June 2007

Grant Results

National Program

Robert Wood Johnson Foundation Local Funding Partnerships

SUMMARY

The National Kidney Foundation of Michigan expanded Healthy Hair Starts with a Healthy Body™, a project to train hair stylists in African-American neighborhoods as lay health promoters to educate their clients about diabetes, high blood pressure and kidney disease.

Project staff expanded the project in three cities in Michigan and added five new cities. The project was part of the Robert Wood Johnson Foundation (RWJF) national program Local Funding Partnerships (for more information see Grant Results).

This program provides matching grants to local grantmakers for innovative, community-based projects that improve the health of vulnerable people.

Key Results and Findings

  • 742 hair stylists in eight cities in Michigan became lay health promoters, educating 19,527 clients about diabetes, high blood pressure and kidney disease.
  • Nearly 60 percent of clients took steps to prevent diabetes, high blood pressure and/or kidney disease or to seek medical advice.

Funding
RWJF provided $460,000 to support this unsolicited project from 2001 to 2006.

 See Grant Detail & Contact Information
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THE PROBLEM

African Americans are at high risk for diabetes and high blood pressure, the leading causes of kidney failure in the United States:

  • The number of African Americans with diabetes more than quadrupled between 1970 and 1999, according to the National Diabetes Education Program, a federally funded program sponsored by the U.S. Department of Health and Human Services' National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC).
  • 31 percent of African Americans with high blood pressure in 1998 did not know they had it, according to the American Heart Association.
  • 26 percent of African Americans had uncontrolled blood pressure despite taking medicine in 1998, and another 15 percent who should have been taking high blood pressure medication were not, according to the American Heart Association.

The Michigan Department of Community Health reported the following statistics about kidney disease in the state in 1998:

  • Kidney disease was the fourth leading cause of death among African-American women.
  • Although only 14 percent of Michigan residents were African American, 47 percent of people on dialysis and 45 percent of people waiting for a kidney transplant were African American.

Healthy Hair Starts with a Healthy Body(TM)

To reduce the high rate of kidney disease among African-American women, the National Kidney Foundation of Michigan established Healthy Hair Starts with a Healthy Body (Healthy Hair) in 1999.

The project trained hair stylists in African-American neighborhoods in Detroit, Grand Rapids and Southfield to educate their clients about diabetes, high blood pressure and kidney disease.

A central part of Healthy Hair is two "health chats" (about one month apart) in which hair stylists:

  • Educate their clients about risk factors for diabetes, high blood pressure and kidney disease.
  • Ask their clients to make healthy lifestyle changes (e.g., improve their diet or stop smoking) and discuss their progress.

After each health chat:

  • Clients fill out a health chat form (a self-administered survey that project staff use to track outcomes) and receive a personal guide progress chart and healthy lifestyle incentives (a healthy soul-food cookbook after the first health chat and a canvas bag containing beauty products and other incentives after the second health chat).
  • Certified diabetes educators contact clients at high or moderate risk for diabetes via telephone (high-risk clients) or mail (moderate-risk clients) to encourage them to visit their doctor and make healthy lifestyle changes.

The Veterans Administration Center for Practice Management and Outcomes Research provided pro bono consulting services to help project staff create the health chat forms and personal guide progress chart and to track outcomes. For more information about the health chats and other components of Healthy Hair, see Appendix 1.

To train the hair stylists, the National Kidney Foundation of Michigan created a Healthy Hair curriculum, in collaboration with a statewide advisory committee composed of 15 professionals representing medicine, public health, nutrition, social work and education. Physicians, nutritionists and other experts from each city conducted the training. For more information about the curriculum, see Appendix 2.

Initial Funding
Initial sources of support for Healthy Hair were:

By December 2000, Healthy Hair had trained 55 hair stylists in 39 Detroit, Grand Rapids and Southfield beauty salons. The hair stylists educated 1,800 women.

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RWJF STRATEGY

In 1987, the RWJF Board of Trustees authorized $8 million to fund a two-year trial of a matching grants program to be called the Local Funding Partnerships program. Many matching grants programs set up by national foundations seek to replicate ideas formulated by the national institution itself.

Local Funding Partnerships was to be different. The local community would identify a pressing need, design the strategy for addressing it and put together a funding package that would provide at least one dollar of outside support for every one dollar of RWJF grant money. Each project would have one lead local funder, but additional supporters would be welcomed.

To be eligible, a project would have to fall within the general scope of RWJF's interest in health and health care. But a proposal would not have to meet the kind of specific criteria common to other RWJF programs. Instead of top-down, Local Funding Partnerships would be bottom-up-with an emphasis on innovation. RWJF hoped this local "ownership" would ensure sufficient support to keep the project going long after the RWJF grant ended.

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THE PROJECT

The National Kidney Foundation of Michigan expanded Healthy Hair by training more hair stylists in Detroit, Grand Rapids and Southfield and expanding the program to five new cities:

  • Flint
  • Lansing
  • Muskegon
  • Pontiac
  • Saginaw

Project staff recruited hair stylists to attend two four-hour training workshops through direct mail and personal contacts. In collaboration with staff of the Veterans Administration Center for Practice Management and Outcomes Research (working under a subcontract) and the advisory committee, project staff:

  • Developed two telephone surveys to learn about the health behaviors of clients and hair stylists who participated in Healthy Hair six months after the second health chat. Due to resource constraints, staff members were only able to survey 60 clients in two cities (Flint and Grand Rapids). They attempted to contact about 200 clients, of whom 60 agreed to take the survey.
  • Revised the health chat forms, personal guide progress chart and other project materials.

Funding

Eighteen other organizations contributed approximately $1.2 million to the project, including the Michigan Department of Community Health ($395,000), the Michigan Nutrition Network ($221,000) and Meijer ($200,000). In-kind donations totaled $196,590. See Appendix 3 for details.

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RESULTS

Project staff reported the following results to RWJF:

  • Healthy Hair trained 742 additional hair stylists in eight cities in Michigan—Detroit, Flint, Grand Rapids, Lansing, Muskegon, Pontiac, Saginaw and Southfield—as lay health promoters who educated their clients about diabetes, high blood pressure and kidney disease. The hair stylists also used what they learned to make their own positive lifestyle changes.

    Deborah Ivory, owner of Optimum Beauty Works and a Healthy Hair participant, says that the project saved her life. Deborah learned that her blood pressure was dangerously high during her training, and called her doctor. He put her in the hospital in order to stabilize her blood pressure. She and her husband, who also has high blood pressure, are taking better care of their health now, including walking together. "I am very thankful to the National Kidney Foundation of Michigan [which ran Healthy Hair] for this program," said Ivory.

    Another hair stylist who participated in Healthy Hair, Doris Griffin, improved her eating habits. "Now I am conscious of trying to eat better, to get in my fruits and vegetables each day," said Griffin who owns De Ge's Look Good Feel Better beauty salon. "Every day there's a consciousness in my mind. That's important."
  • Some 19,527 clients of the hair stylists learned about the importance of healthy behaviors (diet, exercise, smoking cessation and taking prescribed medications) in preventing or reducing the impact of diabetes, high blood pressure and kidney disease. Each woman shared what she learned with three other people, on average.

    Emma Lewis, a client at First Sight salon, shared what she learned as a Healthy Hair participant with her family. "I was able to educate my family on the different diseases," she said. "My husband has high blood pressure, and it runs in my family. I now know that I have to keep a watchful eye."

    "My clients love the program because they're focused on the goals. They're excited to know they aren't by themselves, that they are part of a larger movement," said Linda Lewis, a hair stylist at PHD Hair Salon.
  • In 2005, the National Kidney Foundation of Michigan started Dodge the Punch: Live Right™, a project based on Healthy Hair targeted to African-American men. This barbershop-based project trains barbers to educate their clients about diabetes, high blood pressure and kidney disease.

Findings

Project staff reported the following findings about clients who participated in Healthy Hair from 1999 to 2005 (a period that includes the RWJF grant) in an article, "Healthy Hair Starts with a Healthy Body: A Campaign Using Hair Stylists as Lay Health Advisors to Prevent Chronic Kidney Disease," in Preventing Chronic Disease (July 2007).

  • Nearly 60 percent of 8,148 clients who participated in Healthy Hair took steps to prevent diabetes, high blood pressure and/or kidney disease or to seek medical advice:
    • 46 percent of 7,715 women who said that they planned to eat healthier during their first health chat said they had increased their consumption of fruits and vegetables, were choosing low-fat foods or were limiting their salt intake during their second health chat.
    • 91 percent of 6,738 women who said during their first health chat that they planned to exercise regularly reported that they continued to exercise at least three days a week during their second health chat.
    • More than 2,700 women reported talking with their doctors about their risk for diabetes, high blood pressure and kidney disease:
      • Some 1,750 women received testing for at least one of these conditions.
      • Some 190 women were diagnosed with one or more of these conditions.
  • Many of the 60 clients surveyed six months after participating in Healthy Hair maintained some behavioral changes and remembered the campaign's message:
    • Approximately 60 percent of the women reported exercising at least three to four days a week.
    • Some 18 percent reported eating at least five fruits and vegetables a day.
    • More than 50 percent reported changing the way they cook for their families.
    • Some 70 percent reported improving their shopping habits (e.g., reading labels, selecting lower sodium foods and buying more vegetables).

Project staff reported the following finding about hair stylists in a report to RWJF.

  • Nearly 90 percent of the 742 participating hair stylists reported making positive lifestyle changes because of Healthy Hair.

Communications

Project staff and consultants published articles about the project in On the Cutting Edge (OTCE), published by Diabetes Care and Education (Winter 2006) and Preventing Chronic Disease (July 2007). See the Bibliography for details and online availability.

Media coverage included Black Hairstyles and Trends, Expose On-line Magazine and local newspapers, including the Detroit News, Flint Journal and Michigan Chronicle.

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LESSONS LEARNED

  1. Use multiple marketing methods to recruit project participants. During Healthy Hair, project staff used personal contacts, direct mail and media blitzes to recruit hair stylists. (Project Director)
  2. Consider using hair stylists as lay health promoters. Project staff capitalized on the positive and trusted relationship between hair stylists and their clients to provide health education to African-American women. The National Kidney Foundation of Michigan found this to be an effective way of educating people about key health issues and started a similar program for men. (Project Director)
  3. Provide health-related incentives to reinforce healthy lifestyle messages. The National Kidney Foundation of Michigan reinforced the healthy lifestyle message of Healthy Hair by giving hair stylists healthy soul-food cookbooks to give to their clients after the first health chat and a canvas bag containing beauty products and other incentives after the second health chat. (Project Director)

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AFTER THE GRANT

In late 2006, project staff expanded Healthy Hair to Ypsilanti, Mich., and launched Healthy Families Start with You, which they adapted from Healthy Hair.

Healthy Families is a Head Start-based project to help teach low-income parents and children to make healthy food and exercise choices.

Head Start is a federal program that promotes school readiness by providing educational, health, nutritional, social and other services to low-income children and families.

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GRANT DETAILS & CONTACT INFORMATION

Project

Non-traditional Preventive Education Program for African-American Females with Chronic Health Conditions

Grantee

National Kidney Foundation of Michigan (Ann Arbor,  MI)

  • Amount: $ 460,000
    Dates: August 2001 to July 2006
    ID#:  042800

Contact

Linda Smith-Wheelock, M.B.A., M.S.W.
(734) 222-9800
Lsmith-wheelock@nkfm.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Healthy Hair Starts with a Healthy Body(TM) Health Chat

The First Health Chat
During the first health chat, the hair stylists cover:

  • A brief overview of Healthy Hair.
  • Why the hair stylist is participating in Healthy Hair.
  • What the hair stylist has learned about diabetes, high blood pressure and kidney disease, including how to prevent kidney disease by preventing or controlling diabetes and high blood pressure.
  • Steps clients can take to prevent diabetes and high blood pressure or better manage these conditions:
    • Eat healthy, well-balanced meals by including five servings of fruits and vegetables per day and limiting salt and fat.
    • Exercise 30 minutes a day most days of the week.
    • Stop smoking (if the client is a smoker).
    • Take prescribed medicine (if the client has already been diagnosed with diabetes or high blood pressure).

Hair stylists ask clients to complete a risk survey (the American Diabetes Association's Take the Test and Know the Score) and the first health chat form, which asks about their intentions for disease prevention and seeking a doctor's advice and collects data on disease risk factors and diagnoses.

Hair stylists also give clients educational brochures, posters and decals.

The Second Health Chat
During the second health chat, the hair stylist discusses the client's progress with the healthy steps she decided to take during the first health chat, and asks the client to fill out the second health chat form, which covers the changes she has made.

The form also collects data on diagnoses and the number of people with whom participants shared the project's message.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Healthy Hair Starts with a Healthy Body(TM) Training Curriculum

Day 1

  • Understanding diabetes, high blood pressure and kidney failure.
  • Health status of African Americans.
  • Health chat demonstration and practice.
  • Overview of program tools (project brochure, health chat form, Are You At Risk brochure, referral resource card, the one-month reminder and the promotional poster and decals).

Day 2

  • Nutrition awareness.
  • Importance of exercise.
  • The need for organ donation among African Americans.
  • Helping clients cope with stress.


Appendix 3

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Other Sources of Support for Healthy Hair During the RWJF Grant

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Nwankwo R. "The Effectiveness of a Lay Health Advisor Hair Stylists Campaign." On the Cutting Edge (OTCE), published by Diabetes Care and Education. 27(6): 10–12, 2006. Abstract available online.

Madigan ME, Smith-Wheelock L and Krein SL. "Healthy Hair Starts with a Healthy Body: A Campaign Using Hair Stylists as Lay Health Advisors to Prevent Chronic Kidney Disease." Preventing Chronic Disease: Public Health Research, Practice and Policy, 4(3): July 2007. Available online.

Reports

Healthy Hair Starts with a Healthy Body: A Personal Guide to Leading a Healthier Lifestyle (brochure). Ann Arbor, MI: National Kidney Foundation of Michigan, September 2001.

Healthy Hair Starts with a Healthy Body: Are You at Risk? (brochure and survey). Ann Arbor, MI: National Kidney Foundation of Michigan, January 2002.

Healthy Hair Starts with a Healthy Body: We Care About More than Your Hair (brochure). Ann Arbor, MI: National Kidney Foundation of Michigan, January 2002.

Healthy Hair Starts with a Healthy Body: A Personal Guide to Leading a Healthier Lifestyle (brochure). Ann Arbor, MI: National Kidney Foundation of Michigan, March 2002.

Survey Instruments

"Healthy Hair Starts with a Healthy Body Client Chat Forms 1 and 2," fielded semiannually by the National Kidney Foundation of Michigan, September 2001–July 2006.

"Healthy Hair Starts with a Healthy Body Control Salon Study" (Brief Health Survey), fielded by the National Kidney Foundation of Michigan, December 2001.

"Healthy Hair Starts with a Healthy Body Six Month Post-Intervention Phone Survey," fielded by the National Kidney Foundation of Michigan, April 2002–July 2006.

"Healthy Hair Starts with a Healthy Body End of Campaign Stylist Survey," fielded semiannually by the National Kidney Foundation of Michigan, May 2002–July 2006.

World Wide Web Sites

www.nkfm.org/hair_stylists.htm (no longer available). "Healthy Hair Starts with a Healthy Body," on the National Kidney Foundation of Michigan's Web site, includes quick facts and a list of dates and locations for upcoming hair stylist trainings. Ann Arbor, MI: National Kidney Foundation, Fall 2006.

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Report prepared by: Eve Shapiro
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Jane Isaacs Lowe

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