Discussion

The results of this study highlight the efforts of a screening program designed to reach a population with a disproportionate share of many chronic diseases. The literature is rich in highlighting innovative ways to reach racial/ethnic minority populations, particularly Black people, to screen for specific chronic diseases.^[22–24] Many of these screening activities stress the importance of meeting people where they live and work and have been held in churches, barber/beauty shops, community centers, and other nontraditional locations. The ARBBS initiative sought not only to screen for chronic diseases among a high-risk population but also to provide education and refer people who required follow-up care to a health care provider.

The initial referral and nurse coordinator follow-up were unique aspects of this screening program. The program sought to identify and refer participants with abnormal screening results to an appropriate health care provider and to follow up on treatment outcomes. Using a point of contact after the initial abnormal screening results has been shown to be effective in increasing compliance.^[25] A study by Rorie et al used resident housing advocates (RHAs) to follow up with residents of public housing who had abnormal screening results.^[25] The RHA offered to help make appointments for residents and accompany residents to their follow-up appointment; the proportion of participants who completed a follow-up appointment increased from 15.0% to 55.0%.^[25] Although our program attempted to contact all participants with abnormal screening results, we made contact with 55.7%, and 28.0% kept their follow-up appointments within 30 days of the screening event. Nevertheless, we received anecdotal information that at least 10 participants with abnormal screening results subsequently obtained potentially life-saving surgeries.

Barber and beauty shops have been used as avenues to promote health in the Black community.^[16,26] Many promotion activities were associated with an increase in health knowledge. A study conducted by Luque et al administered a health education intervention in barbershops that aimed to increase the knowledge and awareness of prostate cancer and screening in the African American community.^[26] These researchers found a significant increase in knowledge among clients given educational materials on prostate cancer.^[26] Similarly, the results of our study indicated that the knowledge of chronic diseases and risk factors among participants increased significantly after the intervention.

Modifiable risk factors such as high blood pressure, obesity, diabetes, physical inactivity, and tobacco use increase CVD disparities between non-Hispanic White people and Black and Hispanic people.^[7,27] About 46.8% of Black people and 47.0% of Hispanic people are obese, and both populations are more likely than non-Hispanic White people to be diagnosed with hypertension and diabetes and be physically inactive.^[8,28] Systematic, environmental, and structural factors also contribute to the high risk and mortality rates of CVD among Black and Hispanic people.^[29] Racism, poverty, and low socioeconomic status are associated with increased CVD risk and mortality rates among Black people and Hispanic people.^[5,30] Because of inequities worsened by the social determinants of health among many members of racial/ethnic minority populations, it is essential to provide targeted educational and health-promoting interventions to these populations.

Our initiative had several strengths, including the follow-up of participants with abnormal screening results, the inclusion of Black women and Hispanic populations, and the use of nontraditional locations. In addition, more than half of participants were aged 45 or younger; information obtained by people at these younger ages may help to reduce the risk for chronic diseases later in life. Other health promotion activities, such as screening for HIV and sexually transmitted infections, breast cancer, prostate cancer, and mental health, can easily be incorporated into the structure of our initiative. Programs such as ours can be sustained through in-kind contributions and collaboration with various partner organizations, such as hospitals, universities or colleges, and other local community organizations.

Our study has several limitations. First, we used a convenience sample. Barbershop and beauty shop clientele who self-selected to participate in the program may have been different from those who elected not to participate. Second, we did not measure the long-term effect of knowledge gained during the intervention. We assessed knowledge gained immediately after the intervention. Future studies should be designed to measure the long-term effects of the program on participants’ knowledge and changes in health outcomes. Third, we did not conduct regression analyses to identify variables such as health insurance status, ethnicity, and sex that may be associated with keeping follow-up appointments. Fourth, we did not collect data on people lost to follow-up; this information could have provided additional insight into the effect of our intervention. Future research should explore other types of follow-up interventions, such as medication therapy programs for populations with limited access to these programs. Additionally, a cost-benefit analysis of the initiative should be conducted.

Notwithstanding these limitations, the results of our study add to the evidence that barber and beauty shops are viable options for promoting healthy behaviors and conducting screening programs in racial/ethnic minority communities. To the best of our knowledge, our program was the first to incorporate Black women and Hispanic participants. Participants were screened for chronic health conditions and received education on how to reduce their risk for these conditions. Follow-up on abnormal screening results was a critical element of our program: it sought to ensure that patients were further tested and treated by a medical provider. Screening programs must be intentional in screening, educating, and intervening with populations at risk of chronic diseases. Public health programs that seek to target racial/ethnic minority populations should meet people where they are in the community. Community-based health education and behavior modification can be effective measures to decrease CVD risk factors in racial/ethnic minority populations.