Nearly 60% of clients reached by a stylist in the Healthy Hair program reported having taken steps to prevent the targeted diseases or to seek medical advice. Given this outcome, we believe that the intervention is effective in the short term in bringing attention to healthy behaviors and increasing risk awareness. Surveys taken 6 months after the intervention suggested that many clients maintained some behavioral changes and remembered an enduring campaign message. Although these results may be somewhat overstated, considering that they are based on self-reports, they are nonetheless encouraging. Even though the African American urban salon environment appears to be conducive to rendering health advice, characteristics of the industry present challenges. Many stylists work part-time and have other jobs. Because real estate is often inexpensive and plentiful in large cities such as Detroit, salon owners tend to change locations frequently, sometimes moving in the middle of a campaign. Other shops struggle and close before the campaign concludes. Stylists experience some of the same stresses in their lives as do their African American clients, and these have consequences for the program. As a result, 23% of trained stylists fail to complete the campaign.
The advantages of salon-based programming, nonetheless, outweigh the disadvantages. Data gathered in focus groups during campaign development revealed that clients regarded their stylists as trusted advisors, had known them for an average of 8 years, and patronized their shops at least biweekly for an average of 90 minutes at a time. Client comments gathered in 6-month follow-up surveys attest to the comfort level and receptivity many clients have for receiving health information in salons. Considering the many positive aspects of the Healthy Hair campaigns, we have some lessons learned to share after several years of campaign experience:
Recruitment. Personal outreach by program staff and multipart marketing that included direct mail, peer-to-peer recruitment, and media blitzes were invaluable in recruiting stylists. The role that financial incentives ($50 stipend for training, $4 per client Chat Form) play in attracting stylists is untested. We know anecdotally that many stylists were drawn to the campaign because of personal experience — either their own or a loved one's — with diabetes, hypertension, or kidney disease.
Morale. Mid-campaign luncheons with participating stylists were an effective remedy for lagging commitment and seemed to help in troubleshooting issues that stylists were not otherwise presenting to staff. Occasional gatherings of stylists to foster a shared commitment to improving the African American community through the Healthy Hair campaign also proved helpful.
Quality. Client phone surveys conducted 6 months after the campaign revealed a few instances of potential deception by stylists. The financial rewards combined with the complexity of the intervention may have compelled a few stylists to take shortcuts in their approach or, worse, to exploit the campaign. To help mitigate this problem, we stressed quality during training. We also included a modeled Health Chat and one-on-one practice time to emphasize not rushing through the Health Chat. Staff also made salon visits within 1 week of training to observe Health Chat techniques and to correct problems. Monitoring by staff and discussion during training about creating a system for managing client recruitment, Chat Form storage, second-month re-approach, and incentive awards were also useful ways to help maintain quality.
Support. Diverse, active, and committed groups of local partners that provided structural support for the campaign were essential. Partners can include voluntary health agencies, hospitals, primary care centers, public health departments, and civic and church groups. Ways in which they can assist include providing volunteer trainers, free training space, educational brochures, cookbooks, videos, incentives, and marketing aid. Some Healthy Hair partners even provided nurses to conduct occasional blood pressure checks in salons. Others promoted the program in their corporate newsletters or featured campaign promotions in their employee cafeteria. We shared campaign results with partners along with information on how to apply local resources to improve behavior outcomes. The identification of local partners with the campaign's mission and success may well ensure long-term sustainability.
The Healthy Hair campaign develops community health resources that will last indefinitely while sustaining existing assets. The campaign turns salons into health information centers where owners and stylists provide knowledge that will stay in the community regardless of the long-term welfare of the campaign. During 2000 through 2005, each participating stylist reached an average of 31 clients, for a total of more than 14,000. Those clients, on average, talked to another three people about what they learned. This ripple effect, coupled with the success in behavior change generated from the Healthy Hair Starts with a Healthy Body campaign, demonstrates the usefulness of reaching at-risk populations through hair salons.