This question aligned naturally with the goals of ACHIEVE GREATER, a large NIH-funded initiative focused on addressing cardiometabolic health inequities in the Great Lakes region. With support from the National Institute on Minority Health and Health Disparities (Grant P50MD017351), our team set out to test a different model of prevention—one that did not wait for patients to come to the health system but instead embedded preventive screening directly into the rhythms of daily community life.
A shift away from the “traditional clinic” mindset
In many underserved neighborhoods, the classic healthcare model—waiting for patients to schedule appointments, attend annual checkups, and trust unfamiliar systems—simply does not hold. Men in particular often silo their health concerns, avoid primary care, or only seek help once the disease has progressed. The challenge became: How do you reach men who are not actively seeking care, and may be distrustful of the systems offering it? The answer, supported by a growing body of literature, lies in distributed care—delivering health screening and education through trusted community hubs such as barbershops and churches. Studies have shown that barbershop-based interventions can significantly improve hypertension control when barbers work alongside clinicians, and faith-based health programs have repeatedly demonstrated impact on behavior change and risk-factor awareness. These were not merely convenient locations; they were culturally anchored platforms where trust already existed.
The early months: testing outreach models
We began by partnering with barbershops, particularly those serving Black men—an approach validated by multiple community health trials. Conversations in these settings are personal, frequent, and often surprisingly open. But as our team engaged more deeply, it became clear that this particular set of barbershops was not drawing from the underserved population we aimed to reach. Recruitment was slow, with only a handful of eligible participants. At the same time, another opportunity was emerging. One of our team members had longstanding connections with local churches—congregations deeply embedded in underserved neighborhoods, where health distrust was real, but relationships were strong. We reached out to pastors with letters of support and requests to collaborate. Their response significantly reshaped the project's trajectory.
Church partnerships: where trust accelerated the science
Unlike clinics, churches offered weekly, reliable access to both congregants and leadership. Pastors did more than open their doors—they vouched for us. They invited us to attend services, explain the study from the pulpit, and answer questions during post-service gatherings. That initial endorsement from a trusted figure changed everything. Conversations grew naturally. Men felt comfortable asking about ED, heart health, and what coronary calcium scoring could reveal. They shared their skepticism about healthcare systems, their experiences with medical mistrust, and their hesitation about screening. Each visit became less of a recruitment event and more of an ongoing dialogue. Our sessions often turned into small-group educational meetings—over breakfast, coffee, or informal conversation—where men asked what ED means for vascular health, what resources UH could offer, and how they should talk to their own providers. Over time, the community began referring friends, family members, and fellow congregants. In many ways, the participants began directing the project, reinforcing the idea that prevention works best when it is co-designed with the community itself.
From engagement to insight: what we learned
Ultimately, our cohort reflected exactly the population we hoped to reach—men aged ≥40 with one or more cardiovascular risk factors who rarely engage in structured preventive care. Our analysis confirmed a clear, significant inverse correlation between erectile-function scores and coronary plaque burden. Men with more severe erectile symptoms were more likely to have elevated coronary calcium, and an IIEF-5 cutoff of ≤21 performed strongly as a signal for CAC ≥100—a threshold with established prognostic relevance. These findings support the longstanding hypothesis that ED is not simply a localized problem but a systemic marker of early vascular disease. What made this project unique was where the screening occurred—not in specialty clinics, but in community spaces where men felt safe and heard.
Why this model matters
Sexual-health screening can open doors. Men who would never attend a cardiovascular screening event were willing to engage if the conversation began with sexual health—a topic with immediate, personal relevance. Community messengers amplify impact. Pastors, church elders, and barbers provided a credibility that clinicians alone could not replicate. Trust grows with presence. Returning week after week—rather than appearing briefly for recruitment—built relationships that made honest conversations possible. Distributed care can reduce disparities. When health systems enter community spaces, rather than waiting for patients to cross institutional thresholds, prevention becomes accessible to those who need it most.
Reflection after three years
This project was rooted in science, but sustained by community. The most meaningful transformations occurred not in the CT scanner or during data analysis but in the quiet conversations held over folding tables in church basements—moments where men voiced fears, asked questions, and decided they were ready to take the next step in caring for their cardiovascular health. Our study supports ED as a sentinel marker for subclinical atherosclerosis. But more importantly, it demonstrates that how we deliver preventive care is just as critical as what we deliver. To reach underserved men, we must be willing to meet them in their own spaces, speak to their concerns, and rebuild trust from the ground up.
Written by: Hachem Ziadeh,1 Jad Badreddine,1 Thriaksh Rajan,2 Yann Chemali,3 Stephen Rhodes,1 Lydia Beard,1 Ramy Abou Ghayda4
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
- Case Western Reserve University School of Medicine, Cleveland, OH.
- Northeast Ohio Medical University, Rootstown, OH.
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.