Non-Hispanic Black men suffer and die disproportionately from undetected, untreated, and uncontrolled hypertension: a chronic asymptomatic medical condition that requires frequent surveillance, prescription medication, and continuity of care by a regular medical provider. To improve hypertension detection, treatment, and control in Black men, we propose a randomized controlled trial to evaluate a well-informed and feasible behavior theory-based intervention conducted by barbers, influential peers who will continually monitor their customers'blood pressure (BP), deliver health messages designed to change risk perception and social norms about healthcare utilization, and provide social support for desired changes in healthcare- seeking behavior and BP. Our major hypothesis is that a continuous high BP detection and medical referral program conducted by influential peers in a receptive community setting (barbershops) will change social norms about healthcare utilization, promote treatment-seeking behavior, and thus lower BP among the regular customers with high BP. The specific behavioral objectives are to: 1) Increase the measurement of BP during haircuts and the recognition of elevated readings;2) Increase new referrals to regular medical providers for untreated hypertension, and 3) Increase follow-up medical appointments for under-treated hypertension. To accomplish these objectives, Social Cognitive Theory/Community PROMISE (Peers Reaching Out and Modeling Intervention Strategies) will drive the intervention in which nurses will train and supervise barbers to measure BP and deliver health messages to barbershop customers at each haircut visit. To test our hypothesis, a cohort of 24 previously unstudied barbershops will go through a group- randomization protocol. Four new shops will be enrolled every two months. Serial cross-sectional BP surveys (each lasting 8 weeks) will be conducted by trained interviewers to obtain accurate snap-shots of hypertension control in each of the 24 barbershops before and after a 10-month intervention period consisting of either barber-based intervention or no active intervention. The multilevel analysis plan utilizes hierarchical modeling to address clustering of observations within barbershops and other important covariates. A detailed dissemination plan is proposed as the potential for dissemination is high;there are over 18,000 Black barbershops in major urban centers across the United States.
