Be a Bosom Buddy Salon Project:

Empowering hairdressers to promote

screening mammograms Gillian MacSmith1,2, Emma Webster3 & Catherine Hawke3

1BreastScreen NSW, 2Western NSW Local Health District, 3School of Rural Health, Sydney Medical School

14th National Rural Health Conference

Cairns, April 2017

BreastScreen NSW

Overview

• Overview of the intervention

• Engaging with hairdressers

• Appropriateness and acceptability of

the intervention

• Preliminary results

2

BreastScreen NSW

Project Rationale

• Breastscreen NSW offers FREE screening mammograms every

2 years for women aged 50 – 74.

• Screening mammograms are the most effective

way of detecting breast cancer early, yet only around

1 in 2 women have regular mammograms.

We needed a new and innovative approach to promotion!

3

BreastScreen NSW

The Bosom Buddy Salon Project

• Founded on ‘settings’ based approach to

health promotion2

• Built on the unique relationship shared

between a woman and her hairdresser

• Adapted from the Central West Ontario

‘Be a Breast Friend Salon Project’

conducted by the Canadian Breast Cancer

Foundation1

Bathurst Bosom Buddy Salons

BreastScreen NSW

Supporting evidence

Why hairdressers?

• Considered to be an appropriate, non-clinical setting for a personalised

message5,6,7,8

• Women-focused, with regular attendees who spend a significant amount of

time there were a range of topics are discussed between client and hairdresser6

• Successful in disseminating health information and improving client

knowledge3,4,5

• Successful in reaching a subset of the target population who have otherwise

been unreachable by conventional methods3,4,5

BreastScreen NSW

Aim

To increase awareness of the importance of screening

mammograms by empowering hairdressers to act as

peer health educators by engaging in discussion with

their clients about 4 key breast health messages

METHOD

BreastScreen NSW

Invitation All salons in Orange, Dubbo &

Bathurst were invited to participate (n = 89)

Information Pack

Follow-up phone call or visit

Launch Event

Follow-up phone call or visit

+/- phone call or visit

BreastScreen NSW

Initial Education Session & Start Up Pack

Overview of BreastScreen NSW

Education on 4 key messages

Education on target audience (50-74 years)

Education on how to use promotional material

Sessions were conducted face-to-face in each Salon (n = 24)

BreastScreen NSW

Support visits and Quarterly Forums

Phone call or visit

Fortnightly for first month

Monthly for remainder of Project

Informal discussion (5-10 minutes)

Held in each town

Content shaped by hairdressers

Provide information/share stories

45 – 60 minutes

Ongoing support was provided throughout the Project

Group forums were run every 3 months in each site

BreastScreen NSW

Promotional Material

1500- 2000 copies

Information on BSNSW

Screening locations/times

Local women’s stories

Myth busting & FAQs

Articles: family history, implants, assessment clinics

Bosom Buddy Magazine (5 issues x 2000 copies)

BreastScreen NSW

Promotional Material

Cherry & Pea key ring (x2500)

BreastScreen fridge magnet (x1500)

Branded pens (x5000)

Branded emery boards (x15,000)

Provided throughout the Project

BreastScreen NSW

Evaluation

Pre-Project & Post Project

Telephone Survey

Survey of Women

Reason for Referral Report

• Demographics • Knowledge of 4 messages

• No. of conversations each week • What is/isn’t working

• Content of Quarterly Forum(s)

• Reach of the target audience • If women are comfortable

• If women are encouraged to screen

• Impact on number of screens

Project period: January 2016 – June 2017

RESULTS

BreastScreen NSW

Preliminary results Participating Hairdressers (Pre-Project Survey)

• Recruitment of 24 salons out of 89 (= 27%)

• 64% of hairdressers reported >10 years of experience

• Of the 56% of hairdressers who were eligible for a mammogram,

70% reported having had a mammogram

• 47% of hairdressers reported that >¾ of their clients are women aged

50-74

• 33% reported >½ but <¾ of their clients are women aged 50-74

BreastScreen NSW

Preliminary results

Participating Hairdressers (Telephone Survey)

• Report 9-10 conversations on average per week

• The promotional items are very popular and helpful in

promoting conversation (for women and hairdressers)

• Report that clients are eager to let them know that they

have been for a screening mammogram

‘I got a text message from one of my clients to tell me she had

gone for her first mammogram’

‘One of my clients, who is in her mid 50’s went for her first

mammogram….she is now telling all her friends’

BreastScreen NSW

Survey of women (n = 206)

• 69% reported they had spoken with their hairdresser about

mammograms

• 36% reported that their conversation had encouraged them

to make a booking

• 65% of women reported that they had been going to their

hairdresser for more than 5 years

Preliminary results

BreastScreen NSW

Preliminary results

89%

0% 11%

Do hairdressers believe they are an appropriate person to discuss

mammograms (n=36)?

Yes

No

Unsure

Are hairdressers the appropriate person to talk about mammograms and are women comfortable with this discussion?

How comfortable are women (n=206)?

74%

22%

3% 1% 0%

Very comfortable

Okay

Neutral

Slightlyuncomfortable

Very uncomfortable

BreastScreen NSW

Challenges/Successes Challenges

• Attendance at an event (e.g. Launch event and Quarterly Forums)

• Hairdressers’ primary focus is their clients

• Hairdressers began to feel they were ‘annoying’ regular clients after

6-8 months

Successes

• One-on-one meetings instead of groups sessions

• Pre-arranged times for phone calls and support visits

• The giveaways were popular and useful in prompting conversation

• The magazine was successful with particular interest in local content

BreastScreen NSW

Conclusion The Project has been effective as a ‘setting’ based approach to health

promotion as it has:

• Been successful in starting conversations within the salon

context about screening mammograms;

• Shown that the Salon setting is a comfortable environment for

these conversations; and

• Shown the intervention is suitable for a rural setting where

salons are small and have a client base of regular, long-term

clients who have a unique relationship with their hairdresser.

BreastScreen NSW

Recommendations

• Recruitment should be approached with prearranged,

one-on-one meetings for optimal engagement with

potential participants

• A shorter project period (e.g. 4-6 months) would be

more effective to allow hairdressers to intently focus on

the project for a specific time period without ‘annoying’

regular clients

BreastScreen NSW

Acknowledgement

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• The project is funded by the Cancer Institute NSW’s

Evidence to Practice Grant (FY 2015/2017)

• Adapted from the Central West Ontario

‘Be a Breast Friend Salon Project’

conducted by the Canadian Breast Cancer

Foundation – Ontario Region1

BreastScreen NSW

References • 1Canadian Breast Cancer Foundation (CA). Be a Breast Friend [internet]. Canada: Canadian Breast Cancer Foundation

(CA); 2017 [cited 2017 April 3]. Available from http://www.beabreastfriend.ca/resources.php

• 2World Health Organisation (WHO). Ottawa Charter for Health Promotion [internet]. Ottawa: World Health Organisation; 1986 [cited 2017 April 3]. Available from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

• 3Forte D. Community-based Breast Cancer Intervention Program for Older African American Women in Beauty Salons. Public Health Reports. 1995;110(2):179-183.

• 4Hess P, Reingold J, Jones J, Fellman M, Knowles P, Ravenell J et al. Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men. Hypertension. 2007;49(5):1040-1046.

• 5Turrisi, R., Gunn, MD., Hultgren, BA., Warner, N. & Mallett, KA. The Style Project: Feasibility of Collaborating with Salons for Prevention and Early Detection of Skin Cancer. American Medical Association. 2012; 148 (10).

• 6Solomon, FM., Linnan, LA., Wasilewski, Y., Le, AM., Katz, ML. & Yang, J. Observational study in ten beauty salons: results informing development for the North Carlonia BEAUTY and Health Project. Health Educ Behav. 2004; 31(6): 790-807.

• 7Roosta, N., Wong, MK. & Woodley, MD. Utilising hairdressers for early detection of head and neck melanoma: An untapped resource. J Am Acad Dermatol. 2012; 66; 687-688.

• 8Sadler, GR., Ko, CM., Wu, P., Alisangco, J., Castaneda, SF. & Kelly, C. A Cluster Randomized Controlled Trial to Increase Breast Cancer Screening Among African American Women: The Black Cosmetologists Promoting Health Program. J Natl Med Assoc. 2011; 102 (8): 735-745.

• 9Whitelaw, S. et al. ‘Settings’ based health promotion: a review. Health Promotion International. 2001; 16(4); 339-353.

BreastScreen NSW

Questions?

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December 2014