Barbershop-Based Screening Combs Through Customers for Diabetes

Nancy A. Melville

January 27, 2020

On the heels of research showing the benefits of a barbershop intervention to improve screening for hypertension among black men comes a new study showing further benefits of the barbershop setting for screening another condition commonly undiagnosed in African American men — diabetes.

"Our findings suggest that community-based diabetes screening in barbershops owned by black individuals may play a role in the timely diagnosis of diabetes and may help to identify black men who need appropriate care for their newly diagnosed diabetes," write Marcela Osorio, BA, and colleagues, in their article published online in JAMA Internal Medicine.

With data showing diabetes complications to be disproportionately high among black men compared with other racial and ethnic groups, Osorio, of the Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, and colleagues evaluated the potential benefits of a barbershop-based screening approach using point-of-care A1c testing in such settings specifically owned by black individuals.

Rate of Undiagnosed Diabetes Higher Than Expected

The study was conducted at eight barbershops in Brooklyn, New York City, between September 2017 and January 2019, in neighborhoods identified as having a high prevalence of poor glycemic control.

Among 895 black men aged 18 years and older approached for participation in the study, 312 (34.9%) volunteered for screening and 290 (32.4%) were successfully tested with the point-of-care A1CNow+ test (PTS Diagnostics), which provides results within 5 minutes.

Men with blood disorders such as sickle cell disease or those who recently had blood loss were excluded from the study.

Of the 290 participants, 26 (9.0%) were found through the screening to have A1c levels of 6.5% or higher, considered a criterion for diabetes diagnosis, and three (1.0%) had A1c levels of 7.5% or higher; the highest level was 7.8%.

And 82 participants (28.3%) had A1c levels between 5.7% and 6.4%, which indicates a prediabetes diagnosis.

Participants who were identified in the screening as having abnormal A1c levels (≥ 5.7%) were provided counseling about the importance of dietary modifications, physical activity, and the need for medical management, and they were also provided contact information for local primary care clinics.

Of the 26 men who screened positive for diabetes, 16 (61.5%) were obese and their median age was 41 years (range, 22-65). Eleven (42.3%) had a high school education or lower.

The authors note that the 9% rate of undiagnosed diabetes was higher than expected.

"Our study sample may not be representative of other barbershops; however, the prevalence of undiagnosed diabetes (9.0%) that we found was much higher than the estimated prevalence of undiagnosed diabetes, at 3.6%, among New York City residents," they write.

Reasons for Passing on Participation

Among the 583 men who did not agree to take part in the study, 331 (56.8%) provided a reason, with 187 (56.5%) reporting they were already aware of their health status or were checked by their physician.

About a third (117; 35.3%) reported they believed they were healthy, did not have the time or interest, or did not want to know the result of the screening.

And 26 of the men (7.9%) reported being frightened of needles. Just one reported not wanting to be tested in a barbershop.

Importantly, the barbers, themselves, were often influential in convincing men to participate, the authors note.

"We found that barbers were important health advocates; although we do not have exact numbers, some customers (who initially declined testing) agreed after encouragement from their barber," they report.

Study limitations include the fact that participation rates may not be generalizable to other community-based settings, or other areas of New York City or the United States, the authors note.

In addition, although point-of-care A1c testing is relatively accurate, confirmatory testing is also essential, they assert.

Barbershops Are Good Places to Target and Help Black Men

As reported by Medscape Medical News, a previous barbershop-based intervention designed to screen high-risk black men for hypertension showed impressive improvements.

In that study, participants had their blood pressure measured by their local barber and were referred to trained pharmacists for follow-up and who prescribed medication in a collaboration with primary care providers.

Compared with a control group of men who were only recommended institute lifestyle changes and had follow-up with primary care, the intervention group showed significant reductions in mean systolic blood pressure levels at 6 months as well as 12 months.

The findings underscore that "community-based trials aimed at chronic disease management can be successful in reaching traditionally hard-to-reach, high-risk populations," the authors concluded.

Barbershops have also been used as a location to introduce straight men to HIV prevention programs, in an initiative called "Barbershop Talk With Brothers."

"Black men who live in urban areas of the United States may face socioeconomic barriers to good health, including poor food environments and difficulty in obtaining primary care," note Osorio and colleagues in the current publication.

"Our findings suggest that community-based diabetes screening in barbershops owned by black individuals may play a role in the timely diagnosis of diabetes and may help to identify black men who need appropriate care for their newly diagnosed diabetes," they conclude.

The study received funding through grants from the National Institute of Diabetes and Digestive and Kidney Diseases. Coauthor David C. Lee, MD, also received grants from the New York State Health Foundation and the Juvenile Diabetes Research Foundation outside the submitted work.

JAMA Intern Med. Published January 27, 2020. Abstract

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