title: An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Maori and Pacific people following stroke.
abstract: OBJECTIVE
  Health outcomes research for Maori has been hampered by the lack of adequately validated instruments that directly address outcomes of importance to Maori, framed by a Maori perspective of health. Hua Oranga is an outcome instrument developed for Maori with mental illness that uses a holistic view of Maori health to determine improvements in physical, mental, spiritual and family domains of health. Basic psychometric work for Hua Oranga is lacking. We sought to explore the psychometric properties of the instrument and compare its responsiveness alongside other, more established tools in an intervention study involving Maori and Pacific people following acute stroke.
  
  
  METHODS
  Randomised 2x2 controlled trial of Maori and Pacific people following acute stroke with two interventions aimed at facilitating self-directed rehabilitation, and with follow-up at 12 months after randomisation. Primary outcome measures were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form 36 (SF36) at 12 months. Hua Oranga was used as a secondary outcome measure for participants at 12 months and for carers and whanau (extended family). Psychometric properties of Hua Oranga were explored using plots and correlation coefficients, principal factors analysis and scree plots.
  
  
  RESULTS
  172 participants were randomised, of whom 139 (80.8%) completed follow-up. Of these, 135 (97%) completed the Hua Oranga and 117 (84.2%) completed the PCS and MCS of the SF36. Eighty-nine carers completed the Hua Oranga. Total Hua Oranga scores and PCS improved significantly for one intervention group but not the other. Total Hua Oranga scores for carers improved significantly for both interventions. Total Hua Oranga score correlated moderately with the PCS (correlation coefficient 0.55, p<0.001). Factor analysis suggested that Hua Oranga measures two and not four factors; one 'physical-mental' and one 'spiritual-family'.
  
  
  CONCLUSIONS
  The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting.
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Matire
authors.initials: M
authors.lastname: Harwood
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Api
authors.initials: A
authors.lastname: Talemaitoga
authors.forename: P Alan
authors.initials: PA
authors.lastname: Barber
authors.forename: John
authors.initials: J
authors.lastname: Gommans
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.forename: Kathryn
authors.initials: K
authors.lastname: McPherson
authors.forename: Harry
authors.initials: H
authors.lastname: McNaughton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D017028:Caregivers; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D011379:Prognosis; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome