Home modifications to prevent home fall injuries in houses with Māori occupants (MHIPI): a randomised controlled trial
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BACKGROUND: As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. METHODS: We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. FINDINGS: Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). INTERPRETATION: Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. FUNDING: Health Research Council of New Zealand.
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A further trial of homes with Indigenous Māori occupants from 2013 to 2017 found that the rate of fall injuries was reduced by 31% in modified homes compared with control households.
“The rate of fall injuries was reduced by 31% in the modified homes compared with households in the control group.”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [87]
Because Māori households are on average larger than non-Māori households, the intervention cost of each fall injury prevented in the Māori trial was only around two-thirds of that for the previous HIPI intervention, indicating even greater cost-effectiveness and potential to reduce injury for Māori.
“Because M¯ aori households are, on average, larger than non-M¯ aori households, the intervention cost of each fall injury prevented was only around two-thirds of that for the previous HIPI intervention, indicating even greater cost-effectiveness and an even greater potential to reduce injury for M¯ aori.”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [87]
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Review of the Impact of Housing Quality on Inequalities in Health and Well-Being
Howden-Chapman, P., Bennett, J., Edwards, R., Jacobs, D., Nathan, K., & Ormandy, D. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071521-111836 · Cited by 153 · see citing works
Self-citation
- Authors
- Keall, M. D., Tupara, H., Pierse, N., Wilkie, M., Baker, M. G., Howden-Chapman, P., & Cunningham, C.
- Affiliations
- University of Otago (NZ)
- Massey University (NZ)
- Corresponding author
- Keall, Michael D
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 6
- Issue
- 9
- Pages
- e631-e640
- ISSN
- 2468-2667 (ISSN-L)
- OpenAlex
- W3190372458
- Cited by
- 26
- References
- 27
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 1
- FWCI
- 6.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Massey Research Online (Massey University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Health Research Council of New Zealand
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Occupational Health and Safety Research
- Keywords
- home modification, Māori, Indigenous health inequities, injury prevention, handrails, bathroom safety
- MeSH terms
- Accidental Falls, Accidents, Home, Aged, Housing, Humans, New Zealand, Health Status Disparities
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