Application of an implementation premortem: A novel qualitative approach leveraging prospective hindsight to enhance barbershop health interventions for Black men

Abstract

Barbershop-based efforts to promote health among Black men have been uniquely successful. Despite the success of these efforts, the emphasis on outcomes as opposed to how these outcomes can be achieved has created a gap in the literature. The present study addresses this gap by describing implementation-related program priorities that Black men identify for barbershop-based interventions. Twenty-three Black men participated in implementation premortem activities. Participants were: (i) given details about a barbershop-based health promotion effort, (ii) told that the effort had failed, and (iii) were asked to identify potential sources of program failure and strategies to overcome those challenges. The frequency of program priorities was calculated based on the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, and focus group data were analyzed using an inductive thematic qualitative data analytic approach. Data analyses occurred in three phases: (i) excerpts were grouped by Phase, Domain, and Construct of the EPIS Framework; (ii) themes within each excerpt were then identified using an inductive approach; and (iii) themes were organized into conceptually similar and parsimonious categories. Participants suggested that the biggest source of program failure was that more attention needed to be paid to Program Fit during the Implementation Phase. Participants reported concerns with the accessibility and convenience of the effort. Additional participant concerns included economic issues, community ownership, climate, staffing processes, cultural sensitivity, engagement, and trust. The implementation of health promotion programs for Black men should pay particular attention to how the intervention fits the needs, lives, and contexts of potential participants.

Community health programs in barbershops can be more effective by focusing on accessibility, cultural sensitivity, and community engagement. Our study identifies key strategies to improve the success of these health promotion efforts for Black men.

Lay Summary

Health programs in barbershops have been successful in improving the health of Black men, but it remains unclear why this is the case. Using an “implementation premortem” technique designed to identify and consider possible barriers hindering program implementation and impact, this study engaged 23 Black men in a process designed to identify potential problems. The participants were (i) informed about a health program in barbershops for Black men, (ii) told the program had failed, and (iii) asked to identify reasons for the failure and suggest solutions. The data were analyzed in three steps: (i) organizing information according to a specific framework (EPIS Framework), (ii) identifying common themes, and (iii) categorizing these themes into similar groups. The most common issue identified was during the Implementation Phase and related to Program Fit, indicating the importance of ensuring the program matches the needs of the participants. Other concerns included accessibility, convenience, economic issues, community involvement, staff processes, cultural sensitivity, engagement, and trust. The findings highlight the need to focus on the ways program fit the needs and lives of Black men. By addressing these identified issues, health programs can better reach and benefit Black men.