printable version

STEPS conceptual framework

The STEPS approach focuses on obtaining core data, at each level, on the established risk
factors that determine the major disease burden. It is sufficiently flexible to allow each country to
expand on the core variables and risk factors, and to incorporate optional modules related to local
or regional interests.
:: View the Instrument at a Glance [pdf 27kb]
A good illustration of the conceptual framework underlying STEPS is available in the Instrument
at a Glance.
Step 1- Questionnaire-based assessment

The STEPS approach has three levels and within each level, risk factor assessment is divided
into core, expanded, and optional modules. Step 1 contains as the core or “minimum set”, self-
report measures that all countries should obtain. In addition to socio-economic data, data on
tobacco and alcohol use, some measure of nutritional status and physical inactivity are included
as markers of current and future health status. Standard WHO definitions for measuring the
prevalence of tobacco use and alcohol consumption and internationally derived measures of
physical activity are recommended. The information can be used not only for within-country
trends, but also for comparisons across countries. The questionnaires used in the core data set
are simple and few in number and are not intended to give a complete picture of each behaviour
but rather to provide information on the population distribution of risk.
Step 2- Simple physical measurements

Step 2 adds to Step 1 by the inclusion of simple physical measurements, such as height, weight,
waist circumference, and blood pressure. Step 1 and Step 2 are desirable and appropriate for
most developing countries.
Step 3- Biochemical Measurements

Step 3 includes Steps 1 and 2 and adds biochemical measurements. All the core items from
Steps 1 and 2 can be readily assessed and are not made more complex if the expanded items
are added. However, additional information at Step 3 is of a biochemical nature and requires
access to the appropriate standardized laboratories. Collecting and analysing blood samples is a
relatively complex process and can be done only in the context of a comprehensive survey and in
settings where appropriate resources are available. The addition of Step 3 can increase the cost
and complexity of data collection.