Barber-Based Intervention for Hypertension in Black Men

描述(由申请人提供)：非西班牙裔黑人男性因未被发现、未治疗和未控制的高血压而遭受和死亡的比例不成比例：一种慢性无症状的医疗状况，需要经常监测、处方药物治疗和常规医疗提供者的持续护理。为了改善黑人男性的高血压检测、治疗和控制，我们提出了一项随机对照试验，以评估理发师实施的知情和可行的基于行为理论的干预措施，理发师是有影响力的同龄人，他们将持续监测客户的血压(BP)，传递旨在改变风险认知和关于医疗保健利用的社会规范的健康信息，并为期望的就医行为和BP的变化提供社会支持。我们的主要假设是，由有影响力的同龄人在接受社区环境(理发店)进行的持续高血压检测和医疗转介计划将改变有关医疗保健利用的社会规范，促进就医行为，从而在高血压常客中降低BP。具体的行为目标是：1)增加理发期间的血压测量和对读数升高的认识；2)增加未经治疗的高血压患者向常规医疗提供者的新转诊；以及3)增加对治疗不足的高血压患者的后续医疗预约。为了实现这些目标，社会认知理论/社区承诺(同伴接触和建模干预策略)将推动干预，护士将培训和监督理发师测量血压，并在每次理发时向理发店客户传递健康信息。为了验证我们的假设，24家以前没有研究过的理发店将通过分组随机方案进行测试。每两个月将有四家新商店入驻。训练有素的采访者将进行一系列的血压调查(每次持续8周)，以获得24家理发店在为期10个月的干预期之前和之后的准确高血压控制快照。干预期包括基于理发师的干预或没有积极干预。多层次分析计划利用分层建模来解决理发店和其他重要协变量中观察数据的聚集问题。由于传播的可能性很高，因此提出了一个详细的传播计划；全美主要城市中心有超过18,000家黑色理发店。

DESCRIPTION (provided by applicant): Non-Hispanic Black men suffer and die disproportionately from undetected, untreated, and uncontrolled hypertension: a chronic asymptomatic medical condition that requires frequent surveillance, prescription medication, and continuity of care by a regular medical provider. To improve hypertension detection, treatment, and control in Black men, we propose a randomized controlled trial to evaluate a well-informed and feasible behavior theory-based intervention conducted by barbers, influential peers who will continually monitor their customers' blood pressure (BP), deliver health messages designed to change risk perception and social norms about healthcare utilization, and provide social support for desired changes in healthcare- seeking behavior and BP. Our major hypothesis is that a continuous high BP detection and medical referral program conducted by influential peers in a receptive community setting (barbershops) will change social norms about healthcare utilization, promote treatment-seeking behavior, and thus lower BP among the regular customers with high BP. The specific behavioral objectives are to: 1) Increase the measurement of BP during haircuts and the recognition of elevated readings; 2) Increase new referrals to regular medical providers for untreated hypertension, and 3) Increase follow-up medical appointments for under-treated hypertension. To accomplish these objectives, Social Cognitive Theory/Community PROMISE (Peers Reaching Out and Modeling Intervention Strategies) will drive the intervention in which nurses will train and supervise barbers to measure BP and deliver health messages to barbershop customers at each haircut visit. To test our hypothesis, a cohort of 24 previously unstudied barbershops will go through a group- randomization protocol. Four new shops will be enrolled every two months. Serial cross-sectional BP surveys (each lasting 8 weeks) will be conducted by trained interviewers to obtain accurate snap-shots of hypertension control in each of the 24 barbershops before and after a 10-month intervention period consisting of either barber-based intervention or no active intervention. The multilevel analysis plan utilizes hierarchical modeling to address clustering of observations within barbershops and other important covariates. A detailed dissemination plan is proposed as the potential for dissemination is high; there are over 18,000 Black barbershops in major urban centers across the United States.