01 November 2010

Barbers: Cut, shave, lower your BP

Black men with hypertension appear to benefit from regular blood pressure checks and advice from a somewhat unlikely source - their barbers.


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NEW YORK (Reuters Health) - Black men with hypertension appear to benefit from regular blood pressure checks and advice from a somewhat unlikely source - their barbers.A new study finds that training barbers to check their patrons' blood pressure, offer advice and anecdotes, and even help refer the clients to a doctor if they don't have one, appears to help men get their blood pressure under control. Nationwide, barbershops are increasingly becoming a source of health information and a locus for health outreach, according to the authors led by Dr. Ronald G. Victor, associate director of Cedars-Sinai Heart Institute in California, and this study shows it is a type of intervention that can work."It's a proof-of-concept study," Victor told Reuters Health.Millions of African-American men have high blood pressure, and most do not have it under control - putting them at risk of serious illness and death. Barbershops are community gathering spots for black men, some of whom have been clients for years, visiting once every three to four weeks. As a result, some researchers have asked: Why not work health information into the cut and shave?In the current study, published in the Archives of Internal Medicine, Victor and his team asked patrons of 17 black-owned barbershops in Dallas County, Texas, to be screened for hypertension. They found that 45 percent of the shops' clientele had hypertension, but only 38 percent of the men had brought their blood pressure down to a safe level.The researchers then randomly divided the shops into two groups. In one, shops received pamphlets about the disease and modes of treatment. In the other group, barbers were trained to check patrons' blood pressure during every haircut visit, encourage those with hypertension to see their own doctors or refer them to nursing staff if they did not have a doctor. Barbers even provided clients with referral cards to give to their doctors noting their latest barbershop blood-pressure readings.The barbers also told "model stories" during haircuts about real patrons who got their blood pressure under control. In one, a barber described a man who, in working overtime to support his two daughters, neglected his own health and ended up with diabetes and hypertension. The barber encouraged him to find a doctor who helped him manage his blood pressure and earned the gratitude of the client, who was happy to be well for his daughters' sake. The researchers even made posters depicting these success stories to hang on barbershop walls. "The customers who came in would often recognize the people on the posters, because they were real customers," Victor said.More than 80 percent of patrons said their barbers told a model story during at least half of their haircuts. Barbers measured blood pressure in 77 percent of patrons with hypertension, and helped convince 51percent of those with high readings to see a doctor. "Most of the barbers really did an incredible job," Victor noted.After 10 months, he and his team checked the barber shop clients in both groups again, and found that men in the group that received the full barber-intervention were more likely to have gotten their blood pressure under control than those who had simply received pamphlets at the shop. Specifically, in the intervention group, the proportion of men with hypertension who had brought their blood pressure down to a safe level increased from 34 percent to 54 percent during the study period. However, even the pamphlet-only group showed some improvement - "there were not humungous differences" between the two groups, Victor noted. The lack of a big difference between the two groups isn't surprising, noted Dr. Kevin Fiscella of the University of Rochester School of Medicine & Dentistry in New York, who was not involved in the study. "When you start taking people's blood pressure and giving them information, that is an intervention," he said. Taking the extra step of training the barbers "is a nice way of both hooking people in as well as underscoring the importance" of getting their blood pressure under control, noted Fiscella, who studies methods of delivering health services to underserved populations. However, to take that extra step, Victor and his team paid barbers $3 per blood-pressure recording, $10 per referral request, and $50 for every time a patron returned a blood-pressure reading card signed by the patron's doctor (for which patrons also received a free $12 haircut). To be "scalable and sustainable," researchers would have to find another method besides money to incentivize everybody, Victor said.But even though the differences in improvement between the two groups weren't enormous, even a small increase in the number of people whose blood pressure is under control could have a big impact on public health, by reducing the number of complications, Victor added. "From a public health perspective, (a small improvement) is not trivial."


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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