STEPS 2004, Non Communicable Disease Risk Factor
Nauru, 2004
Identification
SPC_NRU_2004_STEPS_v01_M
STEPS 2004
Non Communicable Disease Risk Factor
| Name | Country code |
|---|---|
| Nauru | NRU |
Other Household Health Survey [hh/hea]
The Government of Nauru and the World Health Organization in 2004 implemented a nation-wide Stepwise Surveillance of Risk Factors for Non-communicable Diseases Survey (Nauru-STEPS) to document the patterns and levels of diabetes and its associated risk factors. The survey is part of a global endeavour to address major noncommunicable disease (NCD) risk factors in developing countries. The Nauru-STEPS survey was one of a series of STEPS surveys planned to obtain evidence to assist the effective delivery of prevention and control programs across the Pacific. It is the first round of STEPS survey's carried out in Nauru and was repeated in 2011 as the second round.
The Nauru-STEPS was a nation-wide representative survey of 15 to 64 year olds with the following objectives:
- To document the national prevalence and patterns of tobacco use, alcohol consumption, dietary behaviours, physical activity, body mass index, elevated blood pressure, and biochemical markers such as blood glucose and blood lipids in Nauru.
- To provide reliable and up-to-date information on NCD risk factors for planning and evaluating public health initiatives, and for identifying future demands for health services in managing and treating NCDs.
The planning and implementation of the survey was a collaborative initiative between the Nauru Ministry of Health (MOH), the World Health Organization (WHO) and the Centre for Physical Activity and Health at the Universities of New South Wales and Sydney in Australia. The study was supported by the Australian Agency for International Development (AusAID).
Sample survey data [ssd]
-individual
-households
Version
- v0.1: Basic raw data, obtained from data entry (before editing).
2007-03-01
Scope
The Nauru-STEPS survey was a representative, population-wide cross-sectional survey and involved collectingdata on levels of NCD risk factors among 15-64 year olds. Data collection moved along a sequential three-step process as follows:
STEP 1: Interview-based questionnaire on selected major health risk behaviours including smoking, alcohol consumption, fruit and vegetable consumption, and physical activity. Additional issues deemed to be of importance in Nauru included history of high blood pressure, diabetes, self-rated general well-being, perceived susceptibility to diabetes and psychosocial and environmental factors related to health behaviours.
STEP 2: Physiological measures of health risks such as blood pressure, body mass and waist girth circumference.
STEP 3: Biochemical measures of health risks including fasting blood glucose and blood lipids. Assessment of albuminuria level was also undertaken in Nauru.
All aspects of the survey were managed by the Nauru MOH staff.
Coverage
National coverage
The survey population included non-institutionalised individuals in the 15-64 year-old age category living in Nauru during the survey period. Indigenous Nauruans, I-Kiribati and Tuvaluan residents comprised approximately 90% of the total population (Bureau of Statistics, 2004). The remaining population consisted of Asians (Chinese, Filipinos and other South East Asians), other Pacific islanders and expatriate residents (i.e. Australians, Europeans, New Zealanders).
This latter group was excluded from the sampling frame as they were considered to be highly transient and relatively low users of health services in Nauru. Individuals with mental illness, physical or developmental disabilities were also excluded from the survey.
Producers and sponsors
| Name | Affiliation |
|---|---|
| Nauru Ministry of Health | Government of Nauru |
| World Health Organisation | Government of Nauru - Nauru Ministry of Health |
| Centre for Physical Activity and Health at the Universities of New South Wales and Sydney in Australia | Government of Nauru - Nauru Ministry of Health |
| Name | Affiliation | Role |
|---|---|---|
| World Health Organisation | Government of Nauru - Ministry for Health | Technical assistance in budget and planning |
| Australian Agency for International Development | Government of Nauru - Ministry for Health | Technical assistance in budget and planning |
| Centre for Physical Activity and Health (CPAH) at the University of Sydney | Government of Nauru - Ministry for Health | Technical assistance in questionnaire design |
| Centre for Physical Activity and Health (CPAH) at the University of Sydney | Government of Nauru - Ministry for Health | Technical assistance in data collection |
| Centre for Physical Activity and Health (CPAH) at the University of Sydney | Government of Nauru - Ministry for Health | Technical assistance in data processing |
| Centre for Physical Activity and Health (CPAH) at the University of Sydney | Government of Nauru - Ministry for Health | Technical assistance in data analysis |
| Name | Role |
|---|---|
| Australian Agency for International Development | Donorfund |
| Government of Nauru | Donor In kind |
| World Health Organisation | Donor fund |
Sampling
Sample selection - approximately 2,500 randomly selected participants aged 15-64 years
Selection process - using a simple random sampling method
Stratification - stratified by age and sex
Stages of sample selection - initial sample size calculations were performed assuming a prevalence of approximately 10% for major variables of interest (e.g.diabetes), an ability to ascertain an estimated prevalence within approximately 1% of the true prevalence with a 95% confidence level. These calculations suggested that a total sample size of approximately 2,584 in the target population of 15 to 64 year olds would be sufficient for the purposes of this study
Strategy for absent respondent/not found/refusals (replacement or not) - a reserve list of an additional 250 participants was generated for each age/sex group to replace any of the original participants in that age/sex group who were ineligible to participate in the study (i.e. those not being in the country during the survey or those individuals with physical or mental disabilities or already deceased).
Overall, usable data for STEPS 1-3 were obtained from 2,272 participants, with a total response rate of 89.7%. Of
the 2,272 respondents, 1086 were men and 1186 were women.
Usable data for STEPS 1-3 were obtained from 2,272 participants, with a total response rate of 89.7%. Of
the 2,272 respondents, 1086 were men and 1186 were women.
Since there is no distinction between rural and urban areas in Nauru, and because closely-related families live in clusters (districts) around the island, cluster sampling would introduce potential bias to the survey. A simple random sampling of individuals within each age/sex stratum (with replacement) avoids this problem and was the strategy of choice for Nauru.
A representative sample of 2,272 participants aged between 15 and 64 years from across Nauru was surveyed, with a total response rate of 89.7%. Of the 2,272 respondents in the survey 1086 were males (47.8%) and 1186 were females (52.2%).
Survey instrument
The questionnaires or instrument for the Nauru Steps Survey 2004 were the core questions in the STEPS 1-3 instrument remained unchanged (Bonita et al., 2001). The Step 1 questionnaire was administered in each household, which collected various information on household members including sex, age and time spent in schools. The Step 1 questionnaire includes behaviours measures for tobacco use, alcohol consumption, diet, physical activity, history of high blood pressure, history of diabetes and general well being.
In addition to a Step 1 questionnaire, questionnaires were administered in each selected household for peoples age 15-64.
The Step 2 questionnaire is mainly for Physical measurements and it includes measurements of heights and weights, blood pressure and heart rate.
The Step 3 questionnaire is for women respondents for Biochemical measurements and it includes blood glucose, blood lipids and albuminuria.
The questionnaires were developed in English from the Steps 1-3 instruments model Questionnaires. After an initial review the questionnaires were translated back into English by an independent translator with no prior knowledge of the survey.
The survey team agreed for additional social and or environmental items relating to NCD control and prevention to be included in the STEPS 1 questionnaire. Examples of some optional items include self-reported health status, perceived susceptability to diabetes, perceived barriers or factors that would enhance adoption of a healthy lifestyle.
To investigate the prevalence of kidney disease in Nauru, items measuring the albuminuria level were added to STEP 3 measures, but the results for this are not presented in the report. Survey participants were requested to bring their urine sample in a collection jar provided by the staff when they presented for STEP 3. For those who forgot to bring in their sample, their urine was collected on the day of the visit.
All questionnaires and modules are provided as external resources.
Data collection
| Start | End | Cycle |
|---|---|---|
| 2004-06-01 | 2004-10-31 | Interview-based questionnaire on selected major health risk behaviours |
| 2004-06-01 | 2004-10-31 | Physiological measures of health risks |
| 2004-06-01 | 2004-10-31 | Biochemical measures of health risks |
| Name | Affiliation |
|---|---|
| Republic of Nauru Hospital | Ministry of Health |
| Nauru General Hospital | Ministry of Health |
A survey team comprising a Project Manager, three Team Supervisors, community health nurses, laboratory technicians, data entry personnel
and administrative staff was formed to co-ordinate planning and data collection.
The Nauru-STEPS survey was modeled on the WHO STEPwise approach to surveillance for NCD risk factors.The survey protocol adhered to the concept that surveillance systems require standardized data collection as well as sufficient flexibility to be appropriate in a variety of country situations and settings. This allows for the development of an increasingly comprehensive surveillance system that would be sensitive to local needs. By adopting the same standardized core questions, all countries implementing STEPS can use the information for
examining within-country trends and for between-country comparisons. The basic STEPS approach was designed as a population-wide cross-sectional survey and involved a collection of data on levels of risk factors. Data collection moves along a sequential three-step process as follows:
STEP 1: Interview-based questionnaire on selected major health risk behaviours including smoking, alcohol consumption, fruit and vegetable consumption, and physical activity. Additional issues deemed to be of importance in Nauru include history of high blood pressure, diabetes, selfrated general health, perceived beliefs about diabetes and susceptibility to diabetes, and perceived environmental support for a healthy lifestyle.
STEP 2: Physiological measures of health risks such as blood pressure, body mass and waist girth circumference.
STEP 3: Biochemical measures of health risks including fasting blood glucose and blood lipids.
Substantial consideration was given to the ordering of the three stages of measurement (STEPS 1,2 AND 3). It was agreed that all participants must be provided with the results of their physical assessments and blood tests. The final three-step process required participants to present for the STEP 3 and 2 measurements on one day and then return on the following day or another convenient time to complete STEP 1 and receive the STEP 3 results. This direct benefit from participation was considered very important in Nauru because it is widely felt that previous risk factor studies in the country have had no demonstrable benefit for the population. The reverse ordering of STEPS 3, 2 and 1 proved to be acceptable to participants and an efficient way for staff to conduct the assessments while providing timely feedback to participants of the results of their blood tests and physical assessments.
Survey staff visited the randomly selected participants at their homes to invite them to participate, and if possible, to attend the health clinic (usually on the following day) for the STEPS 3 and 2 measurements. During this home visit, staff provided a verbal description of the STEPS study, together with the written information sheet. Participants were requested to sign a consent form if they wished to take part in the study. The staff then made an appointment time with the participants to present for the STEPS 2 and 3 measurements, explained the fasting protocol (written fasting instructions were also provided) and the importance of fasting properly. Participants were also briefed on clothing requirements for STEP 2 measurements and given a jar for the collection of the urine
sample.
Data processing
Two staff manually double-entered all survey data into EpiInfo 6.04d database. The double data entry process was preceded by a series of data cleaning activities by STEP 1 staff. These activities included identifying and investigating various issues related to ineligible handwriting, duplicate records, data values outside of preset ranges, and inconsistencies between answers to different but related questions. Any inconsistencies noted by the data entry staff were resolved with the STEPS personnel or Team Supervisors before data entry was completed. Data entry was conducted concurrently with data collection.
Data Access
| Is signing of a confidentiality declaration required? | Confidentiality declaration text |
|---|---|
| yes | Confidentiality of respondents is guaranteed by Articles N to NN of the National Statistics Act of [date]. Before being granted access to the dataset, all users have to formally agree: 1. To make no copies of any files or portions of files to which s/he is granted access except those authorized by the data depositor. 2. Not to use any technique in an attempt to learn the identity of any person, establishment, or sampling unit not identified on public use data files. 3. To hold in strictest confidence the identification of any establishment or individual that may be inadvertently revealed in any documents or discussion, or analysis. Such inadvertent identification revealed in her/his analysis will be immediately brought to the attention of the data depositor. |
- Licensed dataset, accessible under specific terms and conditions
Disclaimer and copyrights
Ministry of Health, Nauru World Health Organization. Nauru STEPwise Survey for Non Communicable Diseases Risk Factors (STEPS) 2004,
Ministry of Health, Government of Nauru
Metadata production
DDI_SPC_NRU_2004_STEPS_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Ramrakha Detenamo | Nauru Bureau of Statistics | Documentation of the study |
2019-05-20
Metadata version
Version 1.0 (May 2019)