A population health management solution designed to reduce health disparities in diabetes prevention will be developed by ProChange and the University of Maryland School of Public Health under a $1.06 million, multi-year contract awarded by the Centers for Disease Control and Prevention (CDC). The innovative solution will combine the trusted relationship between Black barbers and hair stylists and their clients with interactive, tailored text messaging solutions grounded in behavior change science. 

Black Americans are 60% more likely to be diagnosed with diabetes than white Americans and bear a disproportionate burden of the risk for its complications. Although the CDC’s Diabetes Prevention Program (DPP) provides an evidence-based lifestyle change program designed to prevent or delay onset of type 2 diabetes, enrollment and retention remain a particular challenge among Black Americans. 

Population Health Management Solution to be developed by ProChange and UMD

There is growing consensus that accelerating efforts to eliminate racial and ethnic health disparities will require innovative, community-based interventions. The groundbreaking work of HAIR (The Health Advocates In-Reach and Research Campaign)—a community-based network developed by Dr. Stephen Thomas and his team at the Maryland Center for Health Equity within the UMD School of Public Health—demonstrates that barbershops and beauty salons can be mobilized as venues for the delivery of health promotion and disease prevention services designed to eliminate health disparities and advance health equity. According to Dr. Thomas, “There is growing scientific consensus that accelerating efforts to eliminate racial and ethnic health disparities will require innovative, community-based interventions that can be scaled and sustained over the decades to come.”

In fact, HAIR has transformed barbershops and salons into culturally relevant portals for health education and delivery of public health and medical services in the community (e.g., colorectal cancer screening, men’s health, influenza vaccines). The HAIR campaign was endorsed by The White House as the model for “Shots@theShop” COVID-19 vaccination efforts. The network includes 950 barber shops/salons and 300 barbers/stylists who have been trained as lay health advisors and are eligible to be certified as community health workers based on local regulations. 

In close collaboration with barbers and stylists from the HAIR network, the Maryland Community Research Advisory Board, and other community members, ProChange and UMD will culturally adapt, provide diverse delivery channels for, and augment existing evidence-based interventions to prevent diabetes with behavior change theory and tailoring technology. Specifically, they will:

  • Train Black barbers and stylists from the HAIR Network as certified Lifestyle Coaches with a supplemental training customized for them that includes behavior change theory.
  • Facilitate trusted conversations with clients about diabetes risk and referral to an adapted version of ProChange’s bRIght communities program for screening and assessment of readiness to participate in the Diabetes Prevention Program for those with pre-diabetes.
  • Make referrals to either a local DPP, an in-shop DPP, or an asynchronous, self-guided virtual DPP.
  • Develop a customized population health management solution to send automated interactive text messaging that provides tailored behavior change guidance to increase engagement, retention, and impact of the DPP.
  • Conduct a 12-month pilot test with 20 Black barbers and stylists acting as agents of change, who through trusted relationships with their clients, will be a conduit of evidence-based behavior change interventions via empathic, ongoing conversations.

“The participatory design approach we will employ to create an infrastructure to build on the success of barbers and stylists as trusted health care extenders in their communities will enable this population health management solution to meaningfully contribute to health equity,” said Dr. Sara S. Johnson, Co-President and CEO of ProChange, the study’s principal investigator. “The powerful combination of artificial intelligence-driven, culturally tailored interactive text messaging and the rich dialogues between barbers or stylists and their clients has the potential to make an unprecedented impact on diabetes prevention. We are grateful to the CDC for supporting this work.”

Learn more about advancing population health management with ProChange!

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) (Contract # 75D30122C14701). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.