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Although visual depictions of epidemiological data are not new in public health, the US public saw more of them during the COVID-19 pandemic than ever before. In this study, we considered visualizations of forecasts (i.e. predictions of how a disaster will unfold over time) formatted as line charts. We investigated how two choices scientists make when creating a forecast visual - the outcome of focus (cases or deaths) and the amount of data provided (more or less data) about the past or the potential future - shape behavioral intentions via risk-related appraisals (e.g. threat and efficacy). In an online experiment, participants (N = 236) viewed a written health alert about a novel airborne virus, with one of the eight versions of a forecast visual or no visual (text only). The results of the experiment showed that exposing people to a health alert with a forecast visual in it may be less effective than anticipated. Reading a written health alert with a forecast visual was, at best, equal to outcomes from reading an alert without it, and sometimes it performed worse: participants appraised the novel virus as a less urgent threat and the recommended solutions as less efficacious. Implications of the findings for theories of risk and visual health communication and practical considerations for future health communicators were discussed.
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BACKGROUND: Recent USDA Economic Research Service Population Survey cites a stabilization of food insecurity overall in the USA between 2019 and 2020, but Black, Hispanic, and all households with children cited increases - underscoring that the COVID-19 pandemic caused severe disruptions to food insecurity for historically disenfranchised populations. AIM: Describe lessons learned, considerations, and recommendations from the experience of a community teaching kitchen (CTK) in addressing food insecurity and chronic disease management among patients during the COVID-19 pandemic. SETTING: The Providence CTK is co-located at Providence Milwaukie Hospital in Portland, Oregon. PARTICIPANTS: Providence CTK serves patients who report a higher prevalence of food insecurity and multiple chronic conditions. PROGRAM DESCRIPTION: Providence CTK has five components: chronic disease self-management education, culinary nutrition education, patient navigation, a medical referral-based food pantry (Family Market), and an immersive training environment. PROGRAM EVALUATION: CTK staff highlight that they provided food and education support when it was needed most, leveraged existing partnerships and staffing to sustain operations and Family Market accessibility, shifted delivery of educational services based-on billing and virtual service considerations, and repurposed roles to support evolving needs. DISCUSSION: The Providence CTK case study provides a blueprint for how healthcare organizations could design a model of culinary nutrition education that is immersive, empowering, and inclusive.
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COVID-19 , Diabetes Mellitus , Assistência Alimentar , Criança , Humanos , Pandemias , Abastecimento de Alimentos , Hospitais de EnsinoRESUMO
BACKGROUND: The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE: We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN: The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS: Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS: The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES: Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS: Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS: DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.
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Diabetes Mellitus Tipo 2 , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas , Pressão Sanguínea , Pacientes , Programas de Rastreamento , Determinantes Sociais da SaúdeRESUMO
Efforts by universities to reduce the spread of COVID-19 include health campaigns intended to encourage students to wear masks. While well-intended, these efforts may produce counter-persuasion (e.g., decrease masking) if they are seen as threatening individuals' freedom to choose. In a rolling cross-sectional study of one university campaign (n = 681), we found that the presence of the campaign did instigate a form of resistance known as reactance and that reactance was negatively associated with masking behavior. Masking was also diminished by the frequency with which respondents observed others not wearing a mask (anti-masking descriptive norm) and the frequency with which respondents observed others expressing disdain for masking (anti-masking injunctive norm). Most of these findings were magnified among students who identified as politically conservative. There was no evidence that the frequency of seeing others speak in favor of masks (pro-masking injunctive norm) produced an increase in masking. The results provide valuable theoretical insights into the causes of reactance and empirical evidence of the risks associated with student-oriented COVID safety campaigns.
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COVID-19 , Normas Sociais , Humanos , Comunicação Persuasiva , Estudos Transversais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Promoção da SaúdeRESUMO
By fall 2020, students returning to U.S. university campuses were mandated to engage in COVID-19 mitigation behaviors, including masking, which was a relatively novel prevention behavior in the U.S. Masking became a target of university mandates and campaigns, and it became politicized. Critical questions are whether the influences of injunctive norms and response efficacy on one behavior (i.e. masking) spill over to other mitigation behaviors (e.g. hand-washing), and how patterns of mitigation behaviors are associated with clinical outcomes. We conducted a cross-sectional survey of college students who returned to campus (N = 837) to explore these questions, and conducted COVID-19 antibody testing on a subset of participants to identify correlations between behaviors and disease burden. The results showed that college students were more likely to intend to wear face masks as they experienced more positive injunctive norms, liberal political views, stronger response efficacy for masks, and less pessimism. Latent class analysis revealed four mitigation classes: Adherents who intended to wear face masks and engage in the other COVID-19 mitigation behaviors; Hygiene Stewards and Masked Symptom Managers who intended to wear masks but only some other behaviors, and Refusers who intended to engage in no mitigation behaviors. Importantly, the Hygiene Stewards and Refusers had the highest likelihood of positive antibodies; these two classes differed in their masking intentions, but shared very low likelihoods of physical distancing from others and avoiding crowds or mass gatherings. The implications for theories of normative influences on novel behaviors, spillover effects, and future messaging are discussed.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Teste para COVID-19 , Intenção , EstudantesRESUMO
The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.
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The COVID-19 pandemic-related social distancing practices that colleges implemented in Spring 2020 disrupted the typical mechanisms of propinquity (physical proximity) and homophily (shared characteristics) that physical institutions rely on to help students build and maintain relationships critical to learning and wellbeing. To explore how social distancing shaped students' academic and social networks and associated educational outcomes, we conceptualized it as a "network shock" and collected unique ego network data in April 2020. For participating students, maintaining interactions with the same set of individuals before and after social distancing was related to more positive outcomes across a range of self-reported wellbeing and learning indicators. On average, students experienced a loss of frequent academic contacts, while they maintained or replaced social interactions in their interpersonal networks after social distancing. Our investigation of the ways students experienced changes in their social and academic networks after a loss of physical proximity points to the role of interpersonal interaction network continuity for fostering wellbeing and learning in times of disruption, as well as the potential need for support in maintaining or rebuilding academic networks.
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We sought to identify barriers to COVID-19 vaccine uptake among persons who are socially vulnerable in light of the natural cycle of innovation diffusion. Widespread adoption of a health innovation requires a cadre of opinion leaders to build on successes experienced by early adopters. One type of opinion leader in healthcare are health mavens: members of a community who maintain up-to-date health knowledge and share their knowledge others. We surveyed 139 persons who are socially vulnerable regarding their COVID-19 vaccination intention, and evaluated their responses based on psychological traits captured by two scales: innovativeness and health mavenism. Health mavenism was not strongly correlated with COVID-19 vaccine intention. Health mavens often relied on their own healthcare providers (n = 46) and health agency websites (n = 42) for vaccine information. Those who relied on their faith leaders (n = 4) reported a lower likelihood of getting vaccinated (31.5% vs. 76.0%, p < .05). The observed lack of support by health mavens represents a critical barrier to COVID-19 vaccine uptake; targeting campaigns to health mavens may increase COVID-19 vaccine uptake in socially vulnerable communities.
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Vacinas contra COVID-19 , COVID-19 , Humanos , Estudos Transversais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação/psicologia , Difusão de InovaçõesRESUMO
Using Galileo theory and method of multidimensional scaling (MDS), we compared the psychological distances between concepts related to two pandemic viruses, Zika and COVID-19. Surveys (Zika, N = 410; COVID-19, N = 291) were used to investigate the role of media use and interpersonal communication on the relationship between 10 concepts in multidimensional spaces. We asked these four research questions: Do the two spaces represent the two pandemics similarly? What is the relationship of me and of people to each pandemic? What is the effect of virus-related media use and interpersonal talk on the pandemic space? What are optimal messages for moving me closer to Zika and to COVID-19? Media use influenced the distances for both pandemics: With greater media use, the concepts were closer in the Zika space and further apart in the COVID-19 space. Interpersonal communication was associated with few differences in the spaces. Based on the psychological distances between concepts, optimal messages were identified: For Zika, a message with two concepts, people and women, is predicted to be most effective to move Zika to the concept me, whereas for COVID-19, a message with people is predicted to be most effective to move COVID-19 to me.
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COVID-19 , Infecção por Zika virus , Zika virus , COVID-19/epidemiologia , Feminino , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia , Infecção por Zika virus/epidemiologiaRESUMO
Novel, public behaviors, such as masking, should be susceptible to normative influence. This paper advances the theory of normative social behavior by considering a new set of moderators of normative influence - superdiffuser traits - and by clarifying the antecedents and consequences of exposure to collective norms. We use data from a two-wave survey of a cohort living in one U.S. county during the pandemic (N = 913) to assess normative effects on masking. We also used a bipartite network (based on people shopping for food in the same stores) to examine exposure to collective norms. The results show different superdiffuser traits have distinct effects on the relationship between perceived injunctive norms and masking intentions. Exposure to collective norms influences masking, but this influence depends on how people interact with their social environments. Network analysis shows that behavioral homophily is a significant predictor of selective exposure to collective norms earlier (but not later) in the pandemic. Implications for understanding normative influence in a context where opinion leadership matters are discussed.
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As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.
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COVID-19/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI. DATA SOURCES: Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; summaries of CPQI dissemination activities of regional multistakeholder alliances; and the LexisNexis Academic and Access World News databases. STUDY DESIGN/METHODS: Fixed effects regression to isolate the effect of CPQI producers' dissemination activities and the print media's CPQI coverage on chronically ill consumers' self-reported awareness and use of CPQI. PRINCIPAL FINDINGS: Direct CPQI dissemination had no overall effect on either awareness or use of CPQI. One unit increase in the media coverage of an Aligning Forces for Quality (AF4Q) multistakeholder alliance report increased consumer awareness and use of CPQI by 1.4 percentage points (P=0.049) and 1.1 percentage points (P=0.009), respectively. Similar increases for the Centers for Medicare and Medicaid Services (CMS) CPQI and for the nonalliance, non-CMS CPQI improved CPQI use by 1.6 percentage points (P<0.001) and 0.2 percentage points (P=0.041), respectively. CONCLUSION: Even though CPQI producers' direct dissemination efforts had little impact, the small but significant consumer impacts of CPQI's limited press coverage suggests that limited use of media in the dissemination of report cards may be a significant factor behind low consumer awareness and use.
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Doença Crônica , Comportamento do Consumidor , Meios de Comunicação de Massa , Médicos/normas , Indicadores de Qualidade em Assistência à Saúde , Adulto , Idoso , Tomada de Decisões , Feminino , Humanos , Disseminação de Informação , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
Two different lines of research-interpersonal resistance and public campaign design-lead us to consider the use of incentive appeals to motivate behavior change, with a call for greater attention to and use of positive incentives. This study tests the potential to promote antibiotic stewardship through microbiome benefits. In addition, multiple analyses were used: A causal analysis allowed us to identify what moved (e.g., which beliefs and intentions), a latent transition analysis allowed us to reveal who moved (targets, nontargets, or both), and a Markov model allowed us to estimate the stable state of these moves or, in other words, where and how the repetition of the messages would ultimately lead in terms of transitions from state to state. An experiment (N = 298), grounded in the context of antibiotic stewardship, showed that incentive appeals moved people with problematic patterns of past behavior (categorized as Persuaders, Stockers, and Dissenters) to positive patterns of behavioral intentions (categorized as Stewards). The causal analysis, latent class analysis, and equilibrium values for the separate transition matrices showed the relative benefit for a message that highlighted the health and wellness benefits of the microbiome. Implications for persuasion theory and practice are discussed.
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Gestão de Antimicrobianos , Comunicação em Saúde/métodos , Comunicação Persuasiva , Adulto , Idoso , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Motivação , Adulto JovemRESUMO
Innovations promise a better future, which may generate feelings of hope and inspire advocacy. Some innovations are more communal in nature: attempting to address a social problem, through community engagement and wide-spread adoption. For such innovations, the social processes that involve collective aspects of community life may play important roles in fostering hope and interpersonal advocacy. This study uses communication infrastructure theory and discrete emotions theory to investigate hope and advocacy within a field trial for a salient, visible, community-bound innovation to reduce transmission of malaria. Heads of households in one community (N = 119) in West Africa were interviewed. Results showed that innovation hope was predicted by appraisals of innovation attributes. Better appraisals of the innovation's attributes, greater perceived collective efficacy, and recent malaria illness predicted more innovation advocacy. The spatial analysis showed that innovation advocacy was geographically clustered within the community, but hope was not. The implications for theory and practice are discussed.
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Difusão de Inovações , Malária/prevenção & controle , Características de Residência , Adulto , África Ocidental , Idoso , Defesa do Consumidor/estatística & dados numéricos , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Although watchful watching has been recommended as a means of reducing unnecessary use of antibiotics, nonadherence has frequently been observed. Drawing from appraisal theories of emotion, this study (n = 579) examined (a) the factors that shape pediatric caregivers' emotional experiences in the medical contexts and (b) the influence of emotions on (non)adherence behavioral intentions. Caregivers reported more intense negative emotions and less intense positive emotions following watchful waiting advice versus receiving an antibiotic prescription. The differences were mostly driven by false beliefs about antibiotics' effectiveness. Emotional responses predicted intentions to adhere to watchful waiting advice (e.g., counterargue and seek another healthcare provider), with anger being the most consistent determinant of these outcomes. Improving antibiotic stewardship can be achieved by educational efforts to correct false beliefs and by training healthcare providers to manage caregiver emotions.
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Gestão de Antimicrobianos , Ira , Cuidadores , Criança , Emoções , Pessoal de Saúde , HumanosRESUMO
This study used the stress buffering perspective to identify social resources, including social network support, having a high quality marriage, and spousal support, that protect against deleterious effects of the progression of Alpha-1 antitrypsin deficiency (AATD) on quality of life. Participants included 130 married adults living with AATD. We measured participants' quality of life in three ways: perceived stress, life satisfaction, and perceptions of social stigma. The results suggested that disease progression corresponded positively with perceived stress and negatively with life satisfaction. Social network support moderated the association between disease progression and perceived stress and social stigma, and spousal support moderated the association between disease progression and perceived stress and life satisfaction. Marital quality was not a significant moderator. The discussion highlights the stress buffering effects of social support from close others.
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Qualidade de Vida , Deficiência de alfa 1-Antitripsina , Adulto , Humanos , Casamento , Estigma Social , Apoio Social , Estresse PsicológicoRESUMO
Stigmas are a primal phenomena, ubiquitous in human societies past and present. Some evolutionary anthropologists have argued that stigmatization in response to disease is an adaptive behavior because stigmatization may help people and communities reduce the risks they face from infectious diseases and increase reproductive success. On the other hand, some cultural anthropologists and social critics argue that stigmatization has strong negative impacts on community health. One recent analysis resolved this conflict by hypothesizing that stigmas had individual and group-evolutionary benefits in the past but are now maladaptive because of intervening societal transitions. Here, we present a quantitative theory of infectious disease stigmatization. Using a four-compartment model of stigmatization against a chronic disease, we show a stigma ratio, being the ratio of net transmissions by stigmatized people to net transmissions by unstigmatized people, predicts the impact of stigmatization on lifetime infection risk. When stigmatized people are segregated from the rest of the population and there are no alternative interventions that reduce transmission, stigmatization can reduce prevalence and infection risk. When stigmas do not lead to segregation but do discourage behavior change and reduce access to medical interventions, stigmatization acts to increases the lifetime risk of infection in the community. We further show that fear of stigmas can create policy resistance to healthcare access. The societal consequences of fear are worse when effective medical treatment is available. We conclude that stigma's can be adaptive, but good healthcare and leaky ostracism can make stigmas against chronic infectious disease maladaptive, and that the deprecation of stigmas is a natural transition in the modern urban societies.
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Controle de Doenças Transmissíveis , Doenças Transmissíveis/epidemiologia , Teoria dos Jogos , Estereotipagem , HumanosRESUMO
Media coverage of health issues has been criticized for creating health stigmas. The model of stigma communication (MSC, Smith, 2007) provides insights into why this is so, but it has two problems: Some of its mediators have not been supported, and it does not do a good job of predicting the transmission of stigma messages (i.e., social transmission). We present a revised model of stigma message effects in which exposure to stigma messages leads to stigma beliefs and stigmatization as a result of a person-oriented danger appraisal. In addition, message judgments-shock value and common ground-are introduced as mediators of the relationship between danger appraisal and social transmission. Participants (N = 200) were randomly assigned to read a health story written either with or without the intrinsic features of stigma messages. The revised model of stigma-message effects was supported: Reading a health news story written with (vs. without) the intrinsic features of stigma messages resulted in greater danger appraisal, which directly predicted stigma-related outcomes and indirectly predicted social transmission through message judgments. Social transmission varied by message judgment: Shocking messages were shared in ways that facilitate diffusion, but common ground messages were shared with influential others, suggesting different means by which stigma as a collective norm may emerge from interactions among community members.
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Meios de Comunicação de Massa , Estigma Social , Adulto , Feminino , Humanos , Julgamento , Masculino , Medição de RiscoRESUMO
The theory of stigma management communication has helped identify and categorize the communication tactics people use to manage stigmatization, yet communication research has provided little insight into predictors of these tactics. To address this gap, we considered stigmatization through the lens of interpersonal influence: as an act in which stigmatizers attempt to persuade their targets to accept categorization and de-individualization into a social group and, further, to accept its marginalized status in the society at large. We used the obstacle hypothesis, a theory of resistance to interpersonal influence, to derive predictors of stigma management strategies. Participants (N=124) facing possible stigmatization due to their genetic risk for a chronic health condition completed an online survey and shared memories of their initial test disclosures. The empirical tests showed that having a stronger sense of meaning in life, more unsafe experiences, and a broader information network predicted resisting stigmatization. Guilt predicted greater use of avoidance strategies (e.g., secrecy and avoiding risky interpersonal settings). We discussed practical implications of bolstering one's sense of meaning in life and argumentation skills and their connections to resilience research.
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BACKGROUND: Access to long-lasting insecticidal nets (LLINs) has increased and malaria has decreased globally, but malaria transmission remains high in parts of sub-Saharan Africa and insecticide resistance threatens current progress. Eave tubes are a new tool for the targeted delivery of insecticides against mosquitoes attempting to enter houses. The primary objective of this trial is to test whether screening plus eave tubes (SET) provides protection against malaria, on top of universal coverage with LLINs in an area of intense pyrethroid resistance. The trial will also assess acceptability and cost-effectiveness of the intervention. METHODS/DESIGN: A two-armed, cluster randomized controlled trial will be conducted to evaluate the effect of SET on clinical malaria incidence in children living in central Côte d'Ivoire. Forty villages will be selected based on population size and the proportion of houses suitable for modification with SET. Using restricted randomization, half the villages will be assigned to the treatment arm (SET + LLINs) and the remainder will be assigned to the control arm (LLINs only). In both arms, LLINs will be distributed and in the treatment arm, householders will be offered SET. Fifty children aged six months to eight years old will be enrolled from randomly selected households in each of the 40 villages. Cohorts will be cleared of malaria parasites at the start of the study and one year after recruitment, and will be monitored for clinical malaria case incidence by active case detection over two years. Mosquito densities will be assessed using CDC light traps and human landing catches and a subset of Anopheles mosquitoes will be examined for parity status and tested for sporozoite infection. Acceptability of SET will be monitored using surveys and focus groups. Cost-effectiveness analysis will measure the incremental cost per case averted and per disability-adjusted life year (DALY) averted of adding SET to LLINs. Economic and financial costs will be estimated from societal and provider perspective using standard economic evaluation methods. DISCUSSION: This study will be the first evaluation of the epidemiological impact of SET. Trial findings will show whether SET is a viable, cost-effective technology for malaria control in Côte d'Ivoire and possibly elsewhere. TRIAL REGISTRATION: ISRCTN18145556 , registered on 01 February 2017 - retrospectively registered.