Laundromats: Community-Based Partnerships to Increase Reproductive Health Literacy Outreach

Abstract

Laundromats are a regularly visited, highly localized community venue, especially in underserved communities. Few health literacy and health-promotion programs have taken place in laundromats, and there have been no efforts to apply community-based participatory research approaches in this setting. Literacy programs and cancer-prevention initiatives have been held in laundromats, but little data exist on the empirical outcomes of such initiatives or whether the programs have been fashioned as a collaboration between community and researchers. In this paper, we present a brief overview of literacy and cancer-prevention initiatives that have taken place in laundromats and introduce our Wash and Spin Toward Health/Washington Avanzando la Salud Hispana (W.A.S.H.) project. We describe how we applied community-based participatory research principles to launch this effort and identify both benefits and challenges of this approach. We hope this project will stimulate greater interest in laundromat settings for outreach and education efforts, especially those addressing disparities in health literacy and access.

Keywords

community-based participatory research health literacy reproductive health health disparities

Background

The community laundromat and its owner-operator model may be a viable place to regularly reach individuals with health information. There are about 35,000 laundromats in the United States, generally located in neighborhoods with high apartment density, a large number of renters, and median annual household incomes of $28,000 (Martin Ray Laundry Systems, 2021). Laundromats are a community hub with repeat customers (90%), who most often identify as female (60%) and live within one mile of the facility (87%) (Martin Ray Laundry Systems, 2021). Here, we present the literature on laundromat-based interventions and how identified challenges and opportunities have informed the formative phase of W.A.S.H. (Wash and Spin To Health/Washington Avanzando la Salud Hispana), a reproductive health education program employing a community-based participatory research (CBPR) approach.

Laundromat-based interventions

Most laundromat-based studies focus on literacy interventions (Table 1). Laundromat literacy programs overcome barriers to library accessibility and are fashioned for patrons without access to preschool programs, adults with low literacy levels, and individuals living without home-based washing/drying facilities. Innovative laundromat literacy interventions existed as early as 1989. Program delivery has varied from weekly to three times a week. The Wash and Learn Initiative (WALI) offered resources and training to laundromat patrons in seven states. Each literacy center placed in a laundromat was built by a collaboration between libraries and laundromat patrons. Most programs have simply provided a space for materials and have not sustained partnerships between laundromat owners and program creators. Global Book Hour was the only program to clarify the importance of tailoring to community needs, choosing a commonly used space, and finding community members to lead sessions; even so, few other principles of CBPR were reported.

Table 1

Laundromat Literacy Initiatives 1989–Present

Program	Founder	Years	Location	Description	Evaluation/outcomes research	Transferrable insights
Public Library Storytimes (Ford, 2019)	Elizabeth McChesney	1989–2019^a	Chicago, Illinois	Story times. (Attempts to reach program developers for more program information were not successful.)	None	Patron recruitment: laundromat visits are consistent, frequent, and necessary.
Wash and Learn (Laundromat Learning, 2006)	Georgina Smith	2004–2006^a	Brooklyn, New York	Literacy programs in lower-income communities. Paired school teachers and college student volunteers to help children learn about reading and writing. Three nights a week.	None	Patron recruitment: children engaged in literacy activities instead of simply sitting and waiting with parents. Parents also took part, suggesting availability and willingness to engage on their part as well.
Global Book Hour (Truesdell & del Prado Hill, 2015)	Kim S. Truesdell and Pixita del Prado Hill	2010–2015^a	Buffalo, New York	Weekly 90-minute read-aloud sessions in laundromats and grocery stores. Community-based participatory approach. Adjusted program based on community needs. Community members led sessions.	None	Laundromat recruitment: community needs are distinct between sites, making an individualized CBPR approach essential.
Family Read, Play, Learn Program (Coin Laundry Association, 2022; Neuman et al., 2020)	Too Small to Fail Initiative and the Laundry Cares Foundation	2019–2022	National	Dedicated laundromat spaces for literacy spaces in underserved neighborhoods. Literacy kits, retailing $2,600–$4,400, include tables, chairs, a 20-book-a-month subscription, posters, and signage. Tracked laundromats that participated.	Children with access to literacy kits engaged in literacy activities 30 times more than children in control laundromats. No peer-reviewed data published.	Laundromat recruitment: laundromats are willing to participate in initiatives that benefit their patrons and community.
Wash Time is Talk Time (Coin Laundry Association, 2022)	Too Small to Fail Initiative and the Laundry Cares Foundation	2015–2022	National	Dedicated laundromat spaces for literacy spaces in underserved neighborhoods. Literacy kits, retailing $2,600–$4,400, include tables, chairs, a 20-book a month subscription, posters, and signage.	None	Evaluation: measuring engagement will facilitate future CBPR endeavors within the laundromat space.
Wash and Learn Initiative (WALI, 2018)	Laundry Cares Foundation and Libraries without Borders	2017–2019^a	Minnesota, Michigan, Maryland, New York, Pennsylvania, Rhode Island, Washington DC	Literacy resources and training to laundromat patrons. Literacy centers built through collaboration between libraries and patrons of laundromats. Laundromat owners were important supporters of the project. Tracked number of patrons engaging with resources and subsequent actions such as registering for library cards.	Engaged an average of 30 people each day. No peer-reviewed data published.	Laundromat and patron recruitment: laundromat owners’ support is possible and key to project success. Patron guidance is an important element of an effective laundromat-based educational intervention.

Note. References available in Supplemental Material: The Laundromat Literacy Initiatives Citation Supplement. CBPR = community-based participatory research.

No evidence of program extending beyond these years in the formats described.

Program evaluations for laundromat literacy initiatives are rarely published, although testimonies of support from patrons and laundromat owners are common. WALI collected data on the number of patrons engaged, but no peer-reviewed studies were published. One study that did publish some results was conducted by Neuman et al. (2020). This study reviewed the Family Read, Play, Learn Program run by the Laundromat Literacy Coalition and learned that parents strongly supported literacy spaces in the laundromat; children with access to laundromat literacy centers participated in 30 times more literacy-related activities than children in control laundromats (Neuman et al., 2020). Literacy programs were more engaging when a librarian was present, suggesting that experts are important to facilitate effective programs in community spaces (Neuman et al., 2020).

Cancer prevention initiatives

Similar to literacy interventions, there is limited empirical evidence for the use of laundromats as viable sites for health education interventions. When analyzing the effectiveness of seven community sites to disseminate breast cancer information, Kreuter et al. (2008) found that only laundromats provided both high reach and geographic specificity. However, participation by laundromats was 15%, as compared with 100% participation of libraries because of challenges related to reaching laundromat owners due to a lack of on-site telephones or managers (Kreuter et al., 2008). Still, for interventions prioritizing individuals in underresourced communities with limited access to affordable transportation, laundromats have the potential for high reach and impact.

Establishing the W.A.S.H. community advisory board

Our program, W.A.S.H., utilizes CBPR principles to partner with the community to design, implement, and evaluate a reproductive health education intervention in laundromats. Because barriers to health care are related to negative health outcomes, W.A.S.H. aims to reach women in DC living on low incomes who have previously identified lack of reproductive health knowledge as a factor related to delayed care (Russell et al., 2018).

Community advisory board (CAB) formation was our first step when designing W.A.S.H. We contacted local neighborhood associations in the proposed study area and attended neighborhood community meetings to introduce the program idea. Speaking with interested key informants from these meetings, we identified community leaders, both elected and non-elected. We then compiled a list of community laundromats to invite for initial participation. The study’s principal investigator (PI) visited the community laundromats and met with laundromat owners to introduce W.A.S.H. Interested community members, laundromat owners, and reproductive health providers were then invited to join the CAB.

Initially, CAB members (two community members, one laundromat owner, and two reproductive health providers) would meet every 2 months. However, polls on optimal scheduling times, discussion at CAB meetings, and 1:1 meetings with the PI determined that quarterly weekday evening meetings, with the option to participate virtually, would allow for the most engagement. Meetings are held at a community site with dinner catered by a local vendor to invest in the local economy.

The W.A.S.H. CAB has guided all aspects of the formative research. They provided feedback on the first phase of our project—a needs assessment of female laundromat patrons examining baseline reproductive health knowledge, as well as their interest in a laundromat-based educational intervention (reported elsewhere). The CAB informed participant recruitment strategies, desirable participant incentives, and acceptable language for surveys, flyers, and consent forms. In addition, CAB members supported the creation of a study website as an additional mode of outreach, intentionally selecting a domain name that emphasized the DC community location.

The CAB has also recommended effective strategies for connecting with laundromat owners and participants. For example, when one laundromat owner was difficult to contact, a CAB member, who is also a laundromat owner, suggested early morning visits when owners were most likely to be on-site. Currently, the CAB has expanded to include four additional members (an additional laundromat owner and three community members).

Challenges and next steps

CAB collaboration, particularly in these early stages of our W.A.S.H. program, has helped build trust among laundromat owners, patrons, and the research team. As a result, the W.A.S.H. pilot study will overcome three challenges identified from the literature on laundromat-based interventions—laundromat recruitment, patron recruitment, and evaluation of the intervention. First, we will collaborate with CAB laundromat owners to increase laundromat participation by conducting in-person, early-morning visits to recruit additional laundromats, incentivizing participation (e.g., interpretation, free marketing), and helping laundromats establish programs to improve customer experiences (e.g., literacy programs). We also created a recruitment video where CAB laundromat owners offer testimonials for why other owners should join the study (Linnan et al., 2012). Second, we will overcome low patron participation by seeking frequent CAB and community input, employing targeted advertising, offering participants cash incentives, and tracking recruitment progress to allow for necessary adjustments (Clay et al., 2003). Employing in-person recruitment with bilingual/bicultural staff and community members and encouraging word-of-mouth advertising will also build trust, especially with patrons from communities without residency documentation. Third, W.A.S.H. will be informed by results of rigorous, data-driven formative work; specifically, our needs assessment of laundromat patrons, health care provider feedback, and detailed recruitment records. Past and future CAB perspectives will continue to inform all phases of the W.A.S.H. project.

Implications for public health practice

W.A.S.H. focuses on reproductive health education outreach to communities of female laundromat patrons with limited health information access. Unlike outreach at churches, limited to community members attending services, or worksites, with employees focused on job tasks, W.A.S.H. has the potential to reach more marginalized community members. Laundromats extend access to health education materials beyond the hours of other community or health care locations, increasing the accessibility of our proposed intervention to those with work or child care constraints. As an essential service, laundromats also remain open when other community settings may close, such as during the height of COVID-19 restrictions.

Conclusion

Establishing W.A.S.H. utilizing a CBPR approach and centering CAB input will help us build more sustainable community trust and business partnerships. We are eager to build upon previous health literacy-based interventions and provide evidence for laundromats as effective community outreach establishments with the ability to disseminate valuable health information to women at high risk of negative health outcomes because of inequities in resources and access to care.

Supplemental Material

sj-docx-1-hpp-10.1177_15248399231193004 – Supplemental material for Laundromats: Community-Based Partnerships to Increase Reproductive Health Literacy Outreach

Supplemental material, sj-docx-1-hpp-10.1177_15248399231193004 for Laundromats: Community-Based Partnerships to Increase Reproductive Health Literacy Outreach by Roxanne Mirabal-Beltran, Kelsey Rondini and Laura Linnan in Health Promotion Practice

Footnotes

Authors’ Note:

The authors would like to thank participating laundromat owners and the W.A.S.H. Community Advisory Board for their continual guidance and support. The authors are appreciative of Drs. Jane Fall-Dickson, Linda Gallo, and Alejandra de Mendoza for their mentorship on this project. This project was funded with Federal funds (UL1TR001409) from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program, a trademark of DHHS, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.” Research reported in this publication was supported by the NCATS of the NIH (grant number KL2TR001432). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, the NIH, or the U.S. government.

ORCID iD

Roxanne Mirabal-Beltran

Supplemental material

Supplemental material for this article is available online at .

References

Clay

Ellis

M. A.

Amodeo

Fassler

Griffin

M. L.

(2003). Recruiting a community sample of African American subjects: The nuts and bolts of a successful effort. Families in Society, 84(3), 396–404.

Kreuter

M. W.

Alcaraz

K. I.

Pfeiffer

Christopher

(2008). Using dissemination research to identify optimal community settings for tailored breast cancer information kiosks. Journal of Public Health Management & Practice, 14(2), 160–169. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med7&NEWS=N&AN=18287923

Linnan

Harrington

Bangdiwala

Evenson

(2012). Comparing recruitment methods to enrolling organizations into a community-based intervention trial: Results from the NC BEAUTY and health project. Journal of Clinical Trials, 2(3), Article 119. https://www.longdom.org/open-access/comparing-recruitment-methods-to-enrolling-organizations-into-a-community-based-intervention-trial-results-from-the-nc-beauty-and-health-project-2167-0870.1000119.pdf

Martin Ray Laundry Systems. (2021). Key statistics laundromat investors should know. https://martinray.com/p-33942-key-statistics-laundromat-investors-should-know.html

Neuman

S. B.

Portillo

Celano

D. C.

(2020). Looking for literacy in all the right spaces: The laundromat. The Reading Teacher, 74(1), 29–38. https://doi.org/10.1002/trtr.1905

Russell

Rodehau

Quinn

(2018). Human-centered solutions to improve reproductive and maternal health outcomes in Washington, DC. District of Columbia Primary Care Association. https://www.streetsensemedia.org/wp-content/uploads/2021/04/DC-women-health-improvement-project-september-2018-report.pdf

Supplementary Material

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