Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men. The BARBER-1 Study: A Cluster Randomized Trial

Study Questions:

How effective are barbershop-based hypertension (HTN) outreach programs for black men in improving HTN control?

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 (eight 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 (nine 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 = 0.04); the intervention effect persisted after adjustment for covariates (p = 0.03). 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 = 0.08).

Conclusions:

The authors concluded that 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.

Perspective:

This study suggests that an enhanced intervention program in which barbers continuously monitored BP and actively promoted physician follow-up with personalized sex-specific messages resulted in improved BP control among black male barbershop patrons with HTN. The results of this study provide the initial evidence for the effectiveness of a barber-based intervention for controlling HTN in black men, and indicate that more research is needed to develop a highly effective and sustainable intervention model prior to large-scale program implementation. Future studies should evaluate the potential effectiveness of the intervention in other urban centers, alternative incentive structures, comparative effectiveness of the intervention, and projected long-term cost-effectiveness.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension

Keywords: Outcome Assessment (Health Care), Follow-Up Studies, Texas, Health Educators, Blood Pressure, Blood Pressure Determination, Hypertension, Systole


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