Lessons learned from The Black Cosmetologists Promoting Health Program: A randomized controlled trial testing a diabetes education program

Abstract

Purpose

Diabetes is reaching epidemic proportions in the United States and African Americans are at greater risk than most. Disparities in the incidence of diabetes place African American women at a much higher risk than their white counterparts. As such, the purpose of this study was to evaluate a community-based educational intervention program aimed at changing diabetes attitudes, knowledge, and screening behaviors of African American women via cosmetologists trained as community health educators.

Methods

Twenty African American cosmetologists joined the Black Cosmetologist Promoting Health Program. Their salons were randomized to disseminate diabetes or breast cancer information and given educational materials to display in their salons and give to their clients. Their clients (n = 984 women) consented to help evaluate the program, completing a baseline and 6-month follow-up survey regarding their knowledge, attitudes, and behaviors related to diabetes and breast cancer.

Results

At the 6-month follow-up, self-reported knowledge about diabetes increased across both groups. However, despite similar programmatic structure offered to the two groups, there were no significant differences in diabetes knowledge, attitudes, and screening at follow-up.

Conclusion

This non-significant outcome contrasted with the positive outcomes achieved by the parallel breast cancer program. Gladwell's Tipping Point theory could explain the different outcomes. The programs differed in message content, messaging tone, and the environment in which the messages were delivered. The diabetes program lacked a clear, memorable, and upbeat call-to-action and an environment that socially and financially supported the uptake of the recommended actions.

Keywords:

• African Americans
• Community-based communication
• Early detection
• Education
• Breast cancer
• Diabetes (used as a qualifier)
• Prevention
• Women

Acknowledgments

Program literature was generously donated by the American Cancer Society, the California Breast Cancer Early Detection Partnership Program, the Komen for the Cure Foundation, the American Diabetes Association, and the National Heart Blood and Lung Institute. The beauty baskets used as participant incentives were donated by Clairol. Special thanks to the following San Diego cosmetologists and their salons whose contribution to this research study to improve the well-being of African Americans was invaluable: Brenda Adams, Craig Allen, Tarva Armstrong, Charlene Baker, Barbara Ball, Jhonine Barber, Tranita Barnett, Wanda Blocker, Hazel Bomer, Tessie Bonner, Oma Black, Rachelle Brown, Al Bryant, Robert Butler, Toi Butler, William Calhoun, Lucille Cannon, Laticia Carrington, Leslie Chea, Veva Cockell, Geneva Cole, Jonna Council, Gary Davis, Kimmie Davis, Ann Denny, Denise Dulin, Josette Desrosiers, Pride Erwing, Thommie R. Flanagan, Shelton Flournoy, Flower Floyd, Brenda Forte-Pierce, Dellilah Gordon, DeBorah Green, Marilyn Hardy, Jan Harris, Shelbey Harris, Carmel Honeycutt, the late Phoebe Hutcherson, James Hyndman, Carol James, Ariella Angie Johnson, Cheryl Johnson, Ena Johnson, the late Rosemary Jones, Thea Jones, Phyllis Lee, Catherine Leggett, Darlene Loving, Ronnie Martin, Sheryl Martin, Zanola Maxie, De'Borah McCampbell, Valerie McGee, Kenisha McGruder, Janet D. Miller, Jennifer Mitchell, Lloydeisa Moore, Paula Morgan, Carl Mohammad, Sharon Mohammad, Sandra Pearson, Kia-Tana Price, Ethel M. Perkins, Jerry Piatt, Demetra Robinson, Marsha Ryder, Lynette Shine, Ann Smith, Gladys Smoot, Kandi Stephens, Beverly Taylor, Latasha Thomas, Mary Thomas, Beverly Tolbert, Bob Valero, Kim Vasser, Monica Vasser, Jeanne Walsh, Barbara Washington, Clara Watson, Kloria Wilkins, Redell Williams, Sherrice Williams, Julia Wilson, and Sabrina Woods. Special thanks also to the community leaders who enthusiastically helped the authors implement this community-based program: Victoria Butcher, Crystal Butcher, Reverend Alyce Smith-Cooper, Bishop George McKinney, Barbara Odom RN CDE, Reverend George Walker Smith, Robin Ross, and Dr. Robert Ross.

Author information

Georgia Robins Sadler is Principal Investigator for the Black Cosmetologists Promoting Health Program. She is Professor in the Department of Surgery at the UCSD School of Medicine and serves as the Associate Director for Community Outreach at the UCSD Moores Cancer Center. Her research is focused on addressing the nation's health disparities gaps. Other programs include: a program to train medical students in Deaf Culture and American Sign Language; a series of cancer education programs for the Deaf community and their interpreters; programs to increase clinical trials knowledge and participation among traditionally underrepresented communities; and the Asian Grocery-Based Cancer Education Program. Dr. Sadler has served on numerous NIH study sections and chaired Study Section G for two years. She has been integrally involved in collaborating with her legislators to create legislation that reduces barrier to cancer screening/care/clinical trials. She has held numerous civic leadership positions and has won numerous community service and teaching awards. Her cancer education videos in American Sign Language (with open captioning and voice over) have won more than three dozen awards in international, professionally juried video competitions. The majority of her research funding (over a million dollars a year) has been from the NCI.

Celine M. Ko, is Assistant Professor in the Psychology Department at the University of Redlands. She trained in the Joint Doctoral Program in Clinical Psychology at the University of California, San Diego and San Diego State University and conducted her post-doctoral work at the Jonsson Cancer Center at UCLA in health disparities research. She is inherently interested in working to reduce health disparities in the area of cancer prevention, especially among Filipino Americans. Concurrently, she and her colleagues at the University of Redlands are conducting research on the effects of meditation curriculum on stress and academic well-being.

Phillis Wu is an Assistant Clinical Professor at the David Geffen School of Medicine at UCLA-Olive View Medical Center. She earned her medical doctorate at the University of California, San Diego. During her time there she collaborated on numerous projects with Dr. Sadler investigating health disparities in the community. She went on to complete an Internal Medicine Residency at UCLA-Olive View where she also served as Chief Resident. Following this, she completed a fellowship in Hematology & Oncology at the UCLA-Olive View combined program. After finishing her fellowship she joined the faculty in the Division of Hematology & Oncology at UCLA-Olive View Medical Center where she continues her interest in education and community outreach.

Philip Ngai is a Resident Physician at the University of California at Irvine Medical Center, where he is currently training in Internal Medicine and Ophthalmology. Philip earned his combined MD-MBA degree from UC Irvine School of Medicine and Paul Merage School of Business. While in medical school, he performed research at the Gavin Herbert Eye Institute, and has published articles on orbital trauma as well as elastic properties of the optic nerve head. Prior to medical school, Philip obtained his master's training in Physiology and Biophysics at Georgetown. He received undergraduate training from the University of California at San Diego, majoring in bioengineering while minoring in Economics and Healthcare Social Issues. He also performed pharmacokinetic research in the private sector as well as at the UCSD Moores Cancer Center.