June is Men’s Health Month and the month that fathers are honored. We have decided to share a case study report featuring Dr. Byron Conner to honor him during this month. Dr. Conner has been a tireless volunteer, serving the community for decades.
Under the radar, Harvard University highlighted the Colorado Black Health Collaborative (CBHC) in 2017. The John F. Kennedy School of Government and the Cheung Kong Business School in Beijing, China compared CBHC Barbershop Program with a national initiative called the Black Barbershop Health Outreach Program (http://ash.harvard.edu/files/ash/files/case_study_barbershop.pdf).
A program much larger, the Nationwide Black Barbershop Health Outreach Program (BBHOP) screened over 10,000 men across the nation in cities including Los Angeles, Chicago, Atlanta, and New Orleans.
According to Dr. Bill Releford, founder of BBHOP, “health care doesn’t care about Black men” and the sentiment from Black men was “they were just out for the money.” So, African American doctors assessed, researched, and mapped out a way to address the issues through building face-to-face relationships with the community banking on identifying with the cultural perspective.
Dr. Byron Conner, MD started the change in Denver. He learned of the barbershop intervention while attending the National Medical Association Annual Convention. With the help of his wife, Alfredia Conner, a registered nurse, he conducted blood pressure screenings in Wright’s Barbershop (he’d been going to the barbershop since age 17). He kept the operation going for four years on a small scale, but a change took place in 2012.
Health Collaboration in the Black Community
Dr. Conner partnered with the CBHC’s Health Access Committee, which is chaired by Dr. Terri Richardson. She involved the Colorado Kaiser Permanente African American Center of Excellence in Culturally Competent Care (AACE). The team enhanced Dr. Conner’s efforts in barbershops, going from one to 12 [barbershops and beauty salons] as they banked on connecting with owners who were already familiar with them.
Why is this type of program important? Because African Americans face health disparities at alarming rates. At the time of the study for example:
- African-Americans were 40% more likely to have high blood pressure.
- Nearly 44% of African-Americans had some form of cardiovascular disease.
- Black men were 60% more likely to die from a stroke than their white male counterparts.
Sparking the change, Dr. Conner and his wife conducted 45 blood pressure screenings over the first three years. By 2016, the CBHC Barbershop Program had conducted over 3,625 blood pressure screenings across Denver and Aurora. Besides blood pressure screenings, the volunteers provided 781 blood sugar readings, 50 referrals and logged 2098 service hours. This data is reflective of the period from 2012 to 2016. Since then the Program has continued to grow and to date over 8500 people have been screened since inception.
The Barbershop Program focused on empowering African Americans by educating them through everyday interactions in a trusted environment with minimal funds required to operate. This method empowers the medically under-served population.
Neighborhood Nerve Center
A well-known fact is barbershops are a pillar of the Black community. People discuss politics, sports, relationships, stress, food, and being a Black man (or woman) in America. These topics are associated with high blood pressure, so the dialogue happens naturally. The Program used this opportunity to educate patrons while providing blood pressure screenings. Due to the complexities of socioeconomic, cultural, genetic predispositions, and geographical factors, performing the screenings in a non-medical setting allows the men (and women) to be free of “negative psychological baggage.” Starting with Dr. Conner’s efforts with a few blood pressure monitoring cuffs that he used his own funds to purchase and his professional expertise as a Black medical practitioner, the idea has proven to be effective.
After input on the processes, the effort was maximized as the screenings were being performed. Volunteers engage in information sharing with high blood pressure participants.
For example, they ask patrons:
- If they have had their blood pressure checked.
- When they last had their blood pressure checked.
- About their health choices.
- If they seek preventative care.
They also provide health-related resources emphasizing how many of the disparities are diet-related. Diets that are higher in salt and saturated fat and lower in fresh produce and whole grains can lead to health disparities. Figure 1 (below) demonstrates a culturally specific nutrition resource that is shared with the clients. The volunteers are trained through the program to capture outcomes, so everything is measured.
Figure 1 Diet Information
Low-Budget Program with Minimal Funding
- CBHC uses giveaways and promotional items to incentivize participation every Saturday (the busiest day at shops).
- For four hours, the team of trained medical and non-medical volunteers provide free screening and health counseling services at various barbershops and salons.
- Most non-medical volunteers were recruited through CBHC’s partnerships with health entities like Kaiser Permanente, churches, health organizations, and local universities such as Metropolitan State University of Denver and Regis University.
- The medical volunteers are African American doctors that supervise and provide consultations. In a case study, Dr. Terri Richardson mentions that, “the presence of Black medical professionals was powerful because they were rarely seen volunteering within their communities.”
- The volunteers rotate between the partnering barbershops and salons following a step-by-step guide to implementing the health-related interventions.
- A “toolkit” was developed by Dr. Richardson in collaboration with CBHC and the African American Center of Excellence, Colorado [no longer in existence] that can be a guide for starting a Program. The toolkit can be applied to a variety of health education and screening programs that could be utilized in barbershop/salon environments. (https://www.coloradoblackhealth.org/wp-content/uploads/2015/09/Barbershopandsalontoolkit-1.jpg)
- To ensure the cultural component was upheld training explicitly discussed this aspect in the shops. Additionally, the training emphasized the need for volunteers to display confidence, since timid approaches could worsen already strained relations between clients and the medical community.
Dr. Conner learned of this effective way to ignite behavioral change by creating positive interactions with the medical community while combating social stigmas that are associated with African Americans not trusting medical providers. To reduce hypertension rates and improve the long-term health of African American men, women and communities, Colorado Black Health Collaborative has incorporated the Barbershop/Salon Program as an effective way to improve the health education of Denver’s Black Community. CBHC also uses the Program to counsel Black men/women within the trusted environment of the shop. Equipped with new knowledge and peer support, the hope is that men and women are more likely to go to a medical practitioner.
Postscript: The CBHC Barbershop/Salon Program’s Current State
Oftentimes innovative community programs fizzle and die after a few years of success. However, since this case study was written, this CBHC Program continues to thrive. To date over 8500 clients have been screened at the shops and thousands of hours have been recorded by volunteers, since inception in 2012. Started offering HIV screenings through the Program in partnership with a local health clinic. This has been one of Dr. Conner’s goals since he heard about Barbershop Programs in 2008.
Thank you, Dr. Conner and Happy Father’s Day!
Happy Father’s Day as well to all the men out there reading this article.
Other Resources on Barbershops:
Effectiveness of a barber-based intervention for improving hypertension control in black men. Archives of Internal Medicine, 170(20), Retrieved from http://archinte.ama-assn.org/cgi/cont… doi: 10.1001/archinternmed.2010.390.
A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMoa1717250.
Dr. Releford, BBHOP. Retrieved from: https://youtu.be/A0hVZD_p-sw.