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Service Delivery Innovation Profile

Cancer Prevention Messages From Cosmetologists Lead to Positive Lifestyle Changes Among Clients


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Snapshot

Summary

The North Carolina BEAUTY (Bringing Education and Understanding to You) and Health Project recruited and trained licensed hair stylists to serve as lay health advisers who delivered cancer prevention messages to their clients during beauty salon appointments. Surveys conducted after a pilot study found that the majority of clients recalled having health-related conversations with their stylists and reported an increased readiness to change behaviors. A year later, many of these clients had made positive behavior changes, and many of those who had visited a health care provider felt that the stylist counseling helped to enhance their interactions with the provider. The project ended in 2006.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-intervention self-reports from participants regarding readiness to change and health behavior changes adopted.
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Developing Organizations

Lineberger Comprehensive Cancer Center, University of North Carolina; University of North Carolina (UNC) Chapel Hill School of Public Health
end doA 7-week intervention was piloted in 2000; based on the success of the pilot, a larger, 4-year study commenced in 2002.begin pp

Patient Population

Race and Ethnicity > Black or african american; Vulnerable Populations > Racial minoritiesend pp

Problem Addressed

Cancer tends to strike and kill minority women more often than nonminority women.1 Beauty salons—trusted, familiar sites that are an important location for social interaction for African-American women—are typically not leveraged as a potential venue for providing cancer prevention and other health information to this population.
  • High cancer incidence and mortality: Cancer incidence and mortality rates are higher among minority than nonminority women, particularly for breast cancer.1 Cancer is the number-one cause of death for African-American residents of North Carolina.2
  • Potential of new settings for health messages: Researchers believe that new, innovative settings for health interventions are needed to achieve the public health goals laid out in Healthy People 2010.3
  • Beauty salons as an innovative, yet underused, setting: Beauty salons are located in every U.S. community; in fact, there are more than 200,000 licensed salons across the country and more than 11,000 in North Carolina alone.4,5 Clients go to beauty salons often (approximately once every 8 weeks), frequently talking and socializing with their stylists about beauty- and health-related issues. Although health-related programs have been implemented at beauty salons and barber shops to address a wide variety of health issues,4 these settings remain underused in most communities as a venue for conveying health-related information.6

What They Did

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Description of the Innovative Activity

The BEAUTY (Bringing Education and Understanding to You) and Health Project recruited and trained licensed hair stylists in 40 salons to serve as lay health advisers who delivered cancer prevention messages to their clients during beauty salon appointments. Various combinations of the program’s elements were tested first in a pilot study and later in a randomized controlled trial conducted from June 2002 through May 2006. Key elements of the program included the following:
  • BEAUTY and Health Project advisory board guidance: A very active advisory board guided all aspects of this project—forming the initial program idea, helping plan the pilot studies, reviewing all intervention materials, analyzing the results, helping recruit salons/stylists, and promoting all aspects of the project.
  • Participating salons: Participating beauty salons were privately owned (rather than a chain or franchise salon, where stylist turnover tends to be high). The salons served at least 75 customers, with the bulk of clients being African American.
  • Stylist-delivered prevention messages: Trained stylists talked to clients about key risk factors and discussed practical strategies for reducing these risks, such as healthy eating (including tips on how to eat five servings of fruits and vegetables each day and reduce dietary fat intake), increasing physical activity, achieving and maintaining a healthy weight, and adhering to American Cancer Society screening guidelines.
  • Health education displays: Health education displays were set up in salon waiting areas to reinforce cancer prevention messages discussed by the stylists; brochures and other items, such as recipe cards, were provided as part of the displays.
  • Magazine: Copies of a health-related magazine with messages similar to the ones conveyed by the stylists were mailed to customers’ homes. Magazine articles addressed myths and misconceptions about cancer; reinforced messages about healthy eating, physical activity, and weight control; and discussed various related topics, such as maintaining one's hairstyle during exercise. The magazine also included a column by a member of the BEAUTY and Health Project advisory board and features on participating stylists.
  • Incentives: Salon owners who joined the study received recognition in local newspapers for their participation in the project. Stylists who attended training workshops received $75 plus travel costs for attending a 4-hour training session. Participants received $5 in appreciation for completing the surveys.

Context of the Innovation

The North Carolina BEAUTY and Health Project, sponsored by the Lineberger Comprehensive Cancer Center at the University of North Carolina (UNC) Chapel Hill and the American Cancer Society, was conceived by Dr. Laura Linnan, with assistance from researchers at UNC Chapel Hill and the BEAUTY and Health Project advisory board members. Salons participating in the project were privately owned, served at least 75 customers (with the bulk of clients being African American), and were located within 100 miles of UNC Chapel Hill. Lineberger Comprehensive Cancer Center is one of 41 National Cancer Institute–designated comprehensive cancer centers. As part of the UNC system, the center is the only public comprehensive cancer center for the state and the people of North Carolina. Dr. Linnan had performed earlier work in beauty salons by creating smoke-free work environments in Rhode Island beauty salons as part of the Smokefree Shop Initiative.7 This initiative tested the feasibility of using salons to deliver smoking policy interventions; as part of the initiative, researchers conducted a survey of hairdressing facilities and subsequent interventions targeted to respondents' readiness (high/low) to adopt smoke-free policies.

Did It Work?

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Results

Surveys conducted at the end of a pilot study of two salons with five licensed stylists and 162 customers found that the majority of clients recalled having health-related conversations with their stylists and reported an increased readiness to change behaviors. A year later, many of these clients had, in fact, made positive behavior changes. Many participants who later visited a health care provider felt that the stylist counseling helped to enhance these subsequent interactions with the provider. Specific results from the pilot study are as follows:
  • Strong customer recall of health discussions: Surveys administered immediately after the pilot project show that most customers recall discussing specific health messages with their stylists, including healthy weight maintenance (78.6 percent), physical activity (73.2 percent), eating five servings of fruits/vegetables daily (67.9 percent), not smoking (64.2 percent), reducing dietary fat intake (55.3 percent), and calling the cancer hotline (48.2 percent).
  • Increased readiness to change: Overall, 60.7 percent of customers reported an increased readiness to change at least one health behavior as a result of having health-related conversations with their stylist. Higher readiness to change was associated with a greater frequency of conversations with the stylist.
  • Many health changes made at 1-year followup: One year after the intervention, 55 percent of customers reported making positive behavior changes as a result of conversations with their stylists. Of those customers making changes, 74.1 percent reported calling the national cancer hotline, 70.9 percent reported getting at least 30 minutes of physical activity daily, and 70.9 percent reported eating at least five servings of fruits/vegetables daily. Once again, the frequency of conversations was associated with a greater likelihood of changing a health behavior.
  • Enhanced interactions during subsequent provider visits: Of 39 respondents who reported visiting their health care provider after the BEAUTY and Health Project pilot, 66.6 percent reported completing a cancer screening test, 53.8 percent felt they better understood information from their health care provider, 54 percent asked questions of their provider, and 35.9 percent brought information from the BEAUTY and Health Project to the provider.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-intervention self-reports from participants regarding readiness to change and health behavior changes adopted.

How They Did It

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Planning and Development Process

Key elements of the planning and development process included the following:
  • Advisory board creation: Dr. Linnan and a team of researchers at UNC Chapel Hill’s Comprehensive Cancer Center created the BEAUTY and Health Project advisory board, which included licensed stylists, beauty school directors, a beauty product distributor, local health department representatives, community residents, and health professionals from the American Cancer Society and the National Cancer Institute’s Cancer Information Service. The advisory board guided the development of the program, designed protocols for approaching salons, solicited beauty salon owner participation, and developed research questionnaires.
  • Survey of stylists: Area stylists were surveyed on their willingness to participate and on what topics they would feel comfortable discussing with their clients.8
  • Pilot project: A pilot project was conducted in two salons after stylists were trained to provide basic cancer prevention messages.4
  • Project expansion: Based on positive pilot study results, the board applied for and received a grant from the American Cancer Society to fund a 4-year randomized controlled trial to study the program in 40 salons serving African-American women, an underserved population. Baseline results have been reported.9
  • Salon recruitment: Accessing a database of licensed salons from the North Carolina Board of Examiners of Cosmetic Art, project staff telephoned and visited shops within 100 miles of UNC to determine eligibility for and interest in participation.
  • Customer recruitment: Each salon was asked to recruit 55 clients to participate in the project. Interested clients completed a personal data form so that they could be contacted by investigators.
  • Training: Participating owners and stylists attended seven 4-hour training workshops in which they were introduced to the BEAUTY and Health Project and its specific campaigns/messages, learned facts and misconceptions about cancer, viewed a video called We Do More Than Hair, learned about select cancer prevention messages, and engaged in role-playing exercises to learn how to deliver messages to clients. The training sessions also introduced stylists to the health information displays that were placed in each salon and used to facilitate conversations about health messages.
  • Continuing education workshops: A training workshop adapted from those developed by the BEAUTY and Health Project was approved as a continuing education course by the North Carolina State Board of Examiners of Cosmetic Art. All licensed stylists in the state must complete 24 hours of continuing education every 3 years; participation in these training workshops qualified toward those hours.

Resources Used and Skills Needed

  • Staffing: In addition to the UNC research study investigators and the BEAUTY and Health Project advisory board members, the program staff included a project manager, an intervention coordinator, and two or three student interns per semester.
  • Costs: Funding for the pilot phase totaled approximately $35,000, while funding for the 4-year study was $1,341,000. Major expense categories included staffing, recruitment (e.g., travel), materials (e.g., display boards, brochures, magazines), and incentives.
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Funding Sources

American Cancer Society; Lineberger Comprehensive Cancer Center, University of North Carolina
The Lineberger Comprehensive Cancer Center funded the pilot phase. The 4-year research study was funded by the American Cancer Society (TURSG-02-190-01-PBP).end fs

Adoption Considerations

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Getting Started with This Innovation

  • Include cosmetology professionals on advisory board: These individuals can offer valuable guidance on how to structure the program and health messages so that they will be relevant in the beauty salon setting.
  • Offer training at convenient times for stylists: The UNC training workshops were offered on Mondays because many shops were closed that day. One-on-one training sessions can also be offered early in the morning or late in the day to accommodate stylist schedules.

Sustaining This Innovation

Allow flexibility in message delivery: Do not give stylists a script or specify the pace of health message delivery. Stylists should discuss messages in a way that is comfortable and natural for them in the context of their personal relationships with their customers.

Additional Considerations

This intervention was targeted to African-American women who visit beauty salons. It may be particularly applicable to African-American women, whose salon visits tend to last for a longer period of time than those of white women, thus providing the stylist an extended opportunity to share health information. However, the main theoretical basis and development strategies are likely to be suitable for all women who visit beauty salons.

More Information

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Contact the Innovator

Laura A. Linnan, ScD, CHES
Principal Investigator
North Carolina BEAUTY and Health Project
The University of North Carolina at Chapel Hill
Gillings School of Global Public Health
Health Behavior and Health Education
CB #7440
Chapel Hill, NC 27599
(919) 843-8044
E-mail: linnan@email.unc.edu

Innovator Disclosures

Dr. Linnan has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

Linnan LA, Ferguson YO, Wasilewski Y, et al. Using community-based participatory research methods to reach women with health messages: results from the North Carolina BEAUTY and Health Pilot Project. Health Promot Pract. 2005;6(2):164-73. [PubMed]

Solomon FM, Linnan LA, Wasilewski Y, et al. Observational study in ten beauty salons: using formative research results to inform development of the North Carolina BEAUTY and Health Project. Health Educ Behav. 2004;31(6):790-805. [PubMed]

Linnan LA, Kim AE, Wasilewski Y, et al. Working with licensed cosmetologists to promote health: results from the North Carolina BEAUTY and Health Pilot Study. Prev Med. 2001;33(6):606-12. [PubMed]

Linnan L, Ferguson YO. Beauty salons: a promising health promotion setting for reaching and promoting health among African American women. Health Educ Behav. 2007;34(3):517-30. [PubMed]

Linnan L, et al. The North Carolina BEAUTY and Health Project: overview and baseline results. The Community Psychologist. 2007;40(2):61-6.

Footnotes

1 North Carolina Department of Health and Human Services. Cancer replaces heart disease as leading cause of death in N.C. November 19, 2007. Available at: http://www.ncdhhs.gov/pressrel/2007/11-19-07.htm
2 Poland BD, Green LW, Rootman I, editors. Settings for Health Promotion: Linking Theory and Practice. Thousand Oaks, CA: Sage Publications; 2000.
3 Linnan LA, Ferguson YO, Wasilewski Y, et al. Using community-based participatory research methods to reach women with health messages: results from the North Carolina BEAUTY and Health Pilot Project. Health Promot Pract. 2005;6(2):164-73. [PubMed]
4 Interview with Veronica Carlisle, October 16, 2008.
5 Jones DK. Promoting cancer prevention through beauty salons and barbershops. N C Med J. 2008;69(4):339-40. [PubMed] Available at: http://www.ncmedicaljournal.com/wp-content/uploads/NCMJ/Jul-Aug-08/SpotlightSafetyNet.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software External Web Site Policy.).
6 Linnan LA, Emmons KM, Abrams DB. Beauty and the beast: results of the Rhode Island smokefree shop initiative. Am J Public Health. 2001;92(1):27-8. [PubMed]
7 Linnan LA, Kim AE, Wasilewski Y, et al. Working with licensed cosmetologists to promote health: results from the North Carolina BEAUTY and Health Pilot Study. Prev Med. 2001;33(6):606-12. [PubMed]
8 Linnan L, et al. The North Carolina BEAUTY and Health Project: overview and baseline results. The Community Psychologist. 2007;40(2):61-6.
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Original publication: March 02, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 29, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: December 09, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.