The use of hairdressing and beauty salons as health-promotion environments for the prevention and management of non-communicable diseases in ethnically diverse women

Abstract Backgroung Women from some minoritised ethnic groups are disproportionately affected by non-communicable disease (NCDs), due to socioeconomic disadvantage, underlying health problems, health behaviours, and distrust of mainstream health services. Integrating community structures, such as hairdressing and beauty salons into existing primary care pathways can provide a sustainable process to address inequalities in access to health care. The aim of this global scoping review was to map and summarise the evidence about community salon-based interventions targeting ethnically diverse women (eg, Black African, Black Caribbean, and Asian women) for NCD prevention and management, including formative phases, theoretical approaches, and evaluation. Methods Six databases (PubMed, Web of Science, Embase, PsycInfo, MEDLINE, and Global Health) were searched for relevant articles published from inception until July 17, 2020. Search terms included women, Black-African, Black-Caribbean, mixed ethnicity, Asian, Indian, Pakistani, nail bar, hair salon, hairdressers, intervention, and non-communicable disease. Reference lists of relevant articles (excluding letters, editorials, and protocols) were screened using a participants, concept, context framework. All authors independently screened the titles and abstracts identified and eligible full-text articles. Disagreements were discussed between authors to reach consensus, and reasons for exclusion documented. Process and outcome evaluation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Thematic synthesis followed previously published guidance. Risk of bias was assessed using the Quality In Prognosis Study tool. Findings 525 titles and abstracts were screened, and eight met the inclusion criteria. All eight studies were US based. Two used formative phases to inform intervention development, and five referred to conceptual frameworks (Health Belief Model, Social Cognitive Theory, Chronic Care Model). Three studies described codevelopment with key community stakeholders. All studies reported outcome evaluation and the results generally showed positive changes in retention of knowledge, intention to change behaviour, changes in behaviour and in risk awareness. Five studies conducted process evaluation. Indicators included salon or participant attrition, therapists' insights of the intervention, clients' observations from the intervention, confidence of clients in their therapists to deliver the correct health messages, and the confidence and willingness of therapists to deliver health promotion messages. Sociodemographic characteristics were reported in two studies; however, their role in equity of coverage or influence on outcomes were not described. Interpretation Scoped studies were largely US based and applicability to other settings is unclear. More consistent integration of formative phases, community participation, including health or social care partnerships, and process evaluation are crucial to understand the public health impact for women of ethnic minority groups. Funding National Institute of Health Research, Research for Patient Benefit Programme (grant number NIHR202769).