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Table 4 Outcomes

From: Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review

Author, Year

Setting

Primary Outcomes

Primary Results

Secondary Outcomes

Secondary Results (Significant)

Feasibility Outcomes

Feasibility Results

Hess, 2007 [21]

Barbershop

Change in BP

Changes in HTN Treatment rate (percentage of hypertensive subjects receiving prescription BP medication)

HTN control rate

I: BP fell 16 +/− 3/9 +/− 2 mmHg (systolic: 149.1 +/−  2.2 to 133.4 +/−  2.2 mmHg; diastolic: 87.4 +/−  2.6to 78.82.6 mmHg) C: Unchanged (systolic: 146.4 +/−  2.4 to 146.7 +/−  2.4 mmHg; diastolic: 87.9 +/−  2.2 to 88.0 +/−  2.2 mmHg)

Intervention effectremained significant (P < 0.0001) after adjustment for age and body mass index

I: HTN treatment increased from 47 to 92% (P < 0.001)

C: Unchanged

I: HTN control increased from 19 to 58% (P < 0.001)

C: Unchanged

  

Implementation

high percentage of haircuts accompanied by a BP recording, as well as BP readings interpreted correctly.

Hess, 2007 [21]

Barbershop

Proportion of haircuts in which the barber recorded a BP

81% haircuts barber recorded a BP

HTN control rate

HTN control rate increased progressively with increasing levels of intervention exposure: 20+/− 10.7% to 51+/− 9% (p = 0.01)

Association between intervention exposure and HTN control remained significant after controlling for insurance status (p = 0.01)

Implementation

high percentage of haircuts accompanied by a BP recording

BP readings interpreted correctly.

Barbers correctly staged 92% of BPs

Wilson, 2008 [27]

Hair Salon

Self-breast exam (BSE) completion

Clinical breast exam (CBE) completion

CBE intention (12 months)

Mammogram completion

Mammogram intention (12 months)

BSE completion: AOR 1.60 (95% CI: 1.2–2.13)

CBE completion: AOR 1.20 (95% CI: 0.94–1.52)

CBE intention: AOR 1.87 (95% CI: 1.11–3.13)

Mammogram completion: AOR 1.21 (95% CI: 0.84–1.76)

Mammogram intention: AOR 1.34 (95% CI: 0.9–1.2)

  

Implementation- degree of execution

37% intervention vs. 10% control reported exposure to breast health messages

Holt, 2010 [51]

Barbershop

CaP screening/intent to screen (PSA/DRE)

CRC screening/intent to screen (FOBT/FS/CS)

Possible increases in self-reported PSA test and prep for PSA and DRE.

I: constantly greater increase in awareness, screening, and prep for FS

CaP knowledge

CRC knowledge

CRC screening perceived barriers and benefits

Results not significant

Not reported

Not reported

Johnson, 2010 [20]

Hair Salon

Increase in fruit and vegetable consumption

Increase in physical activity

Increase in water consumption

Fruit and vegetable intake increased from pre-posttest for the treatment group

No increase in physical activity

No increase in water consumption

  

Not reported

Not reported

Luque, 2011 [53]

Barbershop

Likelihood of discussing CaP with healthcare provider (4-point Likert scale (very unlikely to very likely))

CaP knowledge (5 pt. Likert scale (low to high))

Somewhat likely to very likely Increased from 75 to 85% p < .001

78% reported increase in knowledge

Feelings of worry about CaP (4 pt. Likert not worried to very worried)

Projected PCS modality intention (PSA, DRE, or both)

Somewhat worried to very worried increased from 35 to 45%. p < .001

85%- Both (PSA & DRE)

Satisfaction with the intervention

Intention to continue the intervention

Expansion and implementation

Participants reported that the materials were easy to understand, had an attractive color scheme, and featured familiar faces printed on the materials.

All barbershop clients surveyed reported positively on the contents of the brochure and poster

53% had discussed CaP at least two times with their barber in the last month

Sadler, 2011 [29]

Hair Salon

Adherence to Mammography screening guidelines

ITT between groups at follow up not significant

ITT for mammography completers in both groups significantly (p < .05) higher at follow up.

Adjusting for age (40+) as covariate yielded adherence to screening OR 2.0 (95% CI: 1.03–3.85) times higher for I vs C

Clinical breast exam adherence

Participants’ awareness and perceptions of their vulnerability for breast cancer

ITT for perception of seriousness of BC as health threat reduced significantly (p < .05) in both groups, but greater reduction in diabetes arm. OR of listing BC as threat 1.8 times higher in BC arm (95% CI: 1.0–3.1).

Practicality

Implementation- degree of execution

57% of the women reported that health education materials were displayed in their salon

57% participants reported that the cosmetologists in their salon were offering health information to their clients

80% of the women felt cosmetologists could effectively carry out intervention

Victor, 2011 [49, 56]

Barbershop

Change in HTN control rates (BP measurements and prescription labels)

Patron-physician follow up interaction (signed referral card)

Greater HTN control in I vs C

Intervention effect: Absolute group difference- 8.8% (95% CI: 0.8–16.9; Unadjusted: p = .04 Adjusted p = .03)

Intervention effect: ITT- 7.8% (95% CI: 0.4–15.3; p = .04)

Barbershop-level changes in HTN treatment rates

HTN awareness

BP levels

Results not significant

Satisfaction with the intervention

Intention to continue the intervention

Practicality

Implementation and Penetration

83% patrons heard a model story during every one or half their haircuts from barber

77% patrons received BP measurement from barber

51% patrons with elevated BP received counseling/physician referral from barber

98% patrons and all 29 barbers would like the intervention to continue

Cost analysis- Cost effectiveness- cost-neutral for health care system would be $50/patron

Odedina, 2014 [52]

Barbershop

CaP screening

CaP knowledge

Decisional conflict

CaP Screening intention: 12.78 (2.48) to 13.37 (2.13) p = .0001

CaP knowledge: 63.60 (22.20) to 74.00 (16.80) p = 0.0021

Intervention effects

Completion of PN Intervention was significantly associated with study completion and CRC screening

Satisfaction with the intervention

Limited Efficacy

> 90% of the participants indicated that they were satisfied with the video

The mean satisfaction rating was 13.67 on a scale ranging from 3 to 15, indicating a highly satisfactory rating for the video

> 75% of the participants indicated that the video: 1) was useful, 2) was understood, 3) not embarrassing, 4) was not too long, 5) not difficult, 6) was relevant, 7) got their attention, 8) has potential to increase CaP knowledge for African American men, and 9) was credible

Sadler, 2014 [30]

Hair Salon

Self-reported diabetes screening test in the past year, annual physical exam, and annual eye exam

There were no significant differences in rates of diabetes screening, routine annual screening, and eye exams from baseline to follow-up and between the two arms at follow-up

Knowledge and attitudes about diabetes

Both groups increased significantly from baseline in their overall diabetes knowledge: diabetes arm (M = 4.47; SD = 1.67) and breast cancer arm (M = 4.61; SD = 1.54), P < 0.05

Practicality

Limited Efficacy

Implementation- degree of execution

75% reported attending salon where health education was being offered.

65% reported cosmetologist made health info available

41% shared info w with family and friends

92% feel cosmetologist could effectively deliver diabetes information

Frencher, 2016 [50]

Barbershop

CaP screening via PSA test

n = 58 completed PSA testing (48%)

CaP knowledge and intention

Changes in knowledge and intention- all significant

Intention to screen- increased from 57 to 73%

Overall- no between group differences

Not reported

Not reported

Cole, 2017 [55]

Barbershop

CRC screening completion (self-report)

ITT; Mixed-effects regression analysis

PN: 17.5% completion;

MINT: 8.4%;

PLUS: 17.8%

PN: AOR = 2.28; 95% CI = 1.38, 4.34;

PLUS: AOR = 2.44; 95% CI = 1.38, 4.34

2xs more likely for CRC screening completion (PN and PLUS) intraclass correlation coefficient = 0.039

  

Not reported

Not reported

Victor, 2018 [44]

Barbershop

Changes/reduction in systolic blood pressure

I: 27.0 mmHg reduction in SBP

C: 9.3 mmHg Mean reduction in SBP

21.6 mmHg > for I than C (95% CI: 14.7, 28.4); p < .001

ITT Intervention effect: 21.0 mmHg > for I than C

(95% CI: 14.0, 28.0); p < .001

Changes in DBP

Rates of meeting BP goals

Numbers of hypertensive meds

Adverse drug reactions

Self-rated health

Patient engagement

Mean reduction in DBP 14.9 mmHg > in I vs C (95% CI, 10.3 to 19.6; P < 0.001)

I: higher % of meeting BP goals

I: Increases in use of antihypertensive meds: 55–100%;

C: 53–63% (p < .001)

Limited Efficacy

Implementation- degree of execution

7 in-person pharmacist visits and 4 follow up calls per participant

6 calls/messages to pharmacist per participant

4 BP

Checks per participant by barber

4 health lessons per participant by barber

Victor, 2019 [45]

Barbershop

Change in SBP

I: mean reduction = 28.6 mmHg

C: mean reduction = 7.2 mmHg

Mean SBP reduction 20.8 mmHg > I vs C (95% CI: 13.9, 27.7; p < 0.0001)

ITT intervention effect: 20.6 mmHg reduction (95% CI: 13.8, 27.3; p < 0.0001)

Changes in DBP

Rates of meeting BP goals

Numbers of hypertensive meds

Adverse drug reactions

Self-rated health

Patient engagement

Mean DBP reduction 14.5 mmHg > I vs C (95% CI, 9.5–19.5 mmHg; P < 0.0001)

I: higher % of meeting BP goals (68% vs 11%; p = 0.0177)

I: Increase in use of antihypertensive meds: 57 to 100%

C: 53 to 65%

No treatment-related adverse events/deaths

I: Greater increase in self-rated health and patient engagement scores

Limited Efficacy

Implementation- degree of execution

11 in-person pharmacist visits (0-6 months = 4;7-12 months = 4)

4 BP checks per participant by barber

4 health lessons per participant by barber

  1. BP Blood Pressure, SBP Systolic Blood Pressure, DBP Diastolic Blood Pressure, I Intervention, C Control, CaP Prostate Cancer, CRC Colorectal Cancer, PA Physical Activity, PCS Prostate Cancer Screening, PSA Prostate Specific Antigen, DRE Digital Rectal Examination, FOBT Fecal Occult Blood Test, FS Flexible Sigmoidoscopy, CS Colonoscopy, BC Breast Cancer, CBE Clinical Breast Examination, BSE Breast Self-Examination, HTN Hypertension, ITT Intention to Treat