = 0.76–2.12, p = 0.36). Additionally, there were no evident differences in the demographics of the responders vs. non-responders within each incentive group (all p > 0.05).ConclusionsUnlike previous research, we were unable to show that higher monetary incentives were more effective for increasing response rates. An AUD$20 unconditional incentive may be no more effective than a lesser amount for encouraging prostate cancer survivors to participate in research involving long questionnaires. Future research should consider the cost-benefits of providing large unconditional incentives, as non-responses will result in lost resources perhaps better utilised in other engagement strategies.

A comparison of survey incentive methods to recruit rural cancer survivors into cancer care delivery research studies.

Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X2 (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.

Invitations, incentives, and conditions: A randomized evaluation of demand-side interventions for health screenings

This randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings.

Survey Research Among Older Migrants: Age-Related Differences in Contact and Cooperation.

Background and ObjectivesGiven the increasing academic interest in older migrants, this study aims at examining the likelihood of establishing contact and cooperation in a survey among first-generation migrants in Germany, comparing migrants of age 50 and older with younger migrants (aged 16–49).Research Design and MethodsWe analyze data from the Migrants’ Welfare State Attitudes (MIFARE) study collected in Germany, which contains information about first-generation migrants from 9 different origin groups living in private households. Potential survey participants were contacted via mail and invited to participate in a paper- or online-based survey. In addition, an incentive experiment was implemented and age-dependent response rates were analyzed. Using logistic regression analyses, we compare older and younger migrants with regard to their likelihood of contact, cooperation, reaction to incentives, and mode choice.ResultsWithin the MIFARE study, older migrants are more likely to be contacted than younger ones. Older migrants are also more likely to cooperate in survey research than younger migrants. Both groups respond equally positively to the use of unconditional incentives. Lastly, older migrants show a strong preference to fill out the questionnaire on paper, rather than online.Discussion and ImplicationsOlder first-generation migrants living in private households are easier to contact and are more likely to cooperate in survey research than younger first-generation migrants. Offering unconditional incentives and surveys on paper are likely to increase response rates among older migrants.

Effect of prenotification on the response rate of a postal survey of emergency physicians: a randomised, controlled, assessor-blind trial

ObjectivesResponse rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey...

Randomized control trial of unconditional versus conditional incentives to increase study enrollment rates in participants at increased risk of lung cancer

IntroductionUnderstanding how incentives and their timing influence study enrollment rates is important to efficient study design and increasing the generalizability of findings. This 2-arm, parallel randomized trial evaluated how conditional vs. unconditional mailed incentives of a $20 gift card affected study enrollment in a sample of participants screened for lung cancer screening. MethodsEligible participants included Black and White adults who underwent lung cancer screening with low-dose CT and had negative screening results at two North Carolina imaging facilities in 2018. We used a stratified randomization scheme, by sex and race, to assign incentive type (conditional vs. unconditional). We used the Tailored Design Method with six points of mailed contact to engage participants. We compared study enrollment rates using chi-square tests and logistic regression analyses. ResultsAfter adjusting for sex, race, age, smoking status, participant residence, and screening site, participants who received unconditional incentives were 74% more likely to enroll than those who received conditional incentives (adjusted OR = 1.74 (95% CI: 1.01, 3.00). ConclusionsType of incentive can play a role in increasing study enrollment, especially mailed surveys that target individuals who currently or previously smoked. Unconditional incentives may be worth the initial cost to engage study participants.

Evaluation of the effectiveness of an incentive strategy on the questionnaire response rate in parents of premature babies: a randomised controlled Study Within A Trial (SWAT) nested within SIFT

BackgroundLoss to follow-up resulting in missing outcomes compromises the validity of trial results by reducing statistical power, negatively affecting generalisability and undermining assumptions made at analysis, leading to potentially biased and misleading results. Evidence that incentives are effective at improving response rates exists, but there is little evidence regarding the best approach, especially in the field of perinatal medicine. The NIHR-funded SIFT trial follow-up of infants at 2 years of age provided an ideal opportunity to address this remaining uncertainty.MethodsParticipants: parents of infants from participating neonatal units in the UK and Ireland followed up for SIFT (multicentre RCT investigating two speeds of feeding in babies with gestational age at birth < 32 weeks and/or birthweight < 1500 g). Interventions: parents were randomly allocated to receive incentives (£15 gift voucher) before or after questionnaire return. The objective was to establish whether offering an unconditional incentive in advance or promising an incentive on completion of a questionnaire (conditional) improved the response rate in parents of premature babies. The primary outcome was questionnaire response rate. Permuted block randomisation was performed (variable size blocks), stratified by SIFT allocation (slower/faster feeds) and single/multiple birth. Multiple births were given the same incentives allocation. Parents were unaware that they were in an incentives SWAT; SIFT office staff were not blinded to allocation.ResultsParents of 923 infants were randomised: 459 infants allocated to receive incentive before, 464 infants allocated to receive incentive after; analysis was by intention to treat. Allocation to the incentive before completion led to a significantly higher response rate, 83.0% (381/459) compared to the after-completion group, 76.1% (353/464); adjusted absolute difference of 6.8% (95% confidence interval 1.6% to 12.0%). Giving an incentive in advance is the more costly approach, but the mean difference of ~£3 per infant is small given the higher return.ConclusionsAn unconditional incentive in advance led to a significantly higher response rate compared to the promise of an incentive on completion. Against a backdrop of falling response rates to questionnaires, incentives can be an effective way to increase returns.Trial registrationSIFT (ISRCTN76463425). Registered on March 5, 2013.; SWAT registration (SWAT 69 available from http://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,864297,en.pdf). Registered on June 27, 2016.

Patient Perspectives and Willingness to Accept Incentives for Tuberculosis Diagnostic Evaluation in Uganda

ObjectivesWe assessed attitudes and perceptions and willingness to accept (WTA) varying incentive structures for completing tuberculosis (TB) diagnostic evaluation among patients in Uganda. MethodsWe surveyed 177 adult patients undergoing TB evaluation at 10 health centers between September 2018 and March 2019. We collected household sociodemographic information and assessed attitudes and perceptions of incentives. We surveyed patients regarding their willingness to complete TB diagnostic evaluation in exchange for incentives ranging in value from 500 Ugandan shillings (USh) to 25 000USh (~$0.15-$6.75). We compared associations between WTA and patient characteristics using ordered logistic regression. ResultsParticipant willingness to return to the health center to complete TB diagnostic evaluation increased proportionally with incentive amount. The median participant accepted between 2000 and 5000 USh. Cash (52%) and transportation vouchers (34%) were the most popular incentive types. Half of respondents preferred unconditional incentives; for a multiday evaluation, 84% preferred conditioning incentive receipt upon returning to the health center. In multivariate models, we found the pairwise difference between the third and lowest income quartile (aOR = 2.38, 95% CI: 1.20-4.69; P = .01), younger age, and difficulty returning to the health center to be significantly associated with WTA higher incentive thresholds. ConclusionsIn Uganda, incentives such as cash transfers or transportation vouchers are an acceptable intervention for facilitating adherence to TB diagnostic evaluation. Household income is associated with preferred incentive structure and amount, especially for those at the cusp of the poverty threshold who are more likely to prefer unconditional and higher valued incentives. Targeted and context-specific socioeconomic supports for at-risk patients are needed to optimize outcomes.

China's Stadium Diplomacy in Africa

China has been building sports stadiums in Africa at an increasing pace owing to its smart power—a combination of its values, cultural influences, and policies—alongside the unconditional economic incentives it gives African countries. The study examines the motives for and consequences of this policy—known as stadium diplomacy—as reflected through newspaper articles published in Chinese, African, and Western online news outlets. Chinese perspectives regard stadium construction as a springboard to increase China's hold on necessary raw materials and facilitate its access to emerging markets. African views are divided as to the benefits of the ties with China. Advocators maintain that the stadiums enable countries to host international sporting events and present a modernist image. Critics point at the discrimination against African labor and the fact that many stadiums are redundant, given that they mainly serve the interests of ruling elites.

Impact of mobile phone delivered reminders and unconditional incentives on measles-containing vaccine timeliness and coverage: a randomised controlled trial in western Kenya

IntroductionShort message service (SMS) reminders coupled with a small monetary incentive conditioned on prompt vaccination have been shown to improve first-dose measles-containing vaccine (MCV1) uptake. We assessed whether SMS reminders...

How to Increase Survey Response and Manage the Postal and Face-to-Face Field Work of Participant Recruitment during the COVID-19 Pandemic: A Note with Preliminary Evidence from Immigrant-Origin and Native Voters in a German Metropolis in Spring 2021

This note presents preliminary evidence from a postal and face-to-face recruitment field for a telephone survey during the COVID-19 pandemic. Drawn from the city register of Duisburg, a metropolis of 500,000 inhabitants, voters eligible for the September 2021 Bundestag elections are the target population. They are stratified into four groups by onomastic classification: native Germans, Germans of Turkish Descent, Germans with a (Post-) Soviet background and Germans of any other immigrant origin. This note presents ten measures of optimising the recruitment of individuals from these four groups under the constraints of an all-encompassing high-incidence pandemic with distance measures and curfews in place, with closed shops and schools and reduced other care facilities. In addition, the report puts forward statistical analyses of some measures applied in an experimental design and estimates the overall and per-person-recruited costs. Overall, the pandemic forced us to make drastic changes to research design and field organisation and to invest much more time and money than planned. Especially overburdened postal deliveries and restrictive policies for public places made the endeavour most difficult. So far, the ongoing fieldwork has produced a response rate of 8.2 % (only individuals willing to participate in telephone interview) with 11.0 % as a likely expected outcome. One individual recruited to take part in the telephone panel survey costs an estimated 53-71 €.Early-bird incentives produced a positive response (meaning the willingness to partake in the survey) of 5.5 % compared to 4.0 % among those without early-bird incentives. The most effective measure to boost overall positive response among initial non-responders was in-person canvassing with unconditional incentive (21.3 %) instead of postal reminders (9.9 %). Canvassing a smaller group of people in person proved to be as costly as reminding a larger group of people in writing: we estimated costs of 60-61 € per additionally recruited survey participants through either channel.

Intentions for Doing Good Matter for Doing Well: The Negative Effects of Prosocial Incentives

Abstract Many firms consider prosocial initiatives to be an effective tool to motivate workers. However, despite some initial supportive evidence, little is known about when and how prosocial incentives work. Our field experiment shows that the instrumental use of prosocial incentives to increase effort can backfire. The negative effect is particularly strong for performance-based prosocial incentives, which are, by construction, more instrumental than unconditional incentives, and for the workers who do not care about the charitable cause. These findings highlight some serious limitations of prosocial incentives: firms’ perceived intentions and the pool of employees will be crucial for their effectiveness.

Revisiting the Effect of Conditional and Unconditional Incentives on Mail Survey Response Rates

A randomized experiment (N = 3,037) examines the impact of conditional and unconditional monetary incentives on response rates to a mail survey in a contemporary context. This is the first large sample study in 10 years to examine the effect of monetary incentives on survey response. Providing monetary incentives of any kind significantly increases response rates by 5pp to 18pp compared to a no-incentive control group. Unlike in past research, when payment amounts are equivalent, unconditional and conditional incentives yield similar response rates, suggesting that conditional incentives may be substantially more cost effective than unconditional incentives. We also find that greater payment amounts may elicit higher response rates, even when the incentive is conditional upon survey response.

Effect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial

Financial incentives might increase participation in prevention such as screening colonoscopy. We studied whether incentives informed by behavioral economics increase participation in risk assessment for colorectal cancer (CRC) and completion of colonoscopy for eligible adults. Employees of a large academic health system (50-64 y old; n = 1977) were randomly assigned to groups that underwent risk assessment for CRC screening and direct access colonoscopy scheduling (control), or risk assessment, direct access colonoscopy scheduling, a $10 loss-framed incentive to complete risk assessment, and a $25 unconditional incentive for colonoscopy completion (incentive). The primary outcome was the percentage of participants who completed screening colonoscopy within 3 months of initial outreach. Secondary outcomes included the percentage of participants who scheduled colonoscopy and the percentage who completed the risk assessment. At 3 months, risk assessment was completed by 19.5% of participants in the control group (95% CI, 17.0-21.9%) and 31.9% of participants in the incentive group (95% CI, 29.0-34.8%) (P < .001). At 3 months, 0.7% of controls had completed a colonoscopy (95% CI, .2%-1.2%) compared with 1.2% of subjects in the incentive group (95% CI, .5%-1.9%) (P= .25). In a randomized trial of participants who underwent risk assessment for CRC with vs without financial incentive, the financial incentive increased CRC risk assessment completion but did not result in a greater completion of screening colonoscopy. Clinicaltrials.gov no: NCT03068052.

The effect of monetary incentive on survey response for vulnerable children and youths: A randomized controlled trial.

In surveys non-responders may introduce bias and lower the validity of the studies. Ways to increase response rates are therefore important. The purpose of the study was to investigate if an unconditional monetary incentive can increase the response rate for vulnerable children and youths in a postal questionnaire survey. The study was designed as a randomized controlled trial. The study population consisted of 262 children and youth who participated in an established intervention study aimed at creating networks for different groups of vulnerable children and youths. The mean age of the participants was 16.7 years (range 11-28) and 67.9% were female. The questionnaire was adapted to three different age groups and covered different aspects of the participants' life situation, including the dimensions from the Strengths and Difficulties Questionnaire (SDQ). In the follow-up survey, participants were randomly allocated to two groups that either received a €15 voucher for a supermarket together with the questionnaire or only received the questionnaire. We used Poisson regression to estimate the differences in response rate (Rate Ratio RR) between the intervention group and the control group. The response rate was 75.5% in the intervention group and 42.9% in the control group. The response rate in the intervention group was significantly higher than in the control group when adjusting for age and gender (Rate Ratio, RR 1.73; 95% CI 1.38-2.17). We did not find any significant differences in scales scores between the two groups for the five scales of the SDQ. In stratified analyses, we found the effect of the incentive to be higher for males (RR 2.81; 95% CI 1.61-4.91) than for females (1.43; 95% CI 1.12-1.84). Monetary incentives can increase the response rate for vulnerable children and youths in surveys. The trial was retrospectively registered at ClinicalTrials.gov Identifier: NCT01741675.

Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study.

BackgroundAccess to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings.ObjectiveThis two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals.MethodsIn Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participant’s satisfaction with the intervention program.ResultsOf the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominately female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the poststudy survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up.ConclusionsThe finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with need to participate in diabetes education in rural communities.