Researchers boost cancer screening rates visiting NYC barbershops

Hospitals have found success engaging patients within such community institutions as libraries and farmers markets, and now a team of outreach specialists have taken it a hair further by hanging out at barbershops.

A new study published in the American Journal of Public Health examined the effectiveness of performing patient navigation services in local barber shops, and found there to be an increase in the cancer screening rate studied.

Community health workers visited more than 100 barbershops in New York City between 2009 and 2013 to provide patient navigation to more than 700 black men.

The idea was to get to know members of the community well enough that they believed the researchers who were urging them to get screened for colorectal cancer. Dr. Joseph Ravenell, an associate professor of population health and medicine at NYU Langone Health who led the research, said any type of community outreach relies on establishing trust.

As such, Ravenell's researchers spent several years talking with barbershop workers and patrons in New York City, aiming to see if developing such relationships outside clinical settings could help to address some of the social factors that lead to health disparities.

"We put a lot of time into developing a relationship with the barbershops," Ravenell said.

Participants were split into three groups, with the first paired with a patient navigator who educated them on the importance of colorectal cancer screening and helped them address potential barriers to getting screened, such as a lack of insurance. A control group was given advice on controlling blood pressure and a third group received both a navigator and the blood pressure control counseling.

The study found 17.5% of men who worked with a navigator and 17.8% of men who got help navigating the system and received counseling got screened for colorectal cancer six months after they enrolled in the trial compared with 8% of men who just received counseling.

Several factors played a role in contributing to the health disparities many of the participants of the trial faced. Only 60% had a personal physician, while only 40% had received a checkup within the past year. Many were uninsured and lacked knowledge about their health and how to manage it. The median salary of trial participants was $16,726, almost one-third had less than a high school education, and nearly one-half were unemployed.

But Ravenell said the results of the trial showed the importance of having healthcare providers meet the health needs of patients who may not otherwise be seen within a clinical setting.

"What this study shows is that having trusted community members who are based in trusted community settings and teaming them with the healthcare system can definitely help to address important healthcare disparities," Ravenell said.

Community engagement has become more prevalent at hospitals in recent years as healthcare has focused greater attention on population health management to improve health outcomes and lower healthcare costs through prevention and wellness.

"What keeps people healthy often has to do with what's going on within their communities," said Dr. James Plumb, a professor of family medicine and co-director for the Center for Urban Health at Jefferson Health, a nine-hospital health system based in Philadelphia.

But a persistent problem that has been a barrier to hospitals' efforts has centered around how to develop community outreach initiatives that can help the most medically vulnerable groups, who often experience higher rates of preventable conditions compared with the general population.

Often such groups have worse health outcomes because they have less frequent access to preventive healthcare services such as cancer screenings and regular checkups. Such has been the case for black men, who are 25% more likely to develop and 50% more likely to die from colon cancer than white men, according to the National Institutes of Health.

A large factor in the higher rates has to do with fact that black men remain less likely to get diagnosed at early stages of the disease; early diagnosis improves the chance for survival. While community initiatives such as cancer screenings have helped to improve access, many are structured to bring patients into the traditional healthcare system, which can be difficult for some patients to navigate.

"The traditional model of patient navigation has been to navigate patients from the primary-care doctor's office to certain types of treatment or certain types of screening," Ravenell said. "But that kind of an approach definitely leaves out those who are less likely to utilize primary care."

Efforts to help patients access healthcare or to provide healthcare services in communities with poorer health outcomes have made strides in the past five years, according to Plumb. He said the rise in community outreach by hospitals was largely influenced by the Affordable Care Act, which required not-for-profit providers to produce a community health needs assessment every three years to maintain their tax-exempt status. "That to me has been a tremendous boon to community engagement by hospitals and academic health centers," Plumb said.

For its part, in September Jefferson plans to begin a pilot project that will embed a health clinic within a community school to give both students and adults living in the area closer access to health services.

Plumb said he did not expect healthcare providers to end their interest in community engagement with the potential repeal of the ACA. He said many will still have an incentive as payment models change from fee-for-service to value-based reimbursement.

"There are fewer resources, and we have to figure out how to better use those resources," Plumb said. "I think community engagement is one way to do that."

An​ edited​ version​ of​ this​ story​ can​ also​ be​ found​ in​ Modern​ Heatlhcare's​ July​ 31​ print​ edition.