Expert Commentary

Shave and a checkup: Health interventions at the barbershop

To improve health outcomes for black men, some researchers are bringing care to non-traditional settings, such as barbershops.


Black men tend to have less frequent contact with physicians or other health care providers than black women and white men and women, according to statistics from the U.S. Centers for Disease Control and Prevention. They experience disparities in many areas of health, including in relative likelihood of contracting HIV and in mortality rates for most cancers.

Over recent decades, some efforts to improve health outcomes for black men have taken a new approach, meeting black men where they are instead of in traditional settings. For example, researchers started conducting health interventions in barbershops, a common gathering place for black men.

A study published in March 2018 in the New England Journal of Medicine highlights the success of this approach in reducing high blood pressure (another condition that is generally more common and severe in black men). We reviewed the literature to find other studies in which health interventions took place in barbershops to broaden understandings of this community-based strategy.


A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops
Victor, Ronald G.; et al. New England Journal of Medicine, 2018. DOI: 10.1056/NEJMoa1717250.

Summary: In this study, 319 black men with uncontrolled high blood pressure received care in barbershops, either through pharmacist-led intervention at these locations, or through barber-recommended lifestyle modification and doctor visits. The researchers found that both groups experienced reductions in blood pressure, though the group that received help and medication from pharmacists experienced a greater reduction.

PEP Talk: Prostate Education Program, ‘Cutting Through the Uncertainty of Prostate Cancer for Black Men Using Decision Support Instruments in Barbershops’
Frencher, Stanley K.; et al. Journal of Cancer Education, 2016. DOI: 10.1007/s13187-015-0871-7.

Summary: This study describes two barbershop interventions to educate black men about prostate cancer screening. Half of the 120 participants received a “culturally tailored” educational video about prostate cancer screening to watch and half were given a culturally nonspecific video. The researchers administered a survey before distributing the videos and requested participants complete a survey after watching. The researchers also followed up three months later to find out whether participants went through with the cancer screening. They found that men who watched the culturally tailored video had an increased degree of certainty in the decision to get screened after watching it, though both groups had similar proportions of participants who intended to undergo screening. About half of the men involved in the study went through with the screening by the three-month follow-up point. The researchers conclude that barbershop-based initiatives hold promise for health education.

Barber-Led Sexual Health Education Intervention for Black Male Adolescents and Their Fathers
Randolph, Schenita D.; et al. Public Health Nursing, 2017. DOI: 10.1111/phn.12350.-

Results: “The following themes were generated: (1) The barbershop was embraced as a venue for an adolescent sexual health father-son intervention, (2) Barbers desired more information about STIs and HIV among Black male youth, (3) The use of incentives to engage barbers and fathers was important, and (4) Time commitment of barbers for a barber-led intervention varied.”

Alternative Locales for the Health Promotion of African American Men: A Survey of African American Men in Chicago Barbershops
Murphy, A. B.; et al. Journal of Community Health, 2017. DOI: 10.1007/s10900-016-0240-4.

Abstract: “127 AA men over age 18y/o receiving grooming services in 25 Chicago area barbershops across 14 predominantly AA communities were consented and recruited for a quantitative survey study. The self-administered surveys were completed in ~15 min and $10 compensation was provided to men. Descriptive statistics were reported for demographic variables and for frequency of responses for locations to find AA men of specific age ranges for health promotion and screening activities. Outside of the traditionally used churches or barbershops, the top recommended recruitment sites by age were: 18–29y/o — city park or a recreational center; 30–39y/o — gym, bars or the street; 40–49y/o — various stores, especially home improvement stores, and the mall; and 50y/o+ — fast food restaurants in the mornings, such as McDonalds, and individual’s homes. The study participants also reported that locations where AA men congregate vary by age. Findings from this study illustrate that AA barbers and barbershops remain a key stakeholder in health promotion among AA men. The findings also demonstrate the need for additional research to examine best practices for identifying locations where diverse groups of AA men that vary by age and sexual orientation may congregate in order to support increased health promotion among AA men.”

Barbershop Talk with Brothers: Using Community-Based Participatory Research to Develop and Pilot Test a Program to Reduce HIV Risk Among Black Heterosexual Men
Wilson, Tracey E.; et al. AIDS Education and Prevention, 2014. DOI: 10.1521/aeap.2014.26.5.383.

Summary: This study describes the development of Barbershop Talk with Brothers (BTWB), an educational program aimed at HIV prevention. Data collected from the pilot test of the program, which involved 78 men, indicates that after the program “attitudes and self-efficacy toward consistent condom use improved, and respondents reported lower levels of sexual risk behavior from baseline to follow-up (all p < 0.05). Perceptions of community empowerment also increased (p = 0.06).”

Using the PRECEDE Planning Approach to Develop a Physical Activity Intervention for African American Men Who Visit Barbershops: Results From the FITShop Study
Hood, Sula; et al. American Journal of Men’s Health, 2015. DOI: 10.1177/1557988314539501.

Abstract: “African American (AA) men have a higher prevalence of many chronic disease risk behaviors compared to Caucasian men, including physical inactivity. Innovative ways to reach AA men with interventions to increase physical activity (PA) and decrease other key risk factors are needed to reduce health disparities in this population. The barbershop is a natural but underutilized setting for reaching AA men. In the Fitness in the Shop (FITShop) study, shop owners, barbers, and customers were recruited from four local barbershops to complete structured interviews and customer focus groups. We assessed knowledge, perceived barriers, and interests/concerns about PA, as well as explored how to best intervene in the barbershop. Barbers and customers endorsed the idea of receiving health and PA information in the barbershop. These formative research results generated information and strategies for developing a multilevel barbershop-based health intervention to promote PA in the barbershop. This article describes the formative research results and how PRECEDE was used to develop a culturally and contextually appropriate, multilevel barbershop-based intervention designed to promote PA and to reduce chronic disease disparities among AA men.”

A Literature Synthesis of Health Promotion Research in Salons and Barbershops
Linnan, Laura A.; et al. American Journal of Preventive Medicine, 2014. DOI: 10.1016/j.amepre.2014.02.007.

Findings: “Included articles were categorized as formative research (n=27), recruitment (n=7), or intervention (n=20). Formative research studies showed that owners, barbers/stylists, and their customers were willing participants, clarifying the feasibility of promoting health in these settings. Recruitment studies demonstrated that salon/shop owners will join research studies and can enroll customers. Among intervention studies, level of stylist/barber involvement was categorized. More than 73.3 percent of intervention studies demonstrated statistically significant results, targeting mostly racial/ethnic minority groups and focusing on a variety of health topics.”

Qualitative Systematic Review of Barber-Administered Health Education, Promotion, Screening and Outreach Programs in African-American Communities
Luque, John S.; et al. Journal of Community Health, 2014. DOI: 10.1007/s10900-013-9744-3.

Excerpt: “The literature search produced 901 unique bibliographic records from peer-reviewed publications. After eliminating articles not meeting the inclusion criteria, 35 articles remained for full-text review. The final article sample consisted of 16 articles for complete abstraction to assess characteristics of studies, role and training of barbers, outcomes targeted, effectiveness, and key findings. All barbershop-based studies reviewed targeted Black men in urban settings. Common study designs were cross-sectional studies, feasibility studies, needs assessments, and one-shot case studies. Barber administered interventions addressed primarily prostate cancer and hypertension, and barbers provided health education, screening, and referrals to health care. Nonintervention studies focused mostly on surveying or interviewing barbers for assessing the feasibility of future interventions. Barbershops are a culturally appropriate venue for disseminating health education materials in both print and media formats. Barbershops are also acceptable venues for training barbers to conduct education and screening. In studies where barbers received training, their knowledge of various health conditions increased significantly and knowledge gains were sustained over time. They were also able to increase knowledge and promote positive health behaviors among their customers, but these outcomes were variable and not consistently documented.”

Cardiovascular Disease Control Through Barbershops: Design of a Nationwide Outreach Program
Releford, Bill J.; et al. Journal of the National Medical Association, 2010. DOI: 10.1016/S0027-9684(15)30606-4.

Abstract: “Black Barbershop Health Outreach Program (BBHOP) was established by clinicians in order to enhance community level awareness of and empowerment for cardiometabolic disorders such as diabetes and cardiovascular disease. At coordinated events utilizing existing infrastructures as well as culturally and gender-specific health promotion, BBHOP volunteers screen for diabetes and hypertension and reinforce lifestyle recommendations for the prevention of cardiometabolic disorders from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Patrons with abnormal findings are referred to participating physicians or health care facilities. We performed a selective review of the literature in order to place this model for health promotion in the context of previous efforts in barbershops. BBHOP is among several successful programs that have sought to promote health in barbershops. Combining a grassroots organization approach to establishing a broad-based network of volunteers and partner agencies with substantial marketing expertise and media literacy, the BBHOP has screened more than 7,000 African American men in nearly 300 barbershops from more than 20 cities across 6 states.”

Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men: The BARBER-1 Study: A Cluster Randomized Trial
Victor, Ronald G.; et al. Archives of Internal Medicine, 2011. DOI: 10.1001/archinternmed.2010.390.

Conclusions: “The effect of blood pressure (BP) screening on hypertension control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician follow-up. Further research is warranted.”

Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men
Hess, P. L.; et al. Hypertension, 2007. DOI: 10.1161/HYPERTENSIONAHA.106.080432.

Abstract: “Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in black men, but such programs have not been evaluated previously. Here we conducted 2 nonrandomized feasibility studies to determine whether an enhanced intervention program of continuous blood pressure (BP) monitoring and peer-based health messaging in a barbershop lowers BP more than standard screening and health education (study 1) and can be implemented by barbers rather than research personnel (study 2). In study 1, we measured changes in HTN treatment and BP in regular barbershop customers with poorly controlled HTN assigned for 8 months to either an enhanced intervention group (n=36) or a contemporaneous comparison group (n=27). Groups were similar at baseline. BP fell by 16±3/9±2 mm Hg in the enhanced intervention group but was unchanged in the comparison group (P<0.0001, adjusted for age and body mass index). HTN treatment and control increased from 47 percent to 92 percent (P<0.001) and 19 percent to 58 percent (P<0.001), respectively, in the enhanced intervention group, whereas both remained unchanged in the comparison group. In study 2, barbers were trained to administer the enhanced intervention continuously for 14 months to the entire adult black male clientele (n=321) in 1 shop. Six barbers recorded 8,953 BP checks during 11,066 haircuts, thus demonstrating a high degree of intervention fidelity. Furthermore, among 107 regular customers with HTN, treatment and control increased progressively with increasing intervention exposure (P<0.01). Taken together, these data suggest that black-owned barbershops can be transformed into effective HTN detection, referral, and follow-up centers. Further research is warranted.”

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