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NCD surveillance: systems to track risk factors Leanne Riley, Team Leader, Surveillance Surveillance and Population-based Prevention Unit Dept. of Chronic Diseases and Health Promotion. NCD Surveillance at WHO. STEPS (adults) GSHS (adolescents) NCD Country Capacity Survey (CCS)
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NCD surveillance: systems to track risk factorsLeanne Riley, Team Leader, Surveillance Surveillance and Population-based Prevention UnitDept. of Chronic Diseases and Health Promotion
NCD Surveillance at WHO • STEPS (adults) • GSHS (adolescents) • NCD Country Capacity Survey (CCS) • Assessment of national level capacity to respond to NCD's in all WHO Member States • 3rd round of data collection in 2010; previous surveys in 2000 & 2005 • Inclusion of results in progress report on the global status of prevention and control of NCDs (due out April 2011)
The STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS)
What is STEPS? • "The WHO STEPwise approach to chronic disease risk factor surveillance provides an entry point for low and middle income countries to get started on chronic disease surveillance activities. It is also designed to help countries build and strengthen their capacity to conduct surveillance."
Objectives • Empower Member States to gather information on chronic disease risk factors for use in planning health programmes and interventions. • Provide standardized questionnaire that allows for comparisons, but is flexible to meet Member States' needs. • Build capacity in Member States in all aspects of national survey implementation; in particular, develop skills in sample design, data collection and data analysis.
Current Activity 120
Different levels of risk factor assessment: STEP 1 – questionnaire STEP 2 – physical measurements STEP 3 – blood samples Three modules per Step: Core Expanded Optional Questionnaire Overview
Questionnaire Overview, cont. • Behavioural Risk Factors • Tobacco use • Harmful alcohol consumption • Unhealthy diet (low fruit and vegetable consumption) • Physical inactivity • Biological Risk Factors • Overweight and obesity • Raised blood pressure • Raised blood glucose • Abnormal blood lipids • Optional Modules on Injury and Violence, Oral Health, Sexual Health
STEPS Methodology • Targets a nationally representative sample of adults aged 25 – 64. • STEP 1 (questionnaire) and STEP 2 (physical measures) are conducted in the household by trained interviewers. • STEP 3 (biochemical measures) is typically clinic-based. • Pocket PCs (PDAs*) are used for data collection: "eSTEPS" • Repeat survey should be done every 3 - 5 years. *(Personal Digital Assistant)
eSTEPS Features / Benefits • Improves quality of data collection with … • automated Kish Method • pre-defined skips • automatic range checks • immediate error checking • Fewer materials for data collectors to carry • No data entry needed • Multiple languages supported • English, French, Spanish, Arabic, Khmer, Georgian, Russian … • PDAs can be charged where power is unreliable by AA battery (cheap) or solar-power (expensive). • SD (external memory) cards provide data security in the event of PDA malfunction.
STEPS Methodology: The Surveillance Loop Recognize need for data on chronic disease risk factors STEPS Implementation Workshop Begin STEPS Planning STEPS Data Collection Workshop Conduct STEPS Implement Interventions Report Results STEPS Data Analysis & Reporting Workshop Data to Action Workshop
Training: Survey Implementation • Scope of survey • Identification of necessary resources • Questionnaire design • Sample design • Data collection logistics • Draft Survey Proposal
Training: Data Collection • PDA Basics • Locating and approaching households • Kish Method • Informed consent • Interview skills • Taking physical measurements • Taking biochemical measurements • Pilot Test
Training: Analysis & Reporting • Weighting data • Mapping data to generic STEPS Instrument (as needed) • Epi Info Analysis training • Half-day hands-on introduction • Running provided analysis code for descriptive analysis • Creation of STEPS Fact Sheet and Data Book (standardized reporting documents) • Begin draft of report and discuss dissemination plan
Training: Data to Action • Using STEPS survey results: • Propose development of new programmes / services or elaboration of existing ones to address key findings of survey • DPAS (Global Strategy on Diet and Physical Activity for Health) documents provide guidelines • Inter-Ministry collaboration
Support Materials • STEPS Manual • survey implementation plan template • suggested timelines • training guides for data collection and data entry staff • data collection forms (e.g. participant information sheets, interview tracking forms) • Generic STEPS Instrument • Sampling Tools • "STEPS Sampling Workbook" • "STEPS sample size calculator"
Support Materials: eSTEPS Software Create (edit) Questionnaire on PC and transfer to PDA eSTEPS Questionnaire Designer eSTEPS Pocket PC (PDA) Data entry Import data from PDA to PC eSTEPS Manager
Support Materials: eSTEPS Guides • Installation Guide • Reviews PDA requirements • Provides step-by-step installation instructions for: • all prerequisite software • the 3 eSTEPS components • User Manual • Provides detailed instructions for: • how to use each eSTEPS component • how to manage the survey data and create the final dataset • WHO provides assistance with the creation of the questionnaire for the PDA and provides ongoing support via phone and e-mail during data collection.
Support Materials, cont. • Data Analysis & Reporting Tools • Epi Info and SPSS analysis programs (Stata coming soon) • standardized fact sheet and data book • survey report template
Support Materials: Analysis Help From generic STEPS Questionnaire From Fact Sheet Analysis Guide From Fact Sheet Analysis Guide
Support Materials: Analysis Help, Cont. From STEPS Generic Instrument From Data Book Template Data Book ex. page
Support Materials: STEPS websitehttp://www.who.int/chp/steps
GSHS: Overview & Objectives • System for surveillance of behavioural risk factors and protective factors in school-aged children • Help countries develop priorities, establish programmes, and advocate for resources • Establish trends in the prevalence of health behaviors and protective factors by country • Allow countries and international agencies to make comparisons across countries
GSHS: Methods • Self-administered questionnaire and generic answer sheet • Targets grades with students aged 13 – 15 years • Completed by students during one classroom period • Anonymous and confidential • 10 Question Modules are available, from which countries can select a minimum of 6: • Alcohol, diet, drugs, hygiene, mental health, physical activity, protective factors, sexual behaviours, tobacco, violence & injury
GSHS: Training • Analysis & Reporting • Workshop • Epi Info training • Analysis of data • Report writing • Data Application and Program Planning Workshop • Policies • Programmes • Other interventions • Survey Implementation Workshop • Sampling • Survey administration • Questionnaire Conduct GSHS Report Data Repeat GSHS Implement School Health and Youth Health Programmes
GSHS: Current Implementation • Worldwide, 104 countries across all six WHO regions have been trained and 60 have finished GSHS data collection (including 9 countries with repeat surveys).