Planning & Preparing a Survey

1. Planning & Preparing a Survey Roles and Responsibilities Implementation Plan Collection Schedule Pilot 2006

2. Roles and Responsibilities:Relationships between Key Players

3. STEPS Site Coordinator • Key player in STEPS planning and implementation • Chairs the Coordinating committee • Drafts and oversees progress of the implementation plan • Supervises data collection & data management teams • Develops partnerships & contributes to health promotions activities • Prepare future STEPS surveys

4. Coordinating Committee for Surveillance (CCS) • Organised within the MoH • Oversees practical & logistic issues of STEPS overall implementation • Acts as an advocacy body • Assists in translating data into policy and programmes • Ensures the long-term sustainability of STEPS surveillance

5. Data-Collection Team • Supervisor • Interviewer • Clinic health professional • Laboratory technician • Administrative staff

6. Supervisor • Trains field staff • Obtains lists of the selected sample & maps of each area • Informs local authorities • Responsible for survey logistics • Supervises interview process & records daily activities • Ensures data quality • Sends progress reports to Site Coordinator • Provides completed instruments to data-entry supervisor

7. Interviewers • Interviews participants in household settings (Step 1) • Takes physical measurements (Step 2)

8. Clinic Health Professionals • Check for appropriate participant consent • Take blood samples from participants & record results Roles and responsibilities (STEP 3) • Nurse practitioners or medical assistants

9. Lab Technicians • Test samples for glucose and lipids • Record results & pass records for data entry • Identify out of range results for clinical attention • Order supplies

10. Administrative staff • Organise logistics • Print & distribute materials • File survey material • Organise publicity for survey

11. Data-Management Team • Supervisor: Trains data entry staff, supervises process & reports interview errors to the data collection team supervisor • Data-entry staff: Logs receipt of completed instruments, files paper copies of instrument, enters survey data, identifies errors & resolves problems with supervisor

12. Statistical Adviser & Data-Analysis Team • Statistical Adviser plays key role in sampling & data management process • Data-analysis team undertakes descriptive and any additional analyses if required

13. WHO Staff • WHO-Geneva • Works with Regional Office & provides global coordination for STEPS implementation across regions • Supports and provides training & technical support to STEPS sites • Develops a global strategy in Chronic Diseases Risk Factors Surveillance • WHO Regional Office with subregional center (CAREC) • Coordinates STEPS implementation in their (sub) region • Identifies countries ready to implement STEPS • Funds & delivers STEPS training • Provides ongoing technical support

14. WHO Staff (cont’d) PAHO/WHO Country Office • Serves on the coordinating committee • Facilitates communications between STEPS sites & the WHO regional offices • Provides some funds for in country field work

15. Implementation Plan Purpose is to • Set out the scope of surveillance and desired goals • Identify required resources • Set out an action plan • Develop a communication strategy • Provide a well planned budget as a basis for funding

16. Implementation Plan (cont’d) Topics • Current situation • Goals & objectives • Scope • Sampling methods • Resources • Action Plan

17. Implementation Plan (cont’d) • Communication & strategy • Reporting & disseminating results • Budget

18. Scope of Survey The purpose of the STEPS survey needs to be clearly defined to identify the scope of the STEPS Survey. • Step 1 core & expanded: behavioural RFs • Tobacco smoking, alcohol consumption, Low intake of fruit & vegetable consumption and Physical inactivity • Demographic details, information on ex-smokers & smokeless tobacco, binge drinking, oil & fat consumption. • Step 2 core & expanded: physical measurements • Excess body fat & raised BP • Hip circumference & heart rate • Step 3 core & expanded: biochemical measurements • Raised blood glucose & raised cholesterol • Triglycerides & HDL Cholesterol

19. Scope of Survey (cont’d) • Step 1 & 2: Feasible in all settings can be done at the same time • Step 3: Recommended in well-resourced settings

20. Scope of Survey (cont’d) • Sites can add optional modules if they wish to describe the prevalence of other specific health problems • Optional questions to Step 1 (injuries & violence, mental health, oral health, family history, woman health, morbidity of hypertension, hypercholesterolemia, diabetes) • Optional measurements to Step 2 (oral health)

21. Choosing a Chemistry-Screening Method for Step 3 • Dry chemistry uses an automated machine. • Wet is being undertaken at the laboratory and is the preferred option but may not be feasible in all settings. • Decision needs to be taken at the onset as Staff, training & clinic equipment is dependent on the choice.

22. Ethical Approval • Every STEPS proposal should undergo technical & ethical review & approval to ensure that the survey • is conducted in a technically and ethically sound manner • recognises & protects the rights of participants • Submission of a proposal to a national ethics review committee • Informed consent needs to be obtained from every survey participant

23. Scheduling Data Collection • Eight to twelve weeks are necessary to complete data collection • Key factors to consider while planning the appropriate time to conduct the survey: • Seasons • Major events • Civil unrest • Keep timeframe as close as possible to recommended timeframe

24. Scheduling Data Collection, cont’d • Data collection scheduled once the following has been accomplished: • Implementation plan and funding have been approved • Translation of STEPS materials • Sample has been drawn • Recruitment and training of data-collection staff (trained interviewers can be used) • Evening and weekends are preferred in some settings (urban). • Schedule blood collection early in the morning (for fasting).

25. Adapting the STEPS Instrument • The STEPS instrument is standardized to enable comparisons, but adaptations are needed in the following cases: • A term needs to be altered for local relevance. • Additional data is required on a risk factor. • A question is not applicable (alcohol, smokeless tobacco).

26. Adapting the STEPS Instrument (cont’d) Rulesto apply when tailoring the instrument: • Never delete a question or measure from core modules. • Never change the standard coding number. • Place additional questions where they best fit. • Do not place additional questions or measures in between core questions or measures. • Code all added questions or measures with the letter "X“. • Remove any expanded sections not covered by your site. • Review and adapt all skip instructions & question numbers for accuracy. • Send a draft of your tailored instrument to WHO Geneva STEPS team for review.

27. Adapting the STEPS instrument (cont’d) Process of tailoringthe STEPS instrument involves the following: • Identify questions that need local adaptation. • Adapt wording, add questions & adjust skip instructions. • Adapt other forms as appropriate (question by question, show cards, interview tracking form). • Translating and back translating the adapted instrument. • Pilot testing the instrument. • Adapting the data-entry tool, data-management code, data-analysis code and report template, as appropriate.

28. Adapting the STEPS Instrument (cont’d) Examples of questions requiring local adaptations

29. Adapting the STEPS instrument (cont’d) Examples of questions requiring local adaptations

30. Translating STEPS Materials • All materials to be translated into languages used in the site. • The census office may help in determining languages to be used. • Translators ideally will have experience in health surveys. • The original intent of the questions need to be maintained. • Back translation is necessary and is done by a different translator to ensure accurate reproduction of meanings. • If STEPS materials are already available in the language needed, check language applicability for the site (e.g. expressions or words may be different; valid for Arabic, Spanish, etc.).

31. Translating STEPS Materials (cont’d) Field documents to be translated • STEPS instrument • Q by Q • Show Cards • Training & Practical Guides • Interview tracking form • Clinic Registration form • Participant information form • Consent forms

32. Pilot Testing • Pilot test of the entire data collection to be conducted • Involves the following aspects of the survey: • Approaching potential participants • Seeking and obtaining informed consent • Making appointments for data collection • Preparing site • Collecting data • Identifying participants who may need follow-up • Double data entry • Basic analysis

33. Pilot Testing (cont’d) • Pilot test to be conducted once • Translation of STEPS materials is finalised • Recruitment and training of data collection staff are done • Ensures interviewers consistency and tests their skills prior to the survey • Allow sufficient time for adjustments to be made prior to starting data collection

34. Pilot Testing (cont’d) Test group • Convenient sample (10 – 20 people) • Men & women • Age range used in STEPS • People from different socio-economic groups (and if applicable, from different ethnic groups)

35. Pilot Testing On completion of pilot test: • Compile all participants' comments into a single report. • Adapt and refine instrument if needed, BUT don’t change intended meanings. • Send the instrument to CAREC/PAHO/WHO STEPS team for comments and quality assurance.