Setting and randomization
The study was conducted in Yongding County and You County, Hunan Province in south-central China. Yongding County comprising 17 towns, has a large ethnic minority population (~ 50%, mainly Tujia and Miao population) in western Hunan Province; and You County comprising 14 towns, has a large ethnic Han population in eastern Hunan Province. The diversity (i.e., application to different geographic locations, ethnic groups, health care systems) of the included populations was used to test whether the ILSM program could be generalized to diverse underserved populations.The town (cluster) was the unit of randomization, and a randomization protocol available on the internet (