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Statement of need
Uncontrolled hypertension is common among Black men, who are underrepresented in trials of pharmacist and nurse interventions in traditional health care settings. In the county served by this proposal, many Black men have no regular source of primary care. The county and its figures are illustrative.
Evidence base
In a cluster-randomized trial in 52 Black-owned barbershops, 319 Black male patrons with systolic blood pressure of 140 mm Hg or more took part. In intervention shops, barbers encouraged patrons to meet with specialty-trained pharmacists in the barbershop, who prescribed medication under a collaborative practice agreement with the patients' physicians. In control shops, barbers encouraged lifestyle changes and doctor visits. At 6 months, systolic blood pressure fell by 27.0 mm Hg in the intervention group and 9.3 mm Hg in the control group, and 63.6% versus 11.7% reached a blood pressure below 130/80 mm Hg. Retention was 95% (Victor et al., 2018).
The 2025 AHA/ACC high blood pressure guideline was developed with nursing and other professional organizations and supports team-based care for hypertension (Jones et al., 2025). This proposal adapts the barbershop model with nurse practitioners as prescribers.
Specific aims
- Reach: enroll 150 Black men aged 21 and older with uncontrolled hypertension through 10 partner barbershops in 12 months.
- Effectiveness: achieve blood pressure below 130/80 mm Hg in at least 50% of participants at 6 months.
- Sustainability: establish referral and billing arrangements with the county's federally qualified health center so the program continues after the grant.
Program design
| Component | Detail |
|---|---|
| Barbers | Trained to measure blood pressure with validated automated cuffs and to encourage visits with the nurse practitioner |
| Nurse practitioners | Visit each shop weekly; assess, prescribe and adjust medications; order labs through the health center |
| Community health worker | Follows up on missed visits, helps with insurance and pharmacy access |
| Data | Blood pressure readings recorded in the health center's record |
Budget justification (year 1)
| Item | Amount | Justification |
|---|---|---|
| Nurse practitioners (1.0 full-time equivalent across two clinicians) | $135,000 | Weekly clinical sessions in 10 shops, documentation and follow-up |
| Community health worker (1.0 full-time equivalent) | $52,000 | Outreach, navigation and retention |
| Barber stipends (10 shops × $1,200) | $12,000 | Time spent on screening and encouragement |
| Validated blood pressure monitors (20) | $2,000 | Two per shop |
| Medications and labs for uninsured participants | $18,000 | Generic antihypertensives and basic metabolic panels |
| Evaluation and data management | $15,000 | A part-time analyst and data system fees |
| Indirect costs (10%) | $23,400 | Administrative support |
| Total | $257,400 |
The figures are illustrative.
Evaluation plan
- Primary outcome: percentage of participants with blood pressure below 130/80 mm Hg at 6 months.
- Secondary outcomes: mean change in systolic blood pressure; retention at 6 and 12 months; adverse events, such as acute kidney injury, which the barbershop trial monitored.
- Implementation: number of shops active, visits per participant, barber screening counts.
- Cost: cost per participant reaching target blood pressure.
Project management
A Gantt chart sets out milestones: hiring and training (months 1 to 2), shop launch in two waves (months 3 and 5), interim analysis at month 9, and a sustainability plan due at month 11. Risks include barber turnover and participants losing insurance, which the community health worker role is designed to reduce.
References
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., Carter, J., Cohen, J. B., Collins, K. J., Commodore-Mensah, Y., Davis, L. L., Egan, B., Khan, S. S., Lloyd-Jones, D. M., Melnyk, B. M., . . . Williamson, J. D. (2025). 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension, 82(10), e212–e316. https://doi.org/10.1161/HYP.0000000000000249
Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Brettler, J., Rashid, M., Hsu, B., Foxx-Drew, D., Moy, N., Reid, A. E., & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in Black barbershops. New England Journal of Medicine, 378(14), 1291–1301. https://doi.org/10.1056/NEJMoa1717250
