The barbershop paradigm: Community engagement for cardiovascular prevention

Abstract

Barbershops and beauty salons provide community-specific opportunities to engage in cardiovascular disease screening and prevention. This editorial articulates the advantages of what is termed the “barbershop paradigm,” the community-engaged endeavor that leverages familiarity, trust, and stakeholder engagement to advance cardiovascular health. The authors summarize the neighborhood-based factors that contribute to cardiovascular health, and then identify the strategies implemented by ShopTalk and their specific advantages.

Picture your local barbershop, in practice a place for a regular trim and a shave, or a visit for neighborhood news and banter with a trusted barber. In principle, the barbershop presents an opportunity for health education, cardiovascular prevention, and a visit for health screening from the same trusted source. Khanani and Haight remind us of the benefits and mechanisms of successful neighborhood-level health initiatives with their summary of the ShopTalk barber and beauty shop intervention [1]. The authors describe an admirable program that provides health education materials, in-shop health screenings, and facilitates healthcare in an underserved community setting.

Neighborhood environment dictates access to education, jobs, public transportation, healthy foods, spaces to exercise, health facilities, and other resources and opportunities. The neighborhood is associated with cardiovascular health via multiple intuitive factors; unsurprisingly, food and physical activity environments are related to dietary and physical behaviors as well as incidence of diabetes and hypertension, and favorable trends in body mass index [2]. Higher neighborhood walkability is associated with decreased prevalence of CAD, partially through decreased prevalence hypertension, hyperlipidemia, obesity, and diabetes [3]. Community-based health interventions can be deployed strategically in neighborhoods where inhabitants are known to be at higher cardiovascular risk. The barbershop initiative summarized by Khanani and Haight demonstrates how much more effective they can be when developed and tailored in collaboration with the communities they serve.

The barbershop intervention serves as a paradigm for community-facing efforts to advance health literacy, screening, and cardiovascular and non-cardiovascular disease prevention. Testimonial from a barber involved in ShopTalk speaks to its potential for health education and dialogue. The 7-step “You Can Too” outlines a process to implement the initiative so that any motivated entity can adapt a similar community-based program with capacity to extend its successes beyond the walls of the barbershop or beauty salon.

The barbershop paradigm has multiple benefits highlighted by these authors and others. The initiatives embed healthcare directly in communities, reduce the obstacles of insurance access, cut downstream costs, and eliminate transportation barriers. In populations that experience legacies of mistrust in healthcare systems or the abandonment of shuttered facilities, health education and messaging can be provided by a trusted individual – the neighborhood barber. While traditional healthcare environments may overlook health literacy as a barrier or even not consider its effects, here health communication is accessible and tailored effortlessly for culture and language. Even better, the comfort of a familiar, neighborhood environment facilitates a jargon-free conversation without concern for judgment [4]. The relationship between barber and client extends well beyond what is typically considered community-based participatory research. Rather, activities are led and valued by members of the community to succinctly address fundamental social and cultural barriers to care. Finally, the approach is highly cost-effective to address and reduce the long-term costs and morbidity of a chronic disease like hypertension [5]. To summarize, the barbershop paradigm offers a strategic, economically practical approach to advance prevention in at-risk neighborhoods and optimize addressing long-standing health disparities.

ShopTalk demonstrates the empowerment and stakeholder engagement fundamental for neighborhood-based cardiovascular disease prevention. Community members lead as stakeholders in the design, evaluation, and delivery of interventions, and their leadership strengthens the effectiveness and sustainability of interventions. We envision other locales – schools, places of worship, gyms, and community kitchens – that can harness the same strategies to serve as hubs for health screening and enhanced care. Through collaborative efforts between residents, community organizations, and healthcare providers, neighborhoods can become vibrant avenues to promote cardiovascular disease prevention and advance health equity.

Funding

Funding for this project was provided by NIH/NHLBI award K24HL160527.

Disclosures

None.

CRediT authorship contribution statement

Ruxandra Ionescu: Conceptualization, Writing – original draft, Writing – review & editing. Jared W. Magnani: Funding acquisition, Supervision, Writing – original draft, Writing – review & editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.