Title: Hairdressing salons to promote NHS online application to reduce under-diagnosis of cardiovascular risk factors among women in London’s deprived and ethnically diverse neighbourhoods: a feasibility study
Funder: Department of Health and Social Care

Abstract: We will determine the feasibility of hairdressers in salons, supported by nurses/healthcare assistants at local GP Practices, promoting an adapted free NHS online application to increase the uptake of NHS Health Checks and promote early detection of high blood pressure and diabetes. We will target women in deprived and ethnically diverse neighbourhoods of South and West London. In the UK, under-diagnosis of cardiovascular disease (CVD) is greater among women than men, particularly among the economically disadvantaged and some ethnic minority groups. Annual CVD-related health care costs the NHS in England about &pound;9 billion. Early detection could produce significant patient and NHS benefits. Underpinned by the community capital they harness, hairdressers in the USA have successfully delivered CVD prevention programmes to a wider community than primary care. Integrating community structures into existing primary care pathways can provide a sustainable process to address inequalities in access to health care. Phase 1 (Readiness) will consult hairdressers, clients, practice nurses, and health care assistants (HCAs) to (i) co-identify a feasible action plan for intervention development and feasibility (ii) agree on culturally appropriate adaptations of an existing NHS online application which clients can use to book NHS Health Checks and e-consultations, and upload BP self-monitoring and access CVD risk information; (iii) co-develop a sampling frame of salons in areas of high CVD risk and identify eligible salons and Practices for a feasibility study. Key activities include concept mapping and co-development workshops, and readiness surveys. Phase 2 (Intervention development) will (i) co-develop with hairdressers and clients culturally appropriate interfaces for an existing NHS online application; (ii) train hairdressers to promote use of the application for booking NHS Health checks, managing follow-up care and accessing culturally appropriate information on prevention behaviours (iii) draft a theory of change with stakeholders. Key activities include co-development and training workshops. Phase 3 (Feasibility) will assess the feasibility of (i) recruiting, training and retaining hairdressers to promote the uptake of NHS Health Checks and early detection of high blood pressure in South and West London with 4 GP practices and 8 salons, with randomisation at salon level, and GP Practices assigned by proximity to salons; (ii) nurses/HCAs to support the hairdressers using online platforms and in-salon visits (iii) collect data to inform the design of a larger trial, including data to assess cost-effectiveness and (iv) and if results indicate that a larger trial is feasible, submit a proposal for a full trial to the NIHR within 12 months of completion of the feasibility study. Key outcome measures are a) recruitment rates for salons, hairdressers and clients. b) rates of NHS Health Checks at one and six months after recruitment, and c) Follow-up rates for salons and clients at 6 months. The study has been designed in consultation with hairdressers, including a salon owner Co-I, and clients. Community stakeholders and hairdressers will be invited to join the expert stakeholder group. We will publicise the results through community online forums, and jointly produced audio-visual and written materials for salons, communities and health professionals.

Lay abstract: The study will examine whether hairdressers in salons can promote a culturally adapted online tool to encourage clients to attend their GP Practice for a check-up to detect high blood pressure and diabetes. The hairdressers will be supported by nurses/health care assistants at the local GP Practices. Heart disease and strokes cost the NHS around &pound;9 billion per year, are highest in deprived areas, and are under- diagnosed in women and ethnic minorities. We will invite women attending salons in deprived South and West London neighbourhoods to join the study. Hairdressers have successfully promoted messages to prevent heart disease/stroke in America, but UK studies are lacking. Phase 1 (Readiness) will consult hairdressers, clients, surgery nurses and health care assistants using online workshops or email feedback to develop a feasible action plan, identify culturally appealing content for adaptations of the online tool and how it can be accessed by users, and which salons and GP practices are suitable to participate. In Phase 2 (Intervention development), hairdressers and clients will co-develop the online tool to fit their needs. We will ask clients to try using blood pressure monitors at home with instructions about when to seek help from a nurse. We will train hairdressers in the use of the online tool and simple health promoting messages so they can respond to queries from clients. We will develop a plan of action with stakeholders for testing if hairdressers can encourage clients to have a check-up. In Phase 3 (Feasibility), we will work with eight hairdressing salons and four GP Practices. We will see whether hairdressers can promote the use of the tool by clients to book and attend their GP for a health check-up. We will ask hairdressers and clients about what enabled or prevented use, including any technological, financial or cultural factors. We will ask nurses and staff at the surgery about their experiences of supporting the hairdressers. We will collect data on recruitment of salons, hairdressers, clients, use of the online tool, attendance to GP for a check-up, and the numbers who continue to take part for 6 months. If successful, these data will be used to design a larger study to examine if the tool reduces the chances of heart disease among women in deprived communities and whether it is good value for money. The study has been designed in consultation with hairdressers, including a salon owner Co-I, and clients, and includes targeting salons that have clients from diverse ethnic groups. Community stakeholders and hairdressers will be invited to join an expert stakeholder group. We will publicise the results through community online forums, and jointly produced audio-visual and written materials for salons, communities and health professionals.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CARDIOVASCULAR