STEPwise Approach to Non-Communicable Diseases Risk Factor Surveillance 2009-2010

The research physicians and field interviewers underwent a four day extensive training in Shaheed Suhrawardy Medical College Hospital (ShSMCH) on questionnaire, interview technique, physical measurement and blood pressure measurement,17 way of supervision and others. Training on physical measurement and blood pressure measurement was extensive to ensure minimal inter observer variation and to increase validity. All the investigators, personnel from health directorate, WHO and Director of ShSMCH and Principal of the medical college were involved in the training process. It is important to mention here that the interviewers were involved in the recently completed GATS. Therefore they already had acquaintance with PSUs and SSUs. Only the sampling of households is newly done to avoid or minimize repeat selections. Only the research physicians were new addition to the field team.

Mapping listing, trained manpower and IT equipments including PDAs of GATS were used in this study.

Data were collected by nine field teams. Each team consisted of one research physician, two women and two men interviewers. Interviewers had at least a bachelor's degree. There was one IT personnel to assist the data collection. All the interviewers and research physicians were specially hired, taking into account their educational background, experience, computer skills and other relevant qualifications. There were total of 36 interviewers for data collection. Equal number of men (18) and women (18) interviewers were recruited to ensure the cultural sensitivity and quality of reporting by ensuring that women respondents were interviewed by women interviewers and men respondents by men interviewers.

Field interviewers were responsible for data collection on questionnaires using handheld devices (iPAQ). Research physicians were responsible for the overall operation of the field team. In addition research physicians conducted spot checks to verify information collected by interviewers and also to ensure the accuracy of household identification in the field as well as ensuring the measurement taken by the interviewers. Research physician also checked blood pressure of four respondents measured by four interviewers randomly and wherever necessary for validation of the data collection. Research physicians were also responsible for aggregation of the individual-level data to their laptops and forwarding the information through email to the National Data Center through secured system to a file transfer protocol (FTP) server on daily basis, IT personnel were responsible for providing technical support with respect to the concerns raised during fieldwork and trouble-shooting any issues with the handheld devices.

Both formative and global assessments by the quality control (QC) personnel were done. None of the nine QC observers reported any violation of SOP in measurement and data collection. The overall rating of interviewer's conduct and performance was found to be satisfactory based on indicators, behavior of interviewer, mode of measurement, maintenances of interview environment and mode of administration of the questionnaire.

Ethical consideration
First of all, ethical clearance was obtained from the ethical committee of Bangladesh Medical Research Council (BMRC). The study was conducted maintaining all possible ethical considerations. Before data collection informed written consent of the study subject was obtained inconformity with the revised declaration of Helsinki. Detailed study related information was read out and explained in the local language from a printed handout. Informed consent form contained objectives and methods of the study, duration and frequency, clinical examination, risks and benefits of the study. Consent was taken in Bengali and interview was also conducted in Bengali. Finger impression was obtained from participants, who do not know how to sign. The respondents had a right to refuse to answer any question without providing the reason for their decisions and could withdraw from the study at any time. The information was dealt with highest confidentiality and used only for this study. Privacy of the respondents was maintained during data collection.