Cut Your Pressure Too: The Los Angeles Barbershop Blood Pressure Study
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      African-American men suffer more than most other groups from hypertension (HTN) but often
      have less access and less contact with doctors. Previous work by the study's Principal
      Investigator in Dallas, Texas, and Altadena, California, showed that barbershops are an
      excellent place to identify black men with high blood pressure and to enlist the aid of their
      barbers as healthcare extenders.

      The purpose of this study in Metro Los Angeles (LA) is to compare two types of barber-based
      patient-centered blood pressure programs to see which type is more effective in improving the
      customers' high blood pressure. One type emphasizes blood pressure medication and the other
      type emphasizes lifestyle modification for high blood pressure.
    

Detailed description: 
      Uncontrolled hypertension (HTN) is one of the most important causes of premature disability
      and death among non-Hispanic black men. Indeed, black men have the highest HTN death rate of
      any U.S. race, ethnic, or gender group, contributing to a lower life expectancy. The
      age-adjusted HTN-related death rate is 3.3-times higher among black men than white men. To
      address this major health disparity, the investigators designed a novel community-partnered
      team approach to improve HTN management among black men and prevent needless strokes, heart
      attacks, kidney failure, and heart failure.

      HTN requires physician (or middle-level provider) interaction to optimize blood pressure (BP)
      medication; black men have less interaction than black women; and thus far lower rates of HTN
      treatment (73% vs. 86%) and control (36% vs. 50%). Black-owned barbershops are a uniquely
      personal setting to discuss health with influential male peers. Barbershop health outreach is
      well-established, but untested as a vehicle for improving HTN control. Scientific evaluation
      is crucial to best allocate finite healthcare dollars and avoid promoting a "community health
      industry" that benefits only the promoters.

      Under-treatment of HTN is common in primary care due to competing demands on physicians'
      time. The best way to improve HTN control is with team-based approaches enlisting
      pharmacists. They are more accessible than physicians, more knowledgeable about medication,
      and receive training on patient education. The investigators' new conceptual model links the
      barber-based intervention to team-based care delivery.

      The purpose of this research study is to compare this new conceptual model to another
      barber-based patient-centered blood pressure program to see which is more effective in
      improving high blood pressure among Black patrons of African American owned barbershops in
      LA. Patrons randomized to Group 1 (the new conceptual model) will provide blood pressure
      readings for patrons aged 35 to 79 years of age and refer those with HTN to a Clinical
      Pharmacist to work with their doctors in optimizing blood pressure medication.

      Patrons of Group 1 shops will also be exposed to role model posters are not intended as
      recruitment materials, but rather are educational tools that intend to highlight positive
      experiences of participation. The text of the role model stories will in no way provide
      statements of the effectiveness of the intervention being evaluated by the present research
      study. Rather, they are the main health messaging tools needed to promote completion of the
      program in order to achieve the experiences described. Essentially the document will be used
      as an intervention tool for peer-based health messaging - stories from real customers in the
      barbershop modeling target behaviors leading that promote continued participation in the
      protocol by peers with the hopes of achieving to the detection, treatment, and control of
      high blood pressure. Each role model story will encourage one of two desired health behaviors
      of potential subjects with elevated BP: 1) ask the barber to check patients' BP with each
      haircut, 2) schedule a follow-up visit with the study pharmacist to get patient's blood
      pressure under control. Large posters in the barbershop will show the model customer, his
      barber, and the study pharmacist who facilitated the desired behavior change. The model's
      (participants) own words will be used on the poster.

      Group 2 barbershop patrons will be exposed to up-to-date information on high blood pressure
      and on lifestyle topics for blood pressure and heart health including weight management,
      healthy cooking, cholesterol lowering, and exercise.

      A pre-specified cross-sectional sub study utilized the trial's initial screening population
      to test for an association between self-reported nocturia (>2 nightly/voids) and elevated
      daytime (in-barbershop) blood pressure.
    

Intervention name(s): BP measurement & pharmacy; BP educational materials
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Blood pressure monitoring by barber, blood pressure medication management by pharmacist, role model posters encouraging program participation; Exposure to hypertension educational materials
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hypertension; High Blood Pressure; African American men; Black men; barbershop