Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial

Abstract

Background: Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain.

Methods: To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers motivates male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control, a cluster randomized trial (BARBER-1) of HTN control was conducted among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Participants underwent 10-week baseline BP screening, and then study sites were randomized to a comparison group that received standard BP pamphlets (8 shops, 77 hypertensive patrons per shop) or an intervention group in which barbers continually offered BP checks with haircuts and promoted physician follow-up with sex-specific peer-based health messaging (9 shops, 75 hypertensive patrons per shop). After 10 months, follow-up data were obtained. The primary outcome measure was change in HTN control rate for each barbershop.

Results: The HTN control rate increased more in intervention barbershops than in comparison barbershops (absolute group difference, 8.8% [95% confidence interval (CI), 0.8%-16.9%]) (P = .04); the intervention effect persisted after adjustment for covariates (P = .03). A marginal intervention effect was found for systolic BP change (absolute group difference, -2.5 mm Hg [95% CI, -5.3 to 0.3 mm Hg]) (P = .08).

Conclusions: The effect of BP screening on HTN 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.

Trial registration: clinicaltrials.gov Identifier: NCT00325533.

Figure 1

Figure 1A. Flow Diagram of the Design of the BARBER-1 Study HTN denotes hypertension ^aEligible barbershops had non-Hispanic black owners and barbers, had been in business for 10 or more years, had 3 or more barbers, had a > 90% black male clientele. ^bOther reasons for not selecting barbershops included 9 or more barbers per shop, inadequate space to accommodate study staff, barber stations separated by walls (inadequate space for peer group influence), insufficient grant funds to enroll a larger number of shops from each geographic quadrant ^cBlack field interviewers administered the baseline health questionnaire and measured blood pressure on adult black male patrons entering the barbershops for 10 weeks to identify those with confirmed HTN and obtain accurate estimates of their baseline blood pressure levels. Patrons found to have elevated blood pressure readings were given written recommendations for physician follow-up. ^dBarbers were paid for offering a blood pressure check to each adult black male patron at every haircut for 10 months and for facilitating physician referral for patrons they identified as having elevated blood pressure readings. ^eBarbershops in the comparison group were given a continual supply of lay education pamphlets from the American Heart Association on Hypertension in Blacks for 10 months. ^fBlack field interviewers collected the follow-up data for 10 weeks, following completion of the 10-month intervention period Figure 1B. Identification of Patrons with HTN at Baseline and Follow-up in Intervention and Comparison Groups. HTN denotes hypertension, BP denotes blood pressure ^a Patrons eligible for BP screening were non-Hispanic black men ages 18 and older (no upper age limit). Race/ethnicity was self-assigned. ^b Screening criteria for HTN were self-reported prescription BP medication or a measured BP ≥ 135/85 mmHg for patrons without self-reported diabetes or BP ≥ 130/80 mmHg for those with diabetes. Patrons meeting the above screening criteria were offered an incentive for returning another day to: (1) complete a 2^nd set of BP readings and a health interview, and (2) bring their prescription pill bottles to the barbershop for interviewers to transcribe medication data from prescription labels. Each incentive was a free haircut. ^cHTN was confirmed if patrons meeting screening criteria had elevated BP on both days or provided a pill bottle with a current prescription for BP medication.

Figure 1

Figure 1A. Flow Diagram of the Design of the BARBER-1 Study HTN denotes hypertension ^aEligible barbershops had non-Hispanic black owners and barbers, had been in business for 10 or more years, had 3 or more barbers, had a > 90% black male clientele. ^bOther reasons for not selecting barbershops included 9 or more barbers per shop, inadequate space to accommodate study staff, barber stations separated by walls (inadequate space for peer group influence), insufficient grant funds to enroll a larger number of shops from each geographic quadrant ^cBlack field interviewers administered the baseline health questionnaire and measured blood pressure on adult black male patrons entering the barbershops for 10 weeks to identify those with confirmed HTN and obtain accurate estimates of their baseline blood pressure levels. Patrons found to have elevated blood pressure readings were given written recommendations for physician follow-up. ^dBarbers were paid for offering a blood pressure check to each adult black male patron at every haircut for 10 months and for facilitating physician referral for patrons they identified as having elevated blood pressure readings. ^eBarbershops in the comparison group were given a continual supply of lay education pamphlets from the American Heart Association on Hypertension in Blacks for 10 months. ^fBlack field interviewers collected the follow-up data for 10 weeks, following completion of the 10-month intervention period Figure 1B. Identification of Patrons with HTN at Baseline and Follow-up in Intervention and Comparison Groups. HTN denotes hypertension, BP denotes blood pressure ^a Patrons eligible for BP screening were non-Hispanic black men ages 18 and older (no upper age limit). Race/ethnicity was self-assigned. ^b Screening criteria for HTN were self-reported prescription BP medication or a measured BP ≥ 135/85 mmHg for patrons without self-reported diabetes or BP ≥ 130/80 mmHg for those with diabetes. Patrons meeting the above screening criteria were offered an incentive for returning another day to: (1) complete a 2^nd set of BP readings and a health interview, and (2) bring their prescription pill bottles to the barbershop for interviewers to transcribe medication data from prescription labels. Each incentive was a free haircut. ^cHTN was confirmed if patrons meeting screening criteria had elevated BP on both days or provided a pill bottle with a current prescription for BP medication.

Figure 2. Baseline and Follow-up HTN Control Rates for Individual Barbershops in Intervention and Comparison Groups

Abbreviation: HTN, hypertension Paired data are shown for each barbershop except for one barbershop in each group lacking follow-up data (filled squares). Group means and standard errors are also shown. The significance of the intervention effect on HTN control was not affected by adjustment for baseline blood pressure, age, marital status, college education, smoking, and participation at both baseline and follow-up (P=0.031).