Hairdressing salons to promote NHS health checks to prevent cardiovascular disease among women in London’s deprived and ethnically diverse neighbourhoods: The BELONG study

Research Question: Can hairdressers, supported by GP practices and community champions, in deprived and ethnically dense London neighbourhoods promote the uptake of NHS health checks among women for cardiovascular disease (CVD) prevention? Background: Heart disease and strokes, costing the NHS around £9 billion per year, are highest in deprived areas, including in inner cities and are under-diagnosed in women and ethnic minorities, signalling missed opportunities for early detection and treatment of risk factors. Early detection of CVD risk factors, such as hypertension and diabetes, is a key focus of the NHS Health Checks and of the NHS long-term plan. Uptake is lower in ethnic minority groups and deprived areas. Our feasibility study showed the potential for trained hairdressers to competently and confidently promote uptake of NHS checks amongst their clients. Additionally, clients promoted uptake amongst their families, signalling broader than intended benefits of BELONG . Aim: To adapt and test the effectiveness of the BELONG intervention on the uptake of the NHS Health Check and /annual hypertension and diabetes reviews in salon clients in deprived and ethnically dense neighbourhoods in Tower hamlets, Lambeth and Lewisham. Methods: Using the MRC Complex intervention guidance and Theory of Change developed in our feasibility study, we will conduct a pragmatic 2-arm parallel cluster effectiveness implementation randomised trial of 900 women (40-74y old) across 30 clusters/salons (15 intervention, 15 control). The primary outcome is change in NHS Health Checks uptake and/annual hypertension and diabetes reviews 12 months post-delivery. Implementation outcomes will be assessed using the PRISM/RE-AIM framework. Eligible women will not have had an NHS Health Check in the last 5y and without certain preexisting health conditions OR diagnosed with Type 2 diabetes or hypertension AND have not had an annual review in the last year. BELONG intervention comprises (i) Trained hairdressers promoting culturally adapted advice on healthy lifestyles, importance of early detection, encourage clients to book NHS Health Checks/and annual reviews with their GPs, and encourage clients to spread the word amongst their female family members and friends. Health care assistants/nurses at nearby surgeries will support hairdressers (ii) culturally-adapted online platform with information about BELONG, community programmes and interactive CVD prevention sessions (iii) Trained community champions will support hairdressers by promoting community programmes for CVD prevention. Control salons will receive health promotion leaflets. Key aspects relate to community engagement and involvement, with partnership building across health and non-health sectors; adaptation of the BELONG intervention from the feasibility study; and multisectoral roundtables to define a Roadmap to sustainability, and capacity development for communities (hairdressers, community champions and peer researchers). Timelines: 0-6 months, partnership building, finalise adaptations, recruit salons and clients, training; 7-19 months implement intervention, ongoing evaluation; 20-24 months roundtables and dissemination activities. Anticipated impact: BELONG will provide the first robust evidence of contextually and culturally tailored salon-primary care-local council partnership intervention to improve the uptake of the NHS Health Check and / annual hypertension and diabetes reviews in women in deprived and ethnically dense neighbourhoods, benefitting their friends and family and primary health care.