SummaryThe Barbershop Quartet is a church-sponsored program that provides African-American men with free health education and screenings for diabetes, hypertension, and prostate and colon cancers though a mobile medical unit parked in front of barbershops throughout Harlem. The program, which is staffed by a team of health professionals, also arranges for free followup care for those who need it. Data suggest that the program has increased access to needed screening and treatment in a population that faces significant barriers to obtaining these services.Suggestive: The evidence consists of program utilization data and anecdotal feedback from participants and barbers.
Developing OrganizationsAbyssinian Baptist Church; Harlem Hospital Center; St. Luke’s Roosevelt Hospital
The Barbershop Quartet is a program of the Men's Ministry at Abyssinian Baptist Church. It was primarily developed with the collaboration of St. Luke's Roosevelt Hospital and Harlem Hospital Center. Other initial community partners included the Ralph Lauren Center for Cancer Care and Prevention and Mount Sinai Hospital.
After a streamlining of the program in 2008, current partners include St. Luke's Roosevelt Hospital; New York University School of Medicine/Center for Healthful Behavior Change; the Albert Einstein College of Medicine Department of Epidemiology and Population Health, Division of Community Collaboration and Implementation Science; and the Albert Einstein Cancer Center, Cancer Prevention & Control Research Program.
Date First Implemented2007
Race and Ethnicity > Black or african american; Gender > Male; Vulnerable Populations > Racial minorities; Urban populations
Problem AddressedAfrican-American men—especially those living in urban areas—disproportionately suffer from many chronic diseases, including diabetes, hypertension, heart disease, and several types of cancer. They are less likely than non-Hispanic White men, however, to receive medical care for these conditions.
- Disproportionately at risk: In 2005, African-American adults were 1.8 times more likely than non-Hispanic Whites to be diagnosed with diabetes and 2.2 times more likely to die from the disease. They were also 1.5 times more likely than non-Hispanic Whites to have high blood pressure, 30 percent more likely to die from heart disease, 1.6 times more likely to be diagnosed with prostate cancer, and 1.2 times more likely to be diagnosed with colon cancer.1,2
- Especially in urban settings: Individuals living in urban settings have an even higher risk of developing and dying from many chronic diseases. In central Harlem, death rates from diabetes, cancer, and heart disease are all significantly higher than the national average, with the diabetes death rate being more than twice as high (51 deaths per 100,000 in Harlem vs. 25 deaths per 100,000 nationwide).3
- Less likely to receive care: More than 23 percent of African-American men aged 18 to 44 do not have a usual source of medical care, compared with 19 percent of non-Hispanic White men. Among those who do, African-American men are nearly twice as likely as non-Hispanic White men to use the emergency department as that source of care and are also less likely to have had a previous office or outpatient visit.4
Description of the Innovative ActivityThe Barbershop Quartet provides African-American men with free health education and screenings for diabetes, hypertension, and prostate and colon cancers though a mobile medical unit parked in front of barbershops throughout Harlem and the Bronx. The program also arranges for free followup care for those who need it. Key elements of the program include the following:
- Mobile medical unit: The program operates out of a one-bedroom recreational vehicle that has been converted into a mobile medical unit. The air-conditioned vehicle features a private room with an examination table, laboratory, and bathroom with running water, along with a waiting area where participants can view educational videos.
- Hours and location: The program offers services on Saturdays during the spring and summer. On these days, the vehicle parks in front of a different Harlem neighborhood barbershop from 8 a.m. to 4 p.m. Program participants receive services on a first-come, first-served basis, with no eligibility requirements.
- Marketing the program: Program volunteers, many of them from Abyssinian Baptist Church's Men's Ministry, canvas the neighborhood surrounding each participating barbershop before and during each day of program operation to publicize the program and recruit participants. The program also works closely with participating barbers to help them encourage their clients to be screened and advertises its services through radio interviews, outreach to area churches, and mailings to more than 3,000 individuals on the Men's Ministry mailing list.
- Screening and education: A health care team consisting of several nurses and a physician from St. Luke's Roosevelt Hospital provides free health education and screening services to all program participants. Available screening services include digital rectal examinations; prostate-specific antigen (PSA) tests; cholesterol, blood pressure, and blood glucose checks; body mass index measurements; and rapid human immunodeficiency virus (HIV) tests. Most test results are available the same day; many participants choose to stop back to get their results after getting their hair cut.
- Barbershop-based screening: The program has expanded its outreach and screening during the fall and winter by providing services inside the barbershops when the weather is too cold to use the mobile medical unit. Prostate and colon screening is then scheduled at a later date at a local hospital facility.
- Participation incentives: To increase participation among men and program promotion among barbers, the program offers a $20 voucher redeemable for a $15 hair cut and $5 barber tip for participating in the program.
- Followup care: Participants in need of a colonoscopy receive education about the test in the mobile unit and have an appointment scheduled for the test at St. Luke's Roosevelt Hospital, which offers the service free of charge. Program staff followup with the participants by telephone with the results. St. Luke's also provides free treatment to all program participants with abnormal test results who cannot afford the appropriate followup care. Treatment typically occurs within 2 weeks of the initial visit to the mobile medical unit.
- Research study participation: Program participants are invited to take part in one of three research studies associated with the program. The studies focus on effective behavioral interventions for hypertension control and improving screening rates for colorectal cancer.
Context of the InnovationThe Barbershop Quartet is a program of the Men's Ministry at Abyssinian Baptist Church, Harlem's largest church with more than 4,000 congregants. In 2007, Dr. Bert Petersen Jr. (a prominent cancer surgeon and church member) approached church leaders about creating a program to address health disparities affecting African-American men in Harlem. Having previously conducted breast cancer education efforts in beauty parlors, Dr. Petersen aspired to launch a similar program for men with the additional element of onsite screening, thus eliminating a key barrier to accessing services.
ResultsAlthough no formal evaluation of participants' health outcomes has been conducted, post-implementation data suggests that the program has increased access to needed screening and treatment in a population that faces significant barriers to obtaining these services. As of October 2010, the program was completing the pilot phase of an evaluation study.
Suggestive: The evidence consists of program utilization data and anecdotal feedback from participants and barbers.
- Facilitating access to screening and treatment: Since 2007, the program has provided screening services to more than 2,400 African-American men. More than 1,900 participants have received PSA tests, and 31 received colonoscopies. Of the 1,973 program participants receiving PSA tests, 437 had abnormal results, with 26 requiring intervention and treatment. As of October 2010, 576 participants had elevated blood pressure, 276 had elevated cholesterol, and 209 had elevated glucose. Many of these individuals received free education and followup treatment for these conditions through the program. In the absence of this program, participants likely would not have had access to these expensive screening and treatment services.
- Positive anecdotal feedback: Verbal feedback from program participants has been overwhelmingly positive. One patient diagnosed with cancer after being seen in the mobile medical unit credits the program with saving his life. Participating barbers report appreciating the opportunity to serve as health advocates for their community.
Planning and Development ProcessKey steps in the planning and development process included the following:
- Obtaining recreational vehicle: Dr. Petersen partnered with a local cancer survivor who had already received funding from the City Council of New York to obtain a recreational vehicle for the purpose of providing cancer-related services. This individual lacked funds to operate the program, and thus was open to partnering with the Barbershop Quartet program.
- Building partnerships and getting buy-in: Dr. Petersen used existing professional relationships to establish partnerships with St. Luke's Roosevelt Hospital, Harlem Hospital Center, Ralph Lauren Center for Cancer Care and Prevention, and Mount Sinai Hospital. Original partner organizations provided in-kind support, including staff and laboratory time.
- Recruiting barbershops: Dr. Petersen and representatives from Abyssinian Baptist Church visited numerous Harlem barbershops to solicit participation. Most barbers were immediately interested, expressing pride in being recognized as leaders in their community and excitement over having the opportunity to make a difference.
- Reevaluating partnerships: In the program's second year of operation, Dr. Petersen streamlined the program's partnerships to simplify services and make them more efficient. To that end, the program currently partners with original collaborating agency St. Luke's Roosevelt Hospital, as well as three new partners: New York University's School of Medicine/Center for Healthful Behavior Change, Albert Einstein College of Medicine, and the Albert Einstein Cancer Center.
- Obtaining funding: In its second year, the program received a small grant from St. Luke's Roosevelt Hospital to help cover the costs of operating the mobile medical unit and testing for program participants. The program also obtained a Citywide Colon Cancer Control Coalition grant from the New York City Department of Health to provide free colonoscopies for uninsured and underinsured individuals.
- Program expansion: With the addition of new funding sources as of October 2010, the program aims to expand its services to all the New York City boroughs, which will require the purchase of an additional mobile screening van. To ensure this growth, the program plans to extend funding requests to locally elected government officials. The program's message to local officials will emphasize civic pride, as well as the cost-savings benefits of providing these services in barbershops.
Resources Used and Skills Needed
- Staffing: The program employs three research assistants and three community outreach workers and also pays the owner and driver of the recreational vehicle a stipend for each day the vehicle is in use. The vehicle is staffed by nurses and physicians from St. Luke's Roosevelt Hospital, all of whom either volunteer their services or receive compensation for their time as a part of their regular duties at the hospital.
- Costs: Currently, program expenses run $200,000 annually, plus in-kind support.
Funding SourcesCenters for Disease Control and Prevention; National Cancer Institute; National Heart, Lung, and Blood Institute (U.S.); New York City Department of Health and Mental Hygiene; St. Luke’s Roosevelt Hospital; National Center On Minority Health And Health Disparities
Getting Started with This Innovation
- Engage the community: Generate energy and excitement for the program by engaging the community in the process. Identify local leaders (in this case barbers) and mobilize them to solicit support and participation. This step can help community members feel ownership over the project.
- Build strong partnerships: Well-established partners in the medical community can provide funding and in-kind support.
Sustaining This Innovation
- Search broadly for ongoing funding: Look locally and beyond for funders who share a commitment to eliminating health disparities in the community.
- Maintain a dedicated leader: Hire a full-time coordinator who is committed to the program's vision and who can nurture the partnerships that keep the program running.
- Learn from successes and failures: If initial hypotheses about interventions and their possible outcomes do not prove successful, be flexible in pursuing other means of serving the target population. Be willing to alter the initial program based on the response of participants.
Spreading This InnovationDr. Petersen reports having several requests from organizations who are interested in using this model to address a wide array of health issues including hypertension, heart disease, diabetes, and obesity.
Additional ConsiderationsThe Barbershop Quartet is collaborating with medical and research personnel at New York University and Albert Einstein College of Medicine to pursue funding to examine the program's effectiveness at increasing colonoscopy screening rates among African-American men, as well as the role of the Black church in the delivery of health care. The latter research will utilize lay health advocates from Abyssinian Baptist Church's Health Ministry to deliver an intervention aimed at improving hypertension control.
Contact the InnovatorBert M. Petersen, Jr., MD
Global Cancer Control
1133 Broadway, Suite #706
New York, NY 10010
Innovator DisclosuresDr. Petersen has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.
Original publication: July 20, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: February 26, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: October 07, 2010.
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.