https://orcid.org/0000-0002-0329-648X
Figures
Abstract
Place-based health interventions may help reach underserved populations. This scoping review summarizes the peer-reviewed literature on the type and effects of place-based health interventions in unconventional public-facing business settings (e.g., retail and services). A literature search was conducted in PubMed, Google Scholar, and APA PsycNet for studies from 1990–2023. Inclusion criteria for studies were: conducted in the United States, delivered a health intervention, based on an unconventional business setting, and targeted a specific health condition. An initial search yielded 2,727 unduplicated studies, which was filtered to 42 studies included in this review. These 42 studies were categorized based on health conditions of focus, including cardiovascular health (12 studies); HIV (6 studies); diabetes (5 studies); cancers (13 studies); and all other conditions (14 studies). The most common unconventional public-facing business settings for health interventions included barbershops or beauty salons; interventions included health education, preventative screenings, pharmacy services, and connections to local healthcare providers and resources. Notably, 34 (81%) of the studies targeted Black populations. Studies reported positive responses from participants for place-based interventions, increased awareness and screening of health conditions, more referrals to healthcare services, and improved health outcomes. While there have been 9 randomized trials conducted across various health conditions, these trials are limited to focus on a few select settings and lack of objective health outcome measures. These findings highlight the need for more rigorously designed studies in diverse settings that can effectively evaluate the impact of place-based health interventions. The existing literature suggests health interventions delivered in public-facing business settings may be a promising strategy to reach underserved populations.
Citation: Tsai J, McCann NA (2025) Usual prevention in unusual settings: A scoping review of place-based health interventions in public-facing businesses. PLoS ONE 20(1): e0317815. https://doi.org/10.1371/journal.pone.0317815
Editor: Lakshminarayana Chekuri, University of Missouri School of Medicine, UNITED STATES OF AMERICA
Received: July 29, 2024; Accepted: January 6, 2025; Published: January 24, 2025
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Data Availability: All relevant data are within the manuscript. This is a review paper so there is no specific datasets. We do provide the syntax for our literature search in the Supplementary Information.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
An important part of public health is reaching all segments of the population where they live, work, and play [1]. However, there are various groups in the United States that can be considered underserved, including some low-income, racial/ethnic minority, and immigrant populations. Thus, there have been increasing efforts to develop unique ways to outreach, engage, and serve these groups. Place-based interventions is one approach to reach people “where they are.” Place-based interventions can range widely, from changing physical environments and areas where groups live (e.g., creating bike lanes to facilitate exercise) to increasing access to resources in neighborhoods (e.g., introducing new farmers markets or transport facilities).
A recent review examined 51 studies of locally-delivered place-based interventions across three elements of place and health: the physical, social, and economic environments [2]. However, these interventions were mostly focused on altering the “place” of people as the intervention, which can disconnect individuals from their familiar community contexts. In contrast, delivering traditional health interventions in unconventional settings—such as salons and barbershops—maintains the familiarity and trust that these spaces offer, potentially leading to better engagement and participation from target populations. For example, a number of novel studies have developed health promotion interventions in salons and barbershops to reach African American communities, which have been summarized in a recent systematic review [3]. However, the vast majority of health promotion activities in real-world settings and in the research literature continue to occur in traditional settings, such as primary care clinics, and clinics embedded in pharmacies, grocery stores, and community health centers.
The Coronavirus Disease-2019 (COVID-19) pandemic also helped popularize these types of place-based health interventions, which were often referred to as “pop-up clinics” by offering COVID-19 vaccines across many public settings, such as groceries, malls, schools, etc. [4]. But what types of other interventions and in which types of settings have these place-based interventions been used? Specifically, what unconventional public-facing business settings have been involved, and which communities have been served?
No prior review found has examined the full scope of these types of place-based health interventions delivered at less conventional public-facing business settings across all health conditions and racial/ethnic groups. Such a review would help public health practitioners, researchers, and business owners understand what is possible in terms of implementing interventions in public-facing business settings. In particular, a review that examines not only the types of settings, but the health conditions targeted and the outcomes can further knowledge about how to reach underserved and minority populations in these settings.
To address this knowledge gap, we conducted a scoping review of studies on delivering preventive health interventions in unconventional public-facing business settings, such as retail and service settings, to understand the type of interventions, the diversity of settings, the broad range of health conditions targeted, and how these interventions have been implemented across various racial and ethnic populations.
Methods
Protocol
A review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [5]. While this protocol was not registered, it followed a systematic approach aligned with PRISMA-ScR standards. The three major search databases used were PubMed, Google Scholar, and APA PsycNet. The search range in each database was set from 1960 to the present; however, the oldest study that met the inclusion criteria was published in 1995, and the most recent in 2023. Inclusion criteria were studies conducted in the United States, provided health interventions (e.g., education, disease screening, connection with healthcare providers, pharmacy services) to clients in one or more business settings for one or more diseases or conditions, were written in English, and were peer-reviewed. Exclusion criteria were studies that were not peer-reviewed, not published in English-written journals, or did not report study of a health intervention in a business setting. We only included peer-reviewed studies to ensure the review focused on studies which had been previously assessed and deemed acceptable for publication as a quality control measure for this review.
Search method
The two authors participated in all stages of the review, with one author leading study screening, selection, and data extraction and the other author assisting and double-checking this work for validity, and rerunning processes when there were discrepancies. Searches were initially conducted in PubMed using keywords and Boolean operators like “public health AND barbershop OR laundromat OR hair salon OR movie theater OR nail salon OR mechanic.” The full syntax of keywords and strategies used in these initial searches are provided in S1 Table. The initial search returned a total of 2,727 unduplicated studies (PubMed 749, Google Scholar 1,930, APA PsycNet 48). Filtering and brief analysis of the titles and abstracts led to exclusion of 2,603 studies and a total of 124 studies entering the initial review process.
Review process
Between January and April 2024, the two authors reviewed all 124 studies. To reduce potential bias, the two authors conducted a calibration exercise, independently reviewing a subset of studies to establish consistency before proceeding with selecting studies and extracting data from the selected studies. In total, 77 studies were removed for not meeting the inclusion criteria following an initial preliminary review of the studies by title and abstract (PubMed 76, Google Scholar 1). Twelve of the excluded studies were systematic reviews, and the other 65 studies were excluded due to conduction of the studies outside of the United States, providing health interventions outside of unusual business settings, or only surveying business clients without providing additional health intervention services. After a secondary review (NM), five more studies were removed after the full text articles were assessed for eligibility due to not meeting the inclusion criteria. This resulted in a final selection of 42 studies. These 42 studies were then sorted into three categories based on targeted health conditions: 1) cardiovascular health conditions, HIV, and diabetes (20 studies), 2) cancers (13 studies), and 3) all other conditions (14 studies). Note that certain included studies may fall into more than one category due to targeting multiple diseases or conditions through its intervention. Fig 1 includes a CONSORT diagram summarizing the study identification and review process.
Data extraction and synthesis
Data extraction was conducted using an Excel-based form, which included fields for study design, business setting, health intervention, population of interest, sample size, target disease or condition, data findings, and conclusions. This Excel form served as a tracking and synthesis tool, while Zotero was used for citation management. To ensure consistency, data extraction was piloted by both reviewers on a subset of studies, following which any discrepancies were discussed and resolved. Synthesized data were categorized descriptively across intervention type, health condition, and setting, allowing for a narrative overview.
To assess the quality of each study included in this review, each study was evaluated using the NIH Study Quality Assessment Tools, matched to the appropriate study type [6]. Observational cohort and cross-sectional studies—including cross-sectional studies, longitudinal studies, descriptive studies, and cohort studies—were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Pre-post studies, such as feasibility studies, program evaluations, and pilot studies, were evaluated with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Finally, controlled intervention studies, specifically randomized controlled trials (RCTs), were assessed using the Quality Assessment of Controlled Intervention Studies. By applying these tools, we ensured that each study design underwent a rigorous and relevant quality assessment. This assessment provided insight into the methodological rigor and potential risk of bias across the included studies.
Results
The 42 studies identified were categorized by the health condition(s) they were focused on in Tables 1–3. Table 1 contained studies providing interventions for cardiovascular health conditions, HIV, and diabetes [7–26]. Table 2 contained studies providing interventions for different cancers [12, 27–38], and Table 3 contained studies providing interventions for all other conditions not falling into the previously listed categories [8, 12, 18, 39–48]. Each table lists the study author(s), study design, intervention setting (e.g., barbershop, nail salon, etc.), study population, sample size, health condition targeted by intervention, geographic area of study, major data findings, and overall findings. Note that some studies provided interventions for multiple conditions with certain studies falling into multiple tables [8, 12, 18]. Among the 42 studies, 36 studies involved health education as an intervention, 20 studies offered preventative screening as an intervention, 9 studies referred and facilitated connection to local healthcare providers and resources, and 3 studies offered pharmacy services as an intervention.
Cardiovascular health conditions
A total of 12 studies were identified by their provided interventions for cardiovascular health conditions. Of these, 2 studies provided interventions for peripheral artery disease, 9 for hypertension or blood pressure monitoring, and 1 for heart disease.
Both studies investigating peripheral artery disease (PAD) at barbershops sampled Black men in a midwestern state, each with a sample size of 37 participants [7, 9]. One of these studies used a longitudinal study design [7], while the other was a qualitative analysis and was a sub-study of the longitudinal study [9]. In the longitudinal study [7], participants completed three visits to the barbershop: a first visit initially screened participants for PAD, a second visit rescreened participants for PAD and presented a PAD education video 4–6 weeks later, and a third visit in which exit interviews and assessments were conducted. The trial ultimately diagnosed PAD in 5/31 (16.1%) of participants and overall awareness of PAD began low at the beginning of the study but significantly increased between the initial and exit visit assessments.
The qualitative study [9] was conducted at the final exit assessment of the longitudinal study [7] and involved individual interviews to understand the perspectives of Black men in receiving barbershop-based screening and PAD education. Several common themes arose such as acknowledgement of barriers like fear, trust, and healthcare access, but participants indicated that the barbershop intervention enhanced knowledge of PAD and cardiovascular disease.
A total of 9 studies investigating hypertension or blood pressure management were identified, and all 9 studies targeted these conditions in either Black men or predominantly Black populations and offered interventions at barbershops or hair salons [8, 10, 11, 13–18]. These studies were conducted in all five regions of the United States (Northeast, Southwest, West, Southeast, and Midwest), and study designs included program evaluations, cluster-randomized trials, exploratory studies, longitudinal studies, pilot intervention studies, cohort studies, and descriptive studies. Additionally, the sample sizes of these hypertension intervention studies ranged widely from 10 to 14,000 participants.
Each of the 9 studies incorporated blood pressure screening into their interventions in different ways. For example, studies that investigated hypertension with larger sample sizes (i.e., 680–14,000) focused on taking blood pressure measurements, using self-report questions asking about recent blood pressure screenings, connecting participants to providers, or training barbers and hair stylists to serve as lay health educators [8, 16–18]. Overall, these larger studies found that barbershops and beauty salons served as suitable locations for blood pressure screenings and reported increased awareness of hypertension and connection to providers by participants.
The other five hypertension studies utilized longitudinal or cluster-randomized trial designs and included baseline and follow-up blood pressure measurements. These studies reported that participants who were connected with pharmacy or other medical providers and provided hypertension education had notable reductions in their blood pressure [10, 11, 13–15]. Two cluster-randomized trials were of particular note due to their study designs (control and intervention groups) and results, which found that the use of barbers as lay health educators and connection with pharmacy and healthcare services led to significant reduction in mean blood pressure in the intervention groups [10, 14]. Two of these hypertension studies with longitudinal components utilized additional unique methods in their interventions. One study incorporated a telehealth component for follow-up care by connecting pharmacy providers with study participants recruited from barbershops online after their blood pressure had been controlled via medication [11]. The other study was a cluster-randomized trial that directly connected some participants to hypertension specialists and observed greater reductions in systolic blood pressure than participants who were first connected to primary care providers [15].
HIV
A total of 6 studies provided interventions for HIV in this review [19–24]. Sample sizes of these studies ranged from 48–1,124 participants, and the designs of the included studies were a cluster-randomized trial, longitudinal studies, descriptive studies, and qualitative analyses. The majority of HIV intervention studies were conducted in the Northeast region of the United States, with one being conducted in the Southeastern United States [20]. Additionally, while most of the studies primarily targeted predominantly Black populations recruited from laundromats, one study recruited participants from a variety of settings; and another study sampled diverse racial/ethnic participants [20, 23]. All 6 studies provided participants education about HIV and safe sex practices.
One notable study was a descriptive study assessing previous HIV knowledge and providing prevention and education services to Black participants (n = 677) at corner stores, beauty supply stores, laundromats, mechanics, and barbershops [20]. The intervention targeted Black communities heavily affected by HIV in Miami, Florida and included a survey collecting demographic information and HIV knowledge and prevention services like free condom distribution and HIV testing. Within these communities, 68.8% had never heard of PrEP (a medication highly effective at reducing the risk of getting HIV), 8% had never been tested for HIV, and 65.9% had no primary care provider [49]. The study found that the intervention delivered at corner and food stores had the most engagement followed by laundromats, barbershops, and beauty salons.
A second notable intervention study based in Delaware utilized the Popular Opinion Model (POL), a community level peer-based outreach strategy designed by the Centers for Disease Control and Prevention, to provide HIV education to over 6,000 racial/ethnic minority participants and HIV tests to 1,124 of those participants [23].
A third notable HIV study was a cluster randomized controlled trial targeting Black men (n = 618) that compared the Shape Up! Barbers Building Better Brothers HIV risk-reduction intervention (based on the theory of planned behavior) or an attention-matched violence prevention control [24]. The Shape Up! intervention led to a significantly increased consistent condom use in the postintervention period.
These three notable studies together suggest place-based interventions can lead to decreased risky behavior associated HIV transmission (e.g. condomless sex, sex with multiple partners, etc.) and increased self-efficacy for condom use among participants [20, 23, 24].
Diabetes
A total of 5 studies provided interventions for diabetes were included in the review [8, 12, 18, 25, 26]. Each of these studies occurred at barbershops or beauty salons, and incorporated diabetes education and prevention strategies. The designs of the 5 diabetes studies included a program evaluation, a longitudinal study, a cohort study, a focus group and qualitative research study, and a cross-sectional study. Two of the studies targeted predominantly Black populations, and two additional studies targeted Black men specifically. The remaining study included a broad sample of participants deemed “at risk” for developing diabetes. The sample sizes of the included studies ranged from 13–14,000 participants.
Three studies provided a diabetes intervention in addition to interventions for other conditions [8, 12, 18]. One study was a program evaluation targeting predominantly Black populations (n = 1,823) in barbershops and beauty salons for high blood pressure, diabetes, tobacco-use associated conditions, high cholesterol, and need for social services [8]. Through partnership with an integrated healthcare system, local barbershops and salons in Baltimore, Maryland, and a mobile health clinic, the program screened 469 participants and connected them with free resources when necessary. Another study was a longitudinal study (n = 356) targeting people at risk for diabetes, heart disease, stroke, colon cancer, and breast cancer in laundromats and investigated perceived risk and susceptibility to these conditions; the study found 18% of participants believed their risk for diabetes was lower than it was [12]. The third study was a cohort study that trained over 700 stylists as lay health educators and reported reaching over 14,000 clients with 60% of clients reporting they took steps to prevent or address their diabetes, hypertension, or kidney disease with a provider [18].
The two remaining diabetes studies were a qualitative study and a cross-sectional study, each targeting Black men in barbershops [25, 26]. In the qualitative study, focus groups with 13 participants found that diet and exercise were recognized as ways to prevent diabetes, and people were supportive of barbershops as sites for a diabetes intervention program [25]. The cross-sectional study sampled 290 participants and provided diagnostic hemoglobin A1C testing on site at barbershops and diabetes education based on screening results [26].
Cancer
A total of 13 studies providing cancer-related prevention, screening, education, and referral services were included in this review [12, 27–38]. Of the 13 studies, 6 of them provided interventions for breast cancer, 4 for prostate cancer, 2 for colorectal cancer, and 1 including both colorectal cancer and breast cancer.
Seven studies provided breast cancer interventions with sample sizes ranging from 162–10,306 participants [12, 32–34, 36–38]. Study designs included longitudinal studies, descriptive studies, randomized-controlled trials, cluster randomized trials, health education programs, and pilot studies. The two cluster randomized trials are noteworthy due to their inclusion of control and intervention groups in their study designs [34, 36]. The majority of studies occurred in beauty salons; but barbershops, churches, neighborhood health centers, laundromats, social service agencies, health fairs, and public libraries were also breast cancer intervention sites. Interventions included health education provided verbally by medical professionals and stylists trained as lay health educators; and education and connection to local resources via kiosks, magazines, store displays, and other paper materials. Regarding target populations, five of the seven interventions targeted Black women specifically, while the other two targeted participants at risk for breast cancer and all women, respectively [12, 38]. One notable study provided breast cancer education for Black women through touch-screen kiosks located in beauty salons, churches, health fairs, neighborhood health centers, laundromats, public libraries and social service agencies [33]. These kiosks used an interactive computer program called Reflections of You that printed magazines for users containing tailored breast cancer education and local breast cancer resources based on participants’ answers to screening questions. These kiosks reached 4,527 participants in under 18 months and reported that 34.1% of participants over 40 had never had a mammogram before the intervention. Another descriptive study by the same lead author used the Reflections of You kiosks to identify appropriate community channels and settings for delivering evidence-based breast cancer health promotion materials [32]. Through the 10,306 kiosks used over a four year period, the study identified laundromats were the only settings that had the highest kiosk use and highest specificity (e.g. proportion of users without health insurance, barriers to getting a mammogram, low breast cancer and mammography knowledge, etc.).
Four studies provided prostate cancer interventions as two pilot studies, a descriptive study, and a non-randomized comparison study [27, 29, 31, 35]. While three of the four studies targeted Black men in barbershops, one study targeted all men in barbershops, churches, industries, meal sites, car dealerships, civic organizations, and housing projects. Sample sizes of each of these studies ranged from 40–1,552 participants. Each study provided prostate cancer education and prevention materials. One notable study due to its large sample size and unique findings was a descriptive study investigating predictors of participation in free prostate cancer screenings in barbershops, churches, industries, meal sites, car dealerships, civic organizations, and housing projects [31]. The study ultimately found that being white, having at least a high school education, being married, perceiving health benefits, and receiving a client navigator or prior education intervention were significant predictors of participation in the study’s free prostate cancer screenings. Another pilot study investigated the feasibility of training barbers to deliver customized (culturally appropriate) prostate cancer education to Black men, mostly through brochures [29]. Through the feasibility pilot study, prostate cancer knowledge scores raised from 60% to 79%.
Three studies provided colorectal cancer interventions in barbershops as a longitudinal study, a qualitative analysis, and a randomized controlled trial respectively [12, 28, 30]. The intervention provided in each of these studies was colorectal cancer education and screening, with two studies focused on Black men and the third study focused on adults in general at risk for developing diabetes, heart disease, stroke, and breast cancer in addition to colorectal cancer. One particularly significant colorectal cancer intervention study due to its incorporation of a telehealth component and large sample size (n = 731) was the randomized controlled trial [30]. This study aimed to test the effectiveness of a preclinical, telephone-based intervention designed to encourage and connect older Black men to colorectal cancer screening opportunities. Black male participants were recruited from barbershops initially and placed in one of three telephone intervention groups: patient navigation by a community health worker for colorectal cancer screening, motivational interviewing by a trained counselor, or both interventions. The study ultimately found that both groups of participants that received navigation by community health worker were most likely to pursue colorectal cancer screening within six months.
Other conditions
Fourteen studies focused on other conditions not already described above, including high cholesterol, overall physical fitness, mental health, nutrition, stroke, unintended pregnancy, violence, influenza, kidney disease, HPV, and COVID-19 [8, 12, 18, 39–48]. These studies included cross-sectional studies, longitudinal studies, descriptive studies, feasibility studies, a randomized controlled trial, pilot studies, cohort studies, and program evaluations. Sample sizes ranged from 20–14,000 participants, and target populations included predominantly Black populations, at risk participants for certain conditions, women across all demographic classifications, adults with children 6 months to 2 years of age, adults over 50 years of age, and citizens in the Northeast Bronx region of New York. Each study provided education, prevention strategies, and screening promotion in some capacity for its respective target condition.
These studies took place in barbershops, beauty salons, nail salons, and movie theaters. One descriptive study is particularly noteworthy because of its relatively large sample size (n = 530 participants), specific target population (adults with children 6 months to 2 years of age and adults over 50 years of age), and with the intervention taking place in movie theaters [43]. This intervention was designed to promote annual influenza vaccination by showing slides providing education about the flu and advocating for people to get their annual flu vaccine prior to presentation of upcoming movie premieres. Among moviegoers exposed to the education slides prior to the film, 24% recalled seeing the flu vaccination slides prior to the movie advertisements although some participants did not arrive to the theater before the start of the film to see the flu vaccination slides.
An additional noteworthy study was a randomized controlled trial aimed at assessing the impact of an intervention conducted in barbershops on mental health and violence threat screening among Black men in Philadelphia, PA [44]. With a sample size of 618 participants, the study found significant effects of the intervention on increasing awareness of Black manhood vulnerability. This heightened awareness contributed to a significant reduction in physical fights among participants. The study’s findings were robust, demonstrating statistically significant pathways from the intervention through both Black manhood vulnerability awareness and hypermasculinity to the outcomes studied.
Another interesting study investigated the effectiveness of using beauticians to educate Black female clients about stroke warning signs and risk factors [46, 50]. Beauticians were trained about stroke warning signs and risk factors, and clients were asked survey questions about their stroke knowledge before and after the intervention. The study reported significant increases in client knowledge of stroke warning signs (40.7% to 50.6%) and to call 911 for stroke symptoms (86% to 94%) with this improvement sustained for five months. However, no significant increase in knowledge of the three stroke risk factors was seen before and after the intervention.
One final study to note is one focused on providing COVID-19 vaccination education and resources in barbershops, hair salons, beauty salons, and faith-based organizations to Northeast Bronx citizens [48]. Forty-five public-facing business sites across Northeast Bronx, New York participated in this COVID-19 intervention by encouraging clients to complete baseline and follow-up surveys about perceptions of COVID-19 vaccines and commitments to future vaccination, having conversations about COVID-19 and offering supporting materials, displaying posters and brochures on site encouraging vaccination, and hosting local health department staff on site. Over a span of four months, COVID-19 vaccination rates across five zip codes in Northeast Bronx were observed to increase from 5.6% to 8.7%, although causality of the intervention cannot be inferred.
Discussion
This unique review of place-based health interventions in public business settings found that a number of studies have been conducted on the topic in the past two decades. We reviewed 42 studies of place-based health interventions offered for various chronic health conditions and certain select business settings. The majority of the interventions offered were health education and preventative health screenings. Thirty-four (81%) of the studies focused on reaching Black populations; all studies, except for one, delivered health interventions in barbershops and beauty salons either solely or among a few other settings. The largest number of studies focused on cancer (13 studies) or cardiovascular disease (12 studies). Additionally, the specific health condition with the greatest number of controlled trials was for hypertension (3 studies).
In general, studies reported that health interventions embedded in public settings were associated with positive outcomes, including increased disease awareness, improved health behaviors and disease management, and high rates of health screening and connection to healthcare services. Given that all studies targeted outreach to racial/ethnic minority populations, the findings suggest place-based interventions are an important way to reach underserved population and potentially address health disparities by providing accessible health education, screenings, and connection to services in places that they visit to purchase goods and services. However, it is essential to acknowledge that conducting health interventions in public spaces may inadvertently lead to unintended consequences, such as stigma and concerns about privacy. The presence of stigma or concerns about privacy can affect participant engagement and willingness to utilize these services, potentially undermining the effectiveness of the interventions. Thus, careful consideration of these social dynamics is crucial when designing and implementing interventions in community settings. Placements of these interventions in barbershops and beauty salons may represent familiar and trusted community settings that can enhance participant engagement. Further study is needed to expand beyond these settings to determine whether other public-facing business settings (e.g., banks, movie theatres, malls) are also effective and acceptable places for health interventions.
Among the 42 studies reviewed, there was a general lack of rigor in the designed studies. Only one study received the maximum quality rating score [24], and no other study was within 2 point of the maximum quality rating score. Most studies were descriptive or observational one-group designs and did not include a comparison group. Although we identified 7 randomized trials, including several cluster randomized trials, these studies varied widely in terms of interventions and health conditions. As a result, we did not attempt to synthesize the results quantitatively. Instead, we summarized the findings of each study individually, highlighting their diverse approaches and outcomes. This decision was based on the heterogeneity of the studies, which made direct comparison challenging. In addition, many of these trials did not appear to be rigorously designed and may have had many threats to internal validity (e.g., confounding variables, inadequate sample size, limited follow-up or differential attrition between groups) that were not fully examined. Almost all studies relied on subjective outcome measures and did not measure objective health outcomes (e.g., service utilization, disease onset and outcome) so there is a need for further rigorous studies with objective outcomes. Together, our review concludes there is a small, growing body of studies of health interventions delivered in public-facing business settings that shows some preliminary success in reaching Black communities for a variety of health conditions, and these interventions may be a promising strategy to reach underserved populations but more rigorous and varied studies are needed to expand and deepen the evidence for these interventions to pinpoint how they are effective, who they are most effective for, and in using which interventions in what places.
This review had several strengths and limitations worth noting. Given the nature of scoping reviews, we took a broad, comprehensive approach to cover a wide range of health conditions, interventions, settings, and study designs. There was wide variability in studies making it challenging to compare studies, and a meta-analysis could not be conducted to quantify a summary of outcomes. Given the range of studies, we are also limited in specificity in drawing conclusions. However, we have tried to summarize findings by health condition to organize the studies and allow researchers to focus on particular health conditions. We only included studies in the United States, and there may be various innovative place-based interventions delivered internationally in other countries that would yield new insights so that is both a limitation of our review and an opportunity for future research. Moreover, we only include published studies, and there may be a “file-drawer problem” of unpublished studies we do not include. Finally, while stakeholder consultation is recognized as beneficial in scoping reviews, no formal stakeholder consultations were conducted for this review, which we acknowledge as a limitation. Additionally, while our approach aligns with best practices for scoping reviews, the absence of protocol registration may limit transparency. We also recognize this as a potential limitation to reproducibility.
These limitations notwithstanding, this review highlights unique and innovative ways to reach underserved populations in places like barbershops and beauty salons. The strongest evidence for these place-based interventions is for cardiovascular disease (especially hypertension) and cancer, but there are opportunities to study this further for various other health conditions. Together, these studies demonstrate possible collaborations between healthcare providers, researchers, and business owners with mutual goals to serve underserved communities. Finally, this review paves numerous paths for needed research in this area, including more experimental studies with objective outcomes, examination of the sustainability and scalability of these interventions, and the cost-effectiveness of interventions to support their adoption by businesses, healthcare providers, and policymakers.
Supporting information
S1 Table. Keywords/operators/truncation used in databases for systematic review.
https://doi.org/10.1371/journal.pone.0317815.s001
(DOCX)
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