The development of a community reintegration outcome measure to assess people with stroke living in low socioeconomic areas

Introduction: Aims: The aim of this study was to develop and psychometrically evaluate an interview–administered questionnaire to assess community reintegration for black people with stroke in low socioeconomic rural and urban South African communities. Methods: A sequential mixed methods design was used. A qualitative approach using semi–structured interviews with adults with stroke and/or their caregivers was undertaken to conceptualize and generate community reintegration interview items. Thereafter quantitative methods including the Delphi technique, nominal groups, factor analysis and internal consistency statistics were used to test the validity and reliability of the outcome measure. Results: Thirty–two interviews (13 urban, 19 rural) generated 67 items. These were reduced to 44 categorized under eight domains during three rounds of the Delphi technique and two nominal group meetings. Factor analysis (FA) and internal consistency statistics on the remaining items, resulted in a two part outcome measure, one for a rural and the other an urban community. The internal consistency of both measures was good (alpha coefficient = 0.95). The new outcome measure, the Maleka Stroke Community Reintegration Measure (M–SCRIM) was compared to the Subjective Index of Physical and Social Outcomes to establish construct validity (urban r = 0.88, p lessthan 0.001; rural r = 0.95, p lessthan 0.001). Conclusion: The M–SCRIM is a valid, reliable interview–administered measure to assess community reintegration following stroke for people living in low socioeconomic communities in South Africa. With further refinement it could be validated for use in other developing countries with similar cultures.