The pandemics of COVID-19 and racial discrimination in America have joined forces to
illuminate inequalities in healthcare delivery and health outcomes of Black Americans. These
pandemics have increased attention to the medical distrust, racism, discrimination, implicit
bias, and unequal treatment that has occurred in this country for centuries.

Trusted venues such as barber shops and beauty salons are gatekeepers and facilitators of
trusted information in the Black community. The investigators are addressing Health
disparities through Engagement, Equity, Advocacy, and Trust (HEEAT) Research Lab partners
with barbers and stylists for health promotion in communities of color. The investigators
co-founded North Carolina Barbers and Stylists for Health Equity (NCBSHE), a network of
barber shops and beauty salons serving primarily Black clientele throughout NC. NCBSHE is led
by barbers and stylists, with academic partners serving the organization in non-leadership
roles.

Due to barriers including access to care, discrimination, and medical distrust, engaging the
Black community in health research and improvement activities requires a community-based
approach. The investigators' novel approach integrates evidence-based strategies that will
address these barriers to engagement. The success of this project in increasing the uptake of
COVID-19 testing in the Black community will serve as a model for other health-related
activities beyond COVID.

Research Approach

The investigators' current and prior work addressing HIV prevention among Black women
successfully trained stylists in the community to bring awareness and knowledge of
pre-exposure prophylaxis (PrEP). The first three months of this COVID-19 project will focus
on training stylists and barbers as Opinion Leaders (OLs), development of edutainment videos,
and training of research staff. An NP will provide telehealth support to customers who test
positive, and the Community Coordinator will facilitate the OL workshop. The workshop will
include updates on COVID-19 in the designated testing areas, CDC guidelines for COVID-19,
clinical presentation, prevention strategies, testing, and telehealth policies and
procedures, and roles and responsibilities of an OL. An OL serves as a community liaison
between the researcher and the community. They do not serve as interventionists but are
informed of research practices and current studies taking place in their community.

Investigators will partner with an established communication strategist team we have
previously worked with to co-develop culturally and socially relevant short clip edutainment
videos.

OLs training as an evidence-based model to promote health. Without ready and convenient
access to credible, peer-reviewed information, people in search of information about health
and well-being appear to turn to trusted local information sources such as personal
connections and trusted healthcare professionals. Kim and colleagues note the importance of
social networks and local information sources among underserved communities. Training of
beauty industry professionals as OLs has been promising. There is evidence that customer
confidence is increased when stylists undertake workshops in preparation for sharing
information.

Edutainment videos are an evidence-based intervention strategy for health promotion and
prevention among communities of color. Grounded in transportation theory, edutainment videos
are designed to entertain and improve literacy while communicating prosocial norms and
behaviors. These short clip videos will be accessible by scanning a QR code in the barber
shop or beauty salon. A trained beauty professional will offer each client the opportunity to
view the video. A $5 off coupon for hair services with the designated salon/shop will be
offered if the client watches the video. At the end of the video, the client will be asked if
they would like to be tested that day. If they respond no, the client will be asked a set of
questions that explain the reason (e.g., I was tested in the past 2 weeks, I prefer to get
tested at my doctor's office, I don't think I have COVID, I don't trust the COVID test). If
the customer says yes, the client will be asked a set of questions about the reason for the
decision (facilitators) (e.g., I feel comfortable testing in this space, the video encouraged
me to be tested today, I have been wanting to get tested, but did not have easy access to
testing).

A nurse-led model of care: the role of the advanced practice nurse and telehealth. NPs are
positioned to advance health equity and support efforts to improve testing in the community.
In prior work by the team and others, the nursing workforce is increasingly being recognized
as being uniquely positioned to drive healthcare innovation to advance health equity. A
recent National Academies of Sciences, Engineering, and Medicine (NASEM) report outlined a
comprehensive vision for nurse-led innovation as a driving force in overhauling conventional
models of health service delivery. Specifically, the NASEM report endorses the scale-up of
nurse-led interdisciplinary care delivered directly in community settings. The NP will be a
liaison for OLs and salons/shops and will contact customers who test positive for COVID to
educate them of next steps. Since COVID, telehealth has been used to improve access to care
and address barriers such as transportation, childcare limitations, and needing time off for
appointments. Telehealth addresses traditional barriers to and disparities in access to care
while also improving efficiency.