High Level Table of Contents PART 1: INTRODUCTION AND ROLES... 1-0 SECTION 1: INTRODUCTION... 1-1-1 SECTION 2: ROLES AND RESPONSIBILITIES... 1-2-1 PART 2: PLANNING AND SET UP... 2-0 SECTION 1: PLANNING AND PREPARING A STEPS SURVEY... 2-1-1 SECTION 2: PREPARING THE SAMPLE... 2-2-1 PART 3: DATA COLLECTION... 3-0 SECTION 1: INTRODUCTION TO ESTEPS AND PREPARATION OF THE DATA COLLECTION ENVIRONMENT... 3-1-1 SECTION 2: DATA COLLECTORS TRAINING AND PILOT TEST... 3-2-1 SECTION 3: DATA COLLECTION PROCESS... 3-3-1 SECTION 4: COLLECTING STEP 1 DATA_INTERVIEWS... 3-4-1 SECTION 5: COLLECTING STEP 2 DATA_PHYSICAL MEASUREMENTS... 3-5-1 SECTION 6: COLLECTING STEP 3 DATA_BIOCHEMICAL MEASUREMENTS... 3-6-1 PART 4: DATA MANAGEMENT AND ANALYSIS, REPORTING AND DISSEMINATING RESULTS... 4-0 SECTION 1: CREATING THE FINAL DATASET... 4-1-1 SECTION 2: DATA ANALYSIS... 4-2-1 SECTION 3: REPORTING RESULTS... 4-3-1 SECTION 4: DATA POLICIES AND ARCHIVING... 4-4-1 PART 5: STEPS INSTRUMENT... 5-0 SECTION 1: THE STEPS INSTRUMENT... 5-1-1 SECTION 2: QUESTION-BY-QUESTION GUIDE... 5-2-1 SECTION 3: SHOW CARDS... 5-3-1 SECTION 4: OPTIONAL MODULES... 5-4-1 PART 6: TEMPLATES AND FORMS... 6-0 SECTION 1: PLANNING AND SET UP TEMPLATES... 6-1-1 SECTION 2: FORMS FOR STEPS FIELD WORK... 6-2-1 SECTION 3: REPORTING TEMPLATES... 6-3-1 PART 7: GLOSSARY... 7-0 SECTION 1: GLOSSARY OF TERMS USED IN STEPS... 7-1-1 WHO STEPS Surveillance Manual TOC 1
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Table of Contents PART 1: INTRODUCTION AND ROLES... 1-0 SECTION 1: INTRODUCTION... 1-1-1 Rationale for Surveillance of NCD Risk Factors... 1-1-3 Selected Risk Factors... 1-1-5 Item Rationales for Risk Factors... 1-1-7 WHO STEPS Overview... 1-1-15 Planning and Implementation Overview... 1-1-19 References... 1-1-20 SECTION 2: ROLES AND RESPONSIBILITIES... 1-2-1 Relationships Between Survey Team and WHO... 1-2-2 STEPS Survey Coordinator... 1-2-3 STEPS Coordinating Committee... 1-2-5 Data Collection Team... 1-2-6 Laboratory Technician... 1-2-9 Statistical Adviser... 1-2-10 IT Specialist/Data Manager and Analysis Team... 1-2-11 WHO Offices... 1-2-13 PART 2: PLANNING AND SET UP... 2-0 SECTION 1: PLANNING AND PREPARING A STEPS SURVEY... 2-1-1 Recruiting Staff... 2-1-3 Number of Staff Required... 2-1-6 Identifying the Scope of the STEPS Survey... 2-1-7 The STEPS Implementation Plan... 2-1-11 Developing a Budget... 2-1-14 Adapting the STEPS Instrument... 2-1-15 Translating STEPS Documents... 2-1-21 Applying for Ethical Approval... 2-1-23 Equipment and supplies for Step 1 and 2... 2-1-24 Equipment and supplies for Step 3... 2-1-27 Choosing a Chemistry Screening Method for Step 3... 2-1-30 Timeframes and Data Collection Considerations... 2-1-31 Scheduling Data Collection... 2-1-33 SECTION 2: PREPARING THE SAMPLE... 2-2-1 Sampling Guidelines... 2-2-2 Determining the Sample Size... 2-2-3 Identifying the Sampling Frame... 2-2-10 Choosing the Sample Design... 2-2-12 Selecting the Sample... 2-2-20 Documenting the Sample Design... 2-2-24 Preparing Data Collection Forms... 2-2-25 Continued on next page WHO STEPS Surveillance Manual TOC 3
Table of Contents, Continued PART 3: DATA COLLECTION... 3-0 SECTION 1: INTRODUCTION TO ESTEPS AND PREPARATION OF THE DATA COLLECTION ENVIRONMENT... 3-1-1 Introduction... 3-1-2 Creating the electronic STEPS Instrument... 3-1-3 Preparing the online esteps platform...3-1-7 Preparing the Android devices... 3-1-10 SECTION 2: DATA COLLECTORS TRAINING AND PILOT TEST... 3-2-1 Training Workshop... 3-2-2 Training Preparation... 3-2-3 Training Lesson Plan... 3-2-5 Training Delivery Tips... 3-2-9 Pilot Testing... 3-2-13 SECTION 3: DATA COLLECTION PROCESS... 3-3-1 Supervising Data Collection... 3-3-2 Sequence of Data Collector s Tasks... 3-3-5 Approaching Selected Households and Participants... 3-3-7 Selecting a Participant within a Selected Household... 3-3-9 Informing Participants... 3-3-10 Obtaining Consent... 3-3-12 Completing the Interview Tracking Form... 3-3-13 SECTION 4: COLLECTING STEP 1 DATA: INTERVIEWS... 3-4-1 Interview Skills... 3-4-2 Recording information on the Android devices... 3-4-8 Question-by-Question Guide... 3-4-11 Show Cards... 3-4-12 Demographic Information (Step 1)... 3-4-13 Behavioural Measurements (Step 1)... 3-4-14 SECTION 5: COLLECTING STEP 2 DATA: PHYSICAL MEASUREMENTS... 3-5-1 Physical Measurements Overview... 3-5-2 Physical Measurements... 3-5-3 Taking Blood Pressure and Recording Heart Rate... 3-5-5 Measuring Height... 3-5-8 Measuring Weight... 3-5-9 Measuring Waist Circumference... 3-5-10 Measuring Hip Circumference... 3-5-12 Completing the Participant Feedback Form (Step 2)... 3-5-14 Referrals and information for Step 3 Measurements... 3-5-15 Continued on next page WHO STEPS Surveillance Manual TOC 4
Table of Contents, Continued SECTION 6: COLLECTING STEP 3 DATA: BIOCHEMICAL MEASUREMENTS... 3-6-1 Biochemical Measurements Overview... 3-6-2 Urine Collection... 3-6-4 Urinary Sodium and Creatinine Measurement... 3-6-6 Blood Collection... 3-6-7 Measurement of Blood Glucose and Lipids... 3-6-9 Completing the Participant Feedback Form (Step 3)... 3-6-11 PART 4: DATA MANAGEMENT AND ANALYSIS, REPORTING AND DISSEMINATING RESULTS... 4-0 SECTION 1: CREATING THE FINAL DATASET... 4-1-1 Downloading the data... 4-1-2 Cleaning the data... 4-1-3 Weighting the data... 4-1-5 SECTION 2: DATA ANALYSIS... 4-2-1 Preparing the Dataset... 4-2-3 Epi Info Overview... 4-2-5 Completing the Fact Sheet... 4-2-8 Completing the Data Book... 4-2-9 SECTION 3: REPORTING AND DISSEMINATING RESULTS... 4-3-1 Summarizing and Displaying Data... 4-3-3 Interpretation of Results... 4-3-5 Preparing and Distributing the Country Report... 4-3-6 SECTION 4: DATA POLICIES AND ARCHIVING... 4-4-1 Data Policy and Procedures... 4-4-2 Archiving your STEPS Materials... 4-4-3 PART 5: STEPS INSTRUMENT... 5-0 SECTION 1: THE STEPS INSTRUMENT... 5-1-1 SECTION 2: QUESTION-BY-QUESTION GUIDE... 5-2-1 SECTION 3: SHOW CARDS... 5-3-1 Tobacco Show Cards... 5-3-1 Standard Alcoholic drink... 5-3-3 Diet (Typical Fruits and Vegetables and Serving Sizes)... 5-3-4 Dietary Salt... 5-3-5 Physical Activity... 5-3-7 Continued on next page WHO STEPS Surveillance Manual TOC 5
Table of Contents, Continued SECTION 4: OPTIONAL MODULES... 5-4-1 Cervical Cancer Optional Module... 5-4A-1 Mental Health / Suicide Optional Module... 5-4B-1 Oral Health Optional Module... 5-4C-1 Sexual Health Optional Module... 5-4D-1 Tobacco Policy Optional Module... 5-4E-1 Violence and Injury Optional Module... 5-4F-1 Optional Module on Objective Measurement of Physical Activity... 5-4G-1 PART 6: TEMPLATES AND FORMS... 6-0 SECTION 1: PLANNING AND SET UP TEMPLATES... 6-1-1 STEPS Implementation Plan... 6-1-2 Budget Template... 6-1-7 Ethical Approval Form... 6-1-10 SECTION 2: FORMS FOR STEPS FIELD WORK... 6-2-1 Notification of WHO STEPS Surveillance Visit... 6-2-2 Script for Data Collectors... 6-2-3 Interview Tracking Form... 6-2-4 Participant Information Form (Steps 1, 2 and 3)... 6-2-5 Consent Form 1 (Steps 1 and 2)... 6-2-8 Consent Form 2 (Step 3)... 6-2-9 Participant Feedback Form (Step 2)... 6-2-10 Participant Feedback Form (Step 3)... 6-2-11 BMI Classification Chart... 6-2-12 Step 3 Appointment Card (Step 3)... 6-2-13 Instructions for Spot Urine Collection (Step 3)... 6-2-14 Fasting Instructions (Step 3)... 6-2-16 Step 3 Registration Form (Step 3)... 6-2-17 SECTION 3: REPORTING TEMPLATES (FACT SHEET, FACT SHEET ANALYSIS GUIDE, DATA BOOK, AND COUNTRY REPORT TEMPLATES)... 6-3-1 Fact Sheet Template... 6-3A-1 Fact Sheet Analysis Guide... 6-3B-1 Data Book Template... 6-3C-1 Country Report Template... 6-3D-1 PART 7: GLOSSARY... 7-0 SECTION 1: GLOSSARY OF TERMS USED IN STEPS... 7-1-1 WHO STEPS Surveillance Manual TOC 6