Abstract
Hypertension remains a primary driver of cardiovascular health disparities, disproportionately affecting Black African and Black Caribbean men, who often face structural barriers to traditional primary care. This stepped-wedge cluster-randomized trial evaluated the effectiveness of a culturally tailored, barbershop-based blood pressure (BP) screening and referral intervention in London, UK. Eight Black-owned barbershops (comprising 412 hypertensive male patrons aged 35 years or older) were randomized to transition from a control phase (standard health leaflets) to an intervention phase (on-site BP screening by trained barbers, lifestyle advice, and direct referral pathways to a clinical pharmacist or general practitioner). The primary outcome was the change in mean systolic blood pressure (SBP) at 6 months. During the intervention phase, mean SBP decreased by 9.4 mmHg (95% CI: 7.2 to 11.6; p < 0.001) more than during the control phase. Diastolic blood pressure also fell significantly, with a mean reduction of 4.8 mmHg (95% CI: 3.1 to 6.5; p < 0.001). Additionally, 62% of referred participants successfully completed a clinical follow-up within 3 months. These findings suggest that utilizing trusted community hubs like barbershops is an effective, culturally responsive strategy for improving hypertension detection and management in high-risk, under-reached populations.
