"The potential public health impact of this community-based research is high, with thousands of black-owned barbershops nationwide," they conclude in the May issue of Hypertension.

Forty percent of blacks have hypertension, of whom fewer than one third have their blood pressure under control, the researchers note. Hypertension detection and treatment is even worse for black men than for black women.

While black churches have been used as outreach and blood pressure screening sites, Hess and his team state, "regular church attendance is much less common among black men than women."

Given the role of black-owned barbershops as community gathering spots for black men, the researchers sought to determine if they could also be a good site for hypertension, detection, referral and follow-up. While theirs isn't the first study to look at this approach, it is the first to investigate its effectiveness.

The researchers conducted two feasibility studies. In the first, they compared two groups of men with poorly controlled hypertension, 27 of whom received standard care including written results of three blood pressure screenings, recommendation for follow-up, and American Heart Association brochures.

The other 36 participated in an enhanced intervention, in which black research assistants and medical and premed students, supervised by a black nurse, gave the men continual feedback via "BP report cards," accounts of strategies other community members used to successfully control their blood pressure, and referrals to nearby doctors, clinics or hospitals. The men also got half-off on haircuts to encourage participation.

After eight months, the percentage of men in the enhanced intervention group who were getting treatment for their hypertension rose from 47 percent to 92 percent, while the percentage of those with their blood pressure under control increased from 19 percent to 58 percent. There was no change in treatment or blood pressure control rates among those receiving standard care.

In the second study, the researchers trained barbers to provide the same intervention for a 14-month period, including continuous blood pressure monitoring, for all shop clientele. Six barbers reported performing 8,953 blood pressure checks during 11,066 haircuts.

"Barbers successfully incorporated BP monitoring, as well as health education and medical referral, into their daily routine for the full 14-month study period," the researchers write. Barbers received financial incentives for participating, they note, but the total amount given to all six was less than would be needed to pay a single entry-level research assistant.

SOURCE: Hypertension, May 2007.

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