Hairdressing salons to promote an NHS educational online application to increase awareness of breast cancer screening among women in London’s deprived and ethnically diverse neighbourhoods: a feasibility study

Problem

Women from ethnic minority and socio-economically disadvantaged backgrounds have disproportionally lower rates of participation for screening for breast cancer. Hairdressing salons are trusted community assets, and have been successfully used for women to improve breast cancer awareness and screening uptake in the United States.We aimed to determine the feasibility of recruiting, engaging, training and retaining hairdressers in salons, supported by nurses/healthcare assistants (HCAs) at local GP Practices, to promote the use of a culturally adapted existing NHS online application, supplemented by symptom checker cards, to increase breast checks (all ages) and breast cancer screening uptake (50-70 years) in women in deprived and ethnically diverse neighbourhoods.

Approach

In Phase 1 (Intervention development), hairdressers and clients will co-develop and adapt an online existing NHS online app to suit their needs. We will train hairdressers in partnership with the Macmillan team so they can respond to queries from clients regarding the app, and advise where clients can seek further support.In Phase 2 (Feasibility), we will work with four hairdressing salons and two GP Practices. We will see whether hairdressers can promote the NHS online App, whether clients use the tool, determine what enabled or prevented hairdressers and clients from performing these tasks, and collect data on recruitment and use over 6 months. A range of data collection methods will be used: intervention fidelity logs held by hairdressers, nurses and HCAs, using a TIDieR checklist and guide; and data on uptake of screening and self-check via patient questionnaires. Qualitative methods (4 focus group discussions, 12 in-depth interviews) will target the following stakeholders: hairdressers; salon clients; nurses and health care assistants.

Findings

We will report the enablers and barriers for use of tool, breast cancer screening uptake and culturally appropriate health promotion materials. Data from focus groups and individual interviews will be analysed using thematic analysis; to support identification, analysing and reporting of patterns (themes) within data. Using qualitative and quantitative findings, the Re-AIM framework, will assist the framing of the process evaluation: Reach (e.g., recruitment and retention of salons and of clients by ethnicity and socio-economic circumstances); Effectiveness (e.g., breast self-examination, uptake of breast cancer screening); Adoption (e.g. nurse support for hairdresser); Implementation (e.g. strategies hairdresser use to promote breast cancer awareness); Maintenance (e.g. sustained motivation of hairdressers and nurses/HCAs) over study period. We will report data on uptake of breast screening and self-check by women.

Consequences

Hairdressing salon settings are a powerful community asset and community partnerships could facilitate breast cancer awareness and prevention services with equitable reach. If successful, these data will be used to design a larger study in partnership with GP practices and salons to examine if the tool increases breast cancer screening awareness and uptake.