~11 minutes

DiMENsion in Nursing: Cultivating Health Awareness in Barbershop Culture

The Significance

DNPs of Color hosted a virtual event titled, DiMENsion in Nursing: Cultivating Health Awareness in Barbershop Culture. The two-hour webinar discussed the current state of health and healthcare access for Black men in America which has been marked by significant disparities. Black men in particular face higher rates of chronic conditions such as hypertension, diabetes, and cardiovascular diseases, often exacerbated by limited access to quality healthcare and socioeconomic challenges. Structural racism and implicit biases within the healthcare system further hinder their access to adequate and timely medical care, leading to worse health outcomes. Moreover, Black men are less likely to have health insurance and more likely to encounter barriers such as financial constraints and a lack of culturally competent care. Addressing these disparities requires systemic changes, increased community outreach, and policy reforms aimed at improving health equity and access. The COVID-19 pandemic has highlighted and worsened these underlying issues, emphasizing the need for targeted interventions to address these health inequities. Efforts to improve health outcomes for Black men must focus on eliminating structural barriers and enhancing access to comprehensive, culturally competent care (Office of Minority Health) (Kaiser Family Foundation).

Dermatology Conditions that Benefit from Early Detection

There are multiple dermatologic conditions where early detection can improve morbidity, mortality, health outcomes, and psychological distress. Below are just a few. Unfortunately, there is a paucity of data on health disparities in dermatology with the exception of disparities in melanoma. This is where nurses and nurse practitioners can and should partner with barbers, cosmetologists and estheticians who can play a valuable role. The nursing model is based on health promotion and disease prevention. You can consider this pitch: primary dermatology preventative care, where the focus is on education, actionable steps, community resources, and teaching the public how to identify credible resources and providers trained in skin of color and culturally sensitive care.

-Acne

-Acne keloidalis nuchae

- Central centrifugal cicatricial alopecia

- Traction alopecia

- Atopic dermatitis

- Contact dermatitis

- Dyschromia/dyspigmentation

- Mycosis fungoides

- Pseudofolliculitis barbae

- Psoriasis

- Seborrheic dermatitis

- Skin cancer, with emphasis on melanoma

- UVA, UVB, and visible light protection

- Vitiligo

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Why Barbers, Cosmetologists, & Estheticians

Less than 5% of dermatologists are Black and Hispanic. There are only 3-4 dermatologists per 100,000 in metropolitan and rural communities. It takes anywhere from 35 to 75 days for people to get an appointment with a dermatology provider. It is imperative that we recognize and educate members adjacent to dermatology who interact with patients and clients on a more frequent basis. It’s not uncommon for people to see their barber, cosmetologists, and esthetician on a weekly or monthly basis throughout the lifespan. Unlike in dermatology, where we may only see patients when there is a real or perceived problem. Barbers, cosmetologists, and estheticians are well known, trusted members of the community. Patients and clients patronize the same barber, stylists, and esthetician for years, often referring their friends and family. They develop close bonds and interact with people in intimate and sometimes vulnerable spaces. They celebrate both the highs and lows of life with their clients. Barbers, cosmetologists, and estheticians sincerely care about the satisfaction and well-being of their clients. They are dedicated to their craft and invest in continuing education as regularly as nurses and nurse practitioners.

In my experience, barbers, stylists, and estheticians enter the beauty industry desiring a set of skills to create a certain aesthetic for their clients and business acumen. Over time, as they encounter the same problems and questions, they begin to develop a curiosity as to the etiology and preventative practices. This curiosity motivates them to seek out credible resources. This can be seen in the new partnership between dermatologists and stylists called, S.T.R.A.N.D.

S.T.R.A.N.D

Dr. Chesahna Kindred, MD, MBA, FAAD is a distinguished board-certified dermatologist, researcher, author, and national speaker. She completed her residency and fellowship at Howard University. After her residency, Dr. Kindred became a leading dermatologist at MedStar Health in Baltimore. Five years later, she founded Kindred Hair & Skin Center in Columbia, Maryland, where she treats a diverse range of patients. When it comes to treating hair loss, she stays at the forefront of providing the latest treatments, including Platelet Rich Fibrin Matrix or PRP/PRFM, laser, and micropigmentation for men and women. At the time of this writing, Dr. Kindred and her staff just celebrated the grand opening of their new location at 11125 Stratfield Ct, Marriottsville, MD 21104. They outgrew their previous location and her pastor, Larry Walker called his pastor, Bishop Robbie Davis, who was kind enough to let her see patients at Celebration Church at Columbia while the Marriottsville location was being built.

Susan L. Peterkin is the CEO and co-founder of the Natural Hair Industry Convention (NHIC), the first natural hair conference designed for professionals. In 2003, she established the Jaha Natural Hair Academy to educate industry professionals. By 2013, the academy introduced the popular hands-on consumer class “My Hair, My Way.” Susan founded NHIC in the same year, aiming to support natural hair care education. Recently, she has shifted away from active styling to collaborate with Dr. Kindred.

Dr. Kindred partnered with Susan to create the PeterKindred Hair and Scalp Wellness Center, the first dermatologic salon that combines hair styling with dermatological care to provide a holistic approach to hair loss treatment with emphasis on scalp care, alopecia, and hair restoration. This innovative salon, is located within the Kindred Hair & Skin Center, which allows Peterkin to address scalp health alongside Dr. Kindred. Peterkin emphasizes the importance of medically informed hair loss treatment techniques that she learned from Dr. Kindred. Together, they also established S.T.R.A.N.D (Stylists Training, Researching, and Networking with Dermatologists), an educational program to bridge the gap between hairstylists and dermatologists through collaborative learning, research, and networking. S.T.R.A.N.D's inaugural course was presented at the Natural Hair Industry Convention in 2023. Their first workshop was held in April 2024 in Maryland. The next one will be in Houston, Texas from October 5-6, 2024. Learn more here https://www.thestrandnetwork.org/

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Preventative Dermatology Nursing Care for Communities of Color

In communities of color, our knowledge and beliefs about skin, hair, and nails often comes from a variety of sources including traditions, social norms, magazines, and the internet, including social media. People first learn from these resources, leaving dermatology providers to dedicate precious time to dispelling myths and common misconceptions. Two barriers to providing care to communities of color are trust and time. By partnering with barbers, stylists, and estheticians, we can leverage the trust they have built; meet people in spaces they feel safe, seen, and heard; and step outside of the clinical setting where we can take the time to truly engage with our patients. In dermatology, the biggest barrier to providing care is the lack of diversity in faculty, research, clinical trials, medical images, and providers trained in skin of color. There are many initiatives underway to improve education, in fact, the incoming President-Elect of the American Academy of Dermatology, Dr. Susan Taylor, MD, FAAD Founded the Skin of Color Society 20 years ago. However, the statistics I shared are still dismal and we do not have this same initiative or recognition in nursing. At least not yet.

‍Me & My Ecosystem

We would love to partner with nursing and community-based groups collaborating with barbers, stylists, and estheticians to bring awareness to the aforementioned dermatologic diseases, early signs of disease, and when to refer. I ask that you share this article with schools of nursing, and cosmetology and barber schools, professional organizations, students, and mentees to encourage more undergraduate and graduate research dedicated to increasing knowledge, identifying evidence-based solutions, implementation science, and translational research in dermatology nursing and population health.

Diversity of Demographics

I previously mentioned that less than 5% of dermatologists are Black and Hispanic, the numbers are even smaller for American Indian, Alaska Natives, Native Hawaiians, Pacific Islanders, and other races/ethnicities. We could estimate that the percentages are likely similar in nursing, or we could collect the data to be more accurate. At the time of this writing, I have yet to find credible, peer-reviewed resources depicting the racial and ethnic demographics of nurse practitioners and physician associates in dermatology. In 2023, Margaret A. Bobonich, DNP, FNP-C, DCNP, FAANP; Veronica Richardson, MSN, ANP-C, DCNP; and Sotero Alvarado, MA wrote an article titled, Dermatology NP & PA Workforce Survey—Practice Characteristics and Compensation, where they asked a number of questions relating to compensation, but did not capture any demographic data other than age, like race, ethnicity, and gender identity which would have given a more comprehensive view of the current landscape and Advance Practice Provider (APP) workforce as is seen in many labor reports. It is well documented that there is a paucity of data when it comes to collecting and reporting gender identity amongst our patients, but not as much when it comes to providers. Perhaps in future studies, this will be the standard because it speaks to improving workplace disparities which are often related age, race, gender, and sexuality. The study in reference was published in the Journal of Clinical and Aesthetic Dermatology and can be viewed by clicking on the hyperlink.

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Kimberly Madison, DNP, AGPCNP-BC

I am a nurse practitioner with a passion for writing, entrepreneurship, education, and mentorship. I created this blog to share my journey as source of motivation and as a blueprint as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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