The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities

Am J Public Health. 2016 Jan;106(1):74-8. doi: 10.2105/AJPH.2015.302962.


Objectives: We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance.

Methods: STEPS is a WHO-developed, standardized but flexible framework for countries to monitor the main NCD risk factors through questionnaire assessment and physical and biochemical measurements. It is coordinated by national authorities of the implementing country. The STEPS surveys are generally household-based and interviewer-administered, with scientifically selected samples of around 5000 participants.

Results: To date, 122 countries across all 6 WHO regions have completed data collection for STEPS or STEPS-aligned surveys.

Conclusions: STEPS data are being used to inform NCD policies and track risk-factor trends. Future priorities include strengthening these linkages from data to action on NCDs at the country level, and continuing to develop STEPS' capacities to enable a regular and continuous cycle of risk-factor surveillance worldwide.

MeSH terms

  • Chronic Disease / epidemiology*
  • Chronic Disease / prevention & control
  • Cluster Analysis
  • Data Interpretation, Statistical
  • Global Health*
  • Health Plan Implementation / methods
  • Health Plan Implementation / organization & administration
  • Health Plan Implementation / statistics & numerical data
  • Humans
  • Population Surveillance / methods*
  • Risk Factors
  • Sampling Studies
  • World Health Organization*