BACKGROUND: The U.S.-Affiliated Pacific Islands (USAPIs) are island territories and independent nations with small populations and limited surveillance capacity. These islands suffer from some of the highest burdens of chronic disease in the world, health disparities among native populations, and low life expectancies. Quality surveillance data on adult chronic diseases is severely constrained due to inconsistent surveys supported by multiple partners, limited resources, and low epidemiological capacity. We designed and implemented a novel chronic disease survey known as a “hybrid” survey due to the fact that it uses indicators, survey questions, and funding from multiple partners while utilizing local resources and building staff capacity to create a sustainable adult chronic disease surveillance system.
METHODS: The first pilot survey using this strategy was conducted in the Commonwealth of the Northern Mariana Islands (CNMI), a territory with no baseline adult chronic disease data. Multiple agencies within CNMI, as well as external domestic and international partners worked together to develop a hybrid survey tool that met CNMI’s chronic disease and risk factor data reporting needs. Households were identified at random according to geographical stratification on four levels. The Kish Selection Method, which uses a pre-assigned table of random numbers to identify the person be interviewed, was used to randomly select one adult from each household to participate in the survey. All surveyors completed a one-week training course. These trained surveyors conducted a face-to-face survey, as well as collected physical and biochemical measures on all participants.
RESULTS: Data were collected from February to April 2016 throughout CNMI. A total of 1091 surveys were completed (3% of the total adult population). The response rate from the original sample was 94.1%. Data were analyzed and disseminated by October 2016, and remain the property of the Division of Public Health within the Commonwealth Healthcare Corporation of CNMI. Data collected are comparable to those available for the U.S. and Guam, supporting the validity of this methodology.
CONCLUSIONS: This was the first pilot of a chronic disease hybrid survey in which multiple partners worked together to collect all necessary data for adult chronic disease and risk factor surveillance with one survey. This serves a sustainable model for ongoing data collection through its use of local resources and capacity building. This chronic disease hybrid survey may be useful to other small resource-limited populations that also struggle with chronic disease surveillance.