BUTION: GENERAL


STEPS Field Manual
Guidelines for Field Staff







The WHO STEPwise approach to Surveillance
of noncommunicable diseases (STEPS)




Noncommunicable Diseases and Mental Health
World Health Organization
20 Avenue Appia, 1211 Geneva 27, Switzerland

For further information:
ncd_surveillance@who.int


WHO STEPS Field Manual


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Copies of this document are available from:
Noncommunicable Diseases and Mental Health
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
Fax: +41 22 791 4769
Email: ncd_surveillance@who.int
URL:
The content of this document is available on the Internet at:
http://www.who.int/ncd_surveillance



© World Health Organization 2003. This document is not a formal publication of the World Health
Organization (WHO). All rights are reserved by the Organization. The document may be freely
reviewed, abstracted, reproduced or translated, in part or in whole, but may not be sold or used for
commercial purposes.
Printed in Switzerland

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Purpose of STEPS Field Manual
The field manual includes:
1. Guidelines for field supervisors for use in supervising and training
interviewers
2. Guidelines for interviewers
3. Question by question instruction guide and protocols to STEPS
instrument
4. A Glossary to provide clarification on the terminology used in the field
manual and the instrument as well as ensuring standardization in
terminology used
5. The Field Manual Appendices presented in a separate document, provides
a wealth of examples of recruitment forms, consent forms and
performance check lists for administering the STEPS instrument


Acknowledgements
The World Health Organization wishes to acknowledge the support from the Governments of
Australia, the Netherlands, Sweden and the United Kingdom towards the development and
implementation of the WHO STEPwise approach to Surveillance (STEPS).
Invaluable contributions towards the development of STEPS have also been received from many
organizations, institutions and individuals that are listed in the Acknowledgements section of the full
document, Surveillance of risk factors for noncommunicable diseases: The WHO STEPwise
approach.



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Table of contents
Purpose of STEPS Field Manual ...................................................................................... 3
Acknowledgement............................................................................................................. 3
Table of contents............................................................................................................... 4
1.
Guidelines for supervisors.................................................................................. 5
2.
Guidelines for interviewers ................................................................................. 7
2.1
Interviewer instructions for using the STEPS instrument .................................... 7
2.2
Conducting interviews in the field........................................................................ 8
2.3 Interviewing
Techniques ................................................................................... 10
3.
Question by Question instruction guide and protocols to STEPS
instrument (version 1.4)..................................................................................... 15
3.1
Step 1 Questionnaire (self report) .................................................................. 15
3.1.1 CORE-
Demographic
information .................................................................. 15
3.1.2 Expanded-
Demographic
information ............................................................ 15
3.1.3
CORE- Tobacco use...................................................................................... 16
3.1.4 Expanded-
Tobacco
use................................................................................ 17
3.1.5
CORE- Alcohol consumption ......................................................................... 18
3.1.6
Expanded- Alcohol consumption ................................................................... 19
3.1.7 CORE-
Diet.................................................................................................... 19
3.1.8 Expanded-
Diet .............................................................................................. 20
3.1.9
CORE- Physical activity................................................................................. 20
3.2
Show cards and instructions for Step 1............................................................. 24
3.2.1
List of work status .......................................................................................... 24
3.2.2
List of tobacco products................................................................................. 25
3.2.3 Alcohol
show
card.......................................................................................... 26
3.2.4
Diet show card ............................................................................................... 27
3.2.5
Physical activities show card ......................................................................... 28
3.3
Step 2 Protocols for physical measures......................................................... 29
3.3.1 Height
measurement
protocol........................................................................ 29
3.3.2
Weight measurement protocol....................................................................... 30
3.3.3
Waist circumference measurement protocol.................................................. 30
3.3.4
Blood pressure measurement........................................................................ 31
3.4
Step 3 Protocols for biochemical measures................................................... 34
3.4.1
Technician roles and responsibilities ............................................................. 34
3.4.2
Blood collection (Fasting) .............................................................................. 34
3.4.3 Cholesterol
measurement
protocol................................................................ 35
3.4.4
Blood glucose measurement protocol ........................................................... 37
4. Glossary.............................................................................................................. 40

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1. Guidelines for supervisors
A supervisor should ideally have previous survey experience, personal qualities and skills to effectively
manage a team of several interviewers. The supervisor also ensures adequate training of field staff and
sets in place protocols for dealing with all logistical problems.
The range of tasks include:
Identification of target population
The supervisor obtains household lists and/or maps for each area in which his/her team will be
working and discuss any special problems. He/she needs to become familiar with the area where
the team will be working and determine the best arrangements for travel and accommodations.
Informing key people
The supervisor will contact the local authorities to inform them about the survey and to gain their
support and cooperation.
He/She will obtain supplies and equipment necessary for the team to complete its assigned
interviews. The supervisor will maintain interviewer morale, ensure contact with the central office
throughout the fieldwork.
Training Interviewers
Thorough training will be conducted to prepare the interviewers for their task. In each case, they
must first study the field manual and appendices at home and do several written exercises. Next,
they undergo several days of in-class training, during which they will study interviewing skills and
techniques and will familiarise themselves with the questionnaire and the question by question
instruction guide (section 3 in the present document). They dont have to take the latter with them
in the field but will therefore know it very well.
Supervising the interviewers
The supervisor assigns work to interviewers, taking into account the linguistic competence of
individual interviewers, and ensuring that there is an equitable distribution of the workload.
The supervision tasks are as follows;
Maintain fieldwork control sheets and make sure that the assignments are carried out
Regularly send completed questionnaires and progress reports to the field coordinator and
keeps the central office informed of the teams location
A field log book is a useful way to record daily activities. Each survey team will be issued
with a field logbook where daily activities will be recorded. The supervisor will keep this. It
will be a useful tool to monitor the performance of the survey team and to standardize the
field work.
Prior to the day of data collection the logbook includes the following information and needs to be
completed each day through data collection process;

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Registration Book for each village; the supervisor will use this to track the number of
participants that have been interviewed.
Codes for the staff, equipment, interview teams and village.
Form to record participants that might need transport.
All the maps of the Enumeration Districts for the particular village
Ensure data quality
To ensure high-quality data collection, th