WHO STEPS Instrument

(Core and Expanded)

The WHO STEPwise approach to chronic disease risk factor surveillance (STEPS)
World Health Organization 20 Avenue Appia, 1211 Geneva 27, Switzerland For further information: www.who.int/chp/steps

STEPS Instrument
Overview
Introduction

This is the generic STEPS Instrument which sites/countries will use to develop their tailored instrument. It contains the: CORE items (unshaded boxes) EXPANDED items (shaded boxes).

Core Items

The Core items for each section ask questions required to calculate basic variables. For example: current daily smokers mean BMI. Note: All the core questions should be asked, removing core questions will impact the analysis.

Expanded items The Expanded items for each section ask more detailed information.

Examples include: use of smokeless tobacco sedentary behaviour.

Guide to the columns

The table below is a brief guide to each of the columns in the Instrument. Description This question reference number is designed to help interviewers find their place if interrupted. Each question is to be read to the participants Site Tailoring Renumber the instrument sequentially once the content has been finalized. Select sections to use. Add expanded and optional questions as desired. Add site specific responses for demographic responses (e.g. C6). Change skip question identifiers from code to question number. This should never be changed or removed. The code is used as a general identifier for the data entry and analysis.

Column Number

Question

Response

Code

This column lists the available response options which the interviewer will be circling or filling in the text boxes. The skip instructions are shown on the right hand side of the responses and should be carefully followed during interviews. The column is designed to match data from the instrument into the data entry tool, data analysis syntax, data book, and fact sheet.

Participant Identification Number

WHO STEPS Instrument

for Chronic Disease Risk Factor Surveillance

<insert country/site name>

Survey Information

Location and Date

1 2 3 4
Purok Number Purok and Barangay Name Interviewer ID (three letter name initials) Date of completion of the instrument

Response

Code

I1 I2

dd mm year

I3 I4

Participant Id Number (ex. P1 - 01)

Consent, Interview Language and Name

5
Yes Consent has been read and obtained No English Cebuano [Add others] [Add others]

Response
1 2 1 2 3 4 If NO, END

Code

I5 I6

Interview Language [Insert Language]

7 8 9

Time of interview (24 hour clock) Family Surname First Name

:
hrs mins

I7 I8
I9 I10

Additional Information that may be helpful

10
Contact phone number where possible Record and file identification information (I5 to I10) separately from the completed questionnaire.

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Participant Identification Number

Step 1 CORE: Demographic Information

Question
11
Sex (Record Male / Female as observed)

Demographic Information

Response
Male Female 1 2

Code C1 C2 C3 C4

12 13 14

Kanus-a ka gipanganak?

If known, Go to C4 dd mm year
Years Years

Pila na imung edad? Pila ka ka-tuig gaeskwela sugod Grade 1 hantod sa paghuman?

EXPANDED: Demographic Information

No formal schooling Less than primary school What is the highest level of education you have completed? Primary school completed Secondary school completed High school completed [INSERT COUNTRY-SPECIFIC CATEGORIES] College/University completed Post graduate degree Refused What is your [insert relevant ethnic group / racial group / cultural subgroup / others] background? [Locally defined] [Locally defined] [Locally defined] Refused Never married Currently married Separated 1 2 3 4 5 6 7 88 1 2 3 88 1 2 3 4 5 6 88 1 2 3 4 5 6 7 8 9 88

15

C5

16

C6

17

What is your marital status?

Divorced Widowed Cohabitating Refused Government employee Non-government employee Self-employed Non-paid Student

C7

Which of the following best describes your main work status over the past 12 months?

18

[INSERT COUNTRY-SPECIFIC CATEGORIES]

Homemaker Retired Unemployed (able to work)

C8

(USE SHOWCARD)

Unemployed (unable to work) Refused

19

How many people older than 18 years, including yourself, live in your household?

Number of people

C9

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Participant Identification Number

EXPANDED: Demographic Information, Continued

Question
Taking the past year, can you tell me what the average earnings of the household have been? (RECORD ONLY ONE, NOT ALL 3) Per week OR per month OR per year Refused If you dont know the amount, can you give an estimate of the annual household income if I read some options to you? Is it [INSERT QUINTILE VALUES IN LOCAL CURRENCY] (READ OPTIONS)

Response
Go to T1 Go to T1 Go to T1
88 1 2 3 4 5 77 88

Code C10a C10b C10c C10d

20

Quintile (Q) 1 More than Q 1, Q 2 More than Q 2, Q 3 More than Q 3, Q 4 More than Q 4 Don't Know Refused

21

C11

Step 1 CORE: Tobacco Use

Behavioural Measurements

Now I am going to ask you some questions about various health behaviours. This includes things like smoking, drinking alcohol, eating fruits and vegetables and physical activity. Let's start with tobacco.

Question
22
Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? (USE SHOWCARD)

Response
Yes No Yes No Age (years) Dont know 77 In Years OR OR in Months in Weeks 1 2 1 2 If No, go to T6 If No, go to T6

Code T1

23

Do you currently smoke tobacco products daily? How old were you when you first started smoking daily?

T2 T3

24

If Known, go to T5a If Known, go to T5a If Known, go to T5a else go to T9

Go to T9 If Other, go to T5other,

Do you remember how long ago it was?

T4a T4b T4c T5a T5b T5c T5d T5e T5other

25

(RECORD ONLY 1, NOT ALL 3) Dont know 77

Manufactured cigarettes Hand-rolled cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos Other Other (please specify):

On average, how many of the following do you smoke each day?

26

(RECORD FOR EACH TYPE, USE SHOWCARD) Dont Know 77

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Participant Identification Number

EXPANDED: Tobacco Use

Question
27 28
In the past, did you ever smoke daily?

Response
Yes No 1 2 If No, go to T9

Code T6 T7 T8a T8b T8c T9 T10 T11a T11b T11c T11d

How old were you when you stopped smoking daily?

Age (years) Dont Know 77 Years ago OR OR Months ago Weeks ago Yes No Yes No Snuff, by mouth

If Known, go to T9 If Known, go to T9 If Known, go to T9

1 2 1 2 If No, go to T12 If No, go to T12

How long ago did you stop smoking daily?

29

(RECORD ONLY 1, NOT ALL 3) Dont Know 77 Do you currently use any smokeless tobacco such as [snuff, chewing tobacco, betel]? (USE SHOWCARD) Do you currently use smokeless tobacco products daily?

30

31

else go to T13
If Other, go to T11other,

On average, how many times a day do you use .

Snuff, by nose Chewing tobacco

32

(RECORD FOR EACH TYPE, USE SHOWCARD) Betel, quid Don't Know 77 Other Other (specify)

T11e T11other T12 T13

Go to T13
Yes No 1 2

33

In the past, did you ever use smokeless tobacco such as [snuff, chewing tobacco, or betel] daily? During the past 7 days, on how many days did someone in your home smoke when you were present? During the past 7 days, on how many days did someone smoke in closed areas in your workplace (in the building, in a work area or a specific office) when you were present?

34

Number of days Don't know 77 Number of days Don't know or don't work in a closed area 77

35

T14

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Participant Identification Number

CORE: Alcohol Consumption

The next questions ask about the consumption of alcohol.

Question
36
Have you ever consumed an alcoholic drink such as beer, wine, spirits, fermented cider or [add other local examples]? (USE SHOWCARD OR SHOW EXAMPLES) Have you consumed an alcoholic drink within the past 12 months? During the past 12 months, how frequently have you had at least one alcoholic drink?

Response
Yes No Yes No Daily 5-6 days per week 1-4 days per week 1-3 days per month Less than once a month Yes No Number Don't know 77 Number Don't know 77 Largest number Don't Know 77 Number of times Don't Know 77 1 2 If No, go to D1 1 2 If No, go to D1 1 2 3 4 5 1 2 If No, go to D1

Code A1a A1b

37

38
(READ RESPONSES, USE SHOWCARD) Have you consumed an alcoholic drink within the past 30 days? During the past 30 days, on how many occasions did you have at least one alcoholic drink? During the past 30 days, when you drank alcohol, on average, how many standard alcoholic drinks did you have during one drinking occasion? (USE SHOWCARD) During the past 30 days, what was the largest number of standard alcoholic drinks you had on a single occasion, counting all types of alcoholic drinks together? During the past 30 days, how many times did you have for men: five or more for women: four or more standard alcoholic drinks in a single drinking occasion?

A2

39 40

A3 A4

41

A5

42

A6

43

A7

EXPANDED: Alcohol Consumption

Usually with meals

44

During the past 30 days, when you consumed an alcoholic drink, how often was it with meals? Please do not count snacks.

Sometimes with meals Rarely with meals Never with meals Monday Tuesday

1 2 3 4

A8

A9a A9b A9c A9d A9e A9f A9g

During each of the past 7 days, how many standard alcoholic drinks did you have each day?

Wednesday Thursday Friday

45

(USE SHOWCARD)

Don't Know 77 Saturday Sunday

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Participant Identification Number

CORE: Diet
The next questions ask about the fruits and vegetables that you usually eat. I have a nutrition card here that shows you some examples of local fruits and vegetables. Each picture represents the size of a serving. As you answer these questions please think of a typical week in the last year.

Question
46 47 48 49
In a typical week, on how many days do you eat fruit? (USE SHOWCARD) How many servings of fruit do you eat on one of those days? (USE SHOWCARD) In a typical week, on how many days do you eat vegetables? (USE SHOWCARD) How many servings of vegetables do you eat on one of those days? (USE SHOWCARD)

Response
Number of days Don't Know 77 Number of servings Don't Know 77 Number of days Don't Know 77 Number of servings Dont know 77

Code
If Zero days, go to D3

D1 D2

If Zero days, go to D5

D3 D4

EXPANDED: Diet
Vegetable oil Lard or suet What type of oil or fat is most often used for meal preparation in your household? Butter or ghee Margarine Other None in particular None used Dont know Other On average, how many meals per week do you eat that were not prepared at a home? By meal, I mean breakfast, lunch and dinner. Number Dont know 77

50

(USE SHOWCARD) (SELECT ONLY ONE)

1 2 3 4 5 If Other, go to D5 other 6 7 77

D5

D5other D6

51

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Participant Identification Number

CORE: Physical Activity

Aning puntaha akong mga pangutana kabahin sa unsa kadaghana o kabug-at ang imung pagehersisyo o pagtrabaho. Sa pagtubag, huna hunaa ang imung kasagarang ginahimo nga para nimo labot sa imung pagehersisyo sama sa pagpanlimpyo, pagtrabaho. Lakip sa mga pangutana kay ang 'vigorous-intensity activities' o ang mga aktibidades nga nanginahanglan ug kusog dayon ikaw panington ug hangakon. Ang 'moderate-intensity activities' kay ang mga aktibidades nga dili ra kayo nanginahanglan ug kusog ug wa ra kayo kausaban sa imung ginhawaan.

Question
Work
for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD)

Response
Yes No 1

Code

52

P1
2 If No, go to P 4

53

In a typical week, on how many days do you do vigorous-intensity activities as part of your work? How much time do you spend doing vigorous-intensity activities at work on a typical day? Does your work involve moderate-intensity activity, that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderate-intensity activities as part of your work? How much time do you spend doing moderate-intensity activities at work on a typical day?

Number of days

:
hrs mins

P2 P3 (a-b)

54

Hours : minutes

Yes No Number of days

55

P4
2 If No, go to P 7

56

:
hrs mins

P5 P6 (a-b)

57

Hours : minutes

Travel to and from places The next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, to place of worship. [Insert other examples if needed] 58
Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places? How much time do you spend walking or bicycling for travel on a typical day? Yes No Number of days 1 2 If No, go to P 10

P7 P8

59

:
hrs mins

60

Hours : minutes

P9 (a-b)

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Participant Identification Number

CORE: Physical Activity, Continued

Question Response Code
Recreational activities The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure), [Insert relevant terms].
Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational (leisure) activities? How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day? Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, volleyball] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderate-intensity sports, fitness or recreational (leisure) activities? Yes No 1

61

P10
2 If No, go to P 13

62

Number of days

P11

63

Hours : minutes

:
hrs mins

P12 (a-b)

Yes No

64

P13
2 If No, go to P16

65

Number of days

P14

66

How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day?

Hours : minutes

:
hrs mins

P15 (a-b)

EXPANDED: Physical Activity

Sedentary behaviour The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, traveling in car, bus, train, reading, playing cards or watching television, but do not include time spent sleeping.
[INSERT EXAMPLES] (USE SHOWCARD)

67

How much time do you usually spend sitting or reclining on a typical day?

Hours : minutes

:
hrs mins

P16 (a-b)

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Participant Identification Number

CORE: History of Raised Blood Pressure

Question
68
Have you ever had your blood pressure measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension? Have you been told in the past 12 months?

Response
Yes No Yes No Yes No 1 2 1 2 1 2 If No, go to H6 If No, go to H6

Code H1 H2a H2b

69

70

EXPANDED: History of Raised Blood Pressure

Are you currently receiving any of the following treatments/advice for high blood pressure prescribed by a doctor or other health worker? Drugs (medication) that you have taken in the past two weeks Advice to reduce salt intake Yes No Yes No Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2

H3a H3b H3c H3d H3e H4 H5

71

Advice or treatment to lose weight

Advice or treatment to stop smoking

Advice to start or do more exercise Have you ever seen a traditional healer for raised blood pressure or hypertension? Are you currently taking any herbal or traditional remedy for your raised blood pressure?

72

73

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Participant Identification Number

CORE: History of Diabetes

Question
74
Have you ever had your blood sugar measured by a doctor or other health worker? Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes? Have you been told in the past 12 months?

Response
Yes No Yes No Yes No 1 2 1 2 1 2 If No, go to M1 If No, go to M1

Code H6 H7a H7b

75

76

EXPANDED: History of Diabetes

Are you currently receiving any of the following treatments/advice for diabetes prescribed by a doctor or other health worker? Insulin Drugs (medication) that you have taken in the past two weeks Special prescribed diet Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

H8a H8b H8c H8d H8e H8f H9 H10

77
Advice or treatment to lose weight

Advice or treatment to stop smoking

Advice to start or do more exercise Have you ever seen a traditional healer for diabetes or raised blood sugar? Are you currently taking any herbal or traditional remedy for your diabetes?

78 79

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Participant Identification Number

Step 2 CORE: Height and Weight

Question
80 81 82 83
Interviewer ID Device IDs for height and weight

Physical Measurements

Response

Height Weight in Centimetres (cm)

Code M1 M2a

M2b
M3 M4 M5

Height Weight If too large for scale 666.6 For women: Are you pregnant?

in Kilograms (kg)

.
Yes No 1 If Yes, go to M 8 2

84

CORE: Waist
85 86
Device ID for waist Waist circumference in Centimetres (cm)

M6 M7

CORE: Blood Pressure

87 88 89
Interviewer ID Device ID for blood pressure Small Cuff size used Medium Large Systolic ( mmHg)

1 2 3

M8 M9 M10 M11a M11b M12a M12b M13a M13b M14

90

Reading 1 Diastolic (mmHg) Systolic ( mmHg)

1 2

91

Reading 2 Diastolic (mmHg) Systolic ( mmHg)

92

Reading 3 Diastolic (mmHg) During the past two weeks, have you been treated for raised blood pressure with drugs (medication) prescribed by a doctor or other health worker? Yes No

93

EXPANDED: Hip Circumference and Heart Rate

94
Hip circumference Heart Rate in Centimeters (cm)

M15 M16a M16b M16c

95

Reading 1 Reading 2 Reading 3

Beats per minute Beats per minute Beats per minute

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Participant Identification Number

Step 3 CORE: Blood Glucose

Question
96 97 98 99

Biochemical Measurements

Response
Yes No 1 2

Code B1 B2 B3 B4

During the past 12 hours have you had anything to eat or drink, other than water? Technician ID Device ID Time of day blood specimen taken (24 hour clock)

Hours : minutes mmol/l mg/dl Yes No

:
hrs mins

100

Fasting blood glucose Choose accordingly: mmol/l or mg/dl Today, have you taken insulin or other drugs (medication) that have been prescribed by a doctor or other health worker for raised blood glucose?

. .
1 2

B5 B6

101

CORE: Blood Lipids

102 103
Device ID Total cholesterol Choose accordingly: mmol/l or mg/dl During the past two weeks, have you been treated for raised cholesterol with drugs (medication) prescribed by a doctor or other health worker? mmol/l mg/dl Yes No

. .
1 2

B7 B8 B9

104

EXPANDED: Triglycerides and HDL Cholesterol

105
Triglycerides Choose accordingly: mmol/l or mg/dl HDL Cholesterol Choose accordingly: mmol/l or mg/dl mmol/l mg/dl
mmol/l

. . . .

B10

106

B11

mg/dl

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