Shirin Djalalinia
1,2 
, Sina Azadnajafabad
1 , Erfan Ghasemi
1 , Moein Yoosefi
1 , Negar Rezaei
1,3 , Yosef Farzi
1 , Ameneh Kazemi
1, Naser Ahmadi
1 , Maryam Nasserinejad
1,4 , Nima Fattahi
1 , Shahabeddin Rezaei
1,5, Elham Abdolhamidi
1, Elmira Foroutan Mehr
1, Rosa Haghshenas
1, Nazila Rezaei
1, Jaleh Abdi
6, Alireza Moghisi
7, Alireza Mahdavihezaveh
7, Ali Akbari Sari
6,8, Alireza Raeisi
7,9, Hamidreza Jamshidi
10, Bagher Larijani
3, Farshad Farzadfar
1,3* 1 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
3 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Ohio State University, Columbus, OH, USA
6 National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
7 Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
8 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
9 School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
10 Research Institute for Endocrine Sciences, School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.
Methods: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.
Results: By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.
Conclusion: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.