Open Access Open Badges Study protocol

Protocol for a national, mixed-methods knowledge, attitudes and practices survey on non-communicable diseases

Alessandro R Demaio1*, Otgontuya Dugee2, Gombodorj Amgalan2, Elena Maximenco3, Adiya Munkhtaivan4, Silke Graeser3, Tine Kryger1, Janchiv Oyunbileg2, Pekka Jousilahti5, Maximilian De Courten1 and Palam Enkhtuya2

Author Affiliations

1 Copenhagen School of Global Health, University of Copenhagen, Copenhagen, Denmark

2 Public Health Institute, Ministry of Health, Ulaanbaatar, Mongolia

3 EPOS Health Management, MCA-Mongolia Health Project, Ulaanbaatar, Mongolia

4 Millennium Challenge Account, Mongolia Health Project, Ulaanbaatar, Mongolia

5 National Institute for Health and Welfare, Helsinki, Finland

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BMC Public Health 2011, 11:961  doi:10.1186/1471-2458-11-961

Published: 30 December 2011



Mongolia is undergoing rapid epidemiological transition with increasing urbanisation and economic development. The lifestyle and health of Mongolians are changing as a result, shown by the 2005 and 2009 STEPS surveys (World Health Organization's STEPwise Approach to Chronic Disease Risk Factor Surveillance) that described a growing burden of Non-Communicable Diseases and injuries (NCDs).

This study aimed to assess, describe and explore the knowledge, attitudes and practices of the Mongolian adult population around NCDs in order to better understand the drivers and therefore develop more appropriate solutions to this growing disease burden. In addition, it aimed to provide data for the evaluation of current public health programs and to assist in building effective, evidence-based health policy.


This national survey consisted of both quantitative and qualitative methods. A quantitative household-based questionnaire was conducted using a nationally representative sample of 3854 rural and urban households. Participants were selected using a multi-stage cluster sampling technique in 42 regions across Mongolia, including rural and urban sites. Permanent residents of sampled households were eligible for recruitment, if aged between 15-64 years. This quantitative arm was then complemented and triangulated with a qualitative component: twelve focus group discussions focusing on diet, exercise and alcohol consumption. Discussions took place in six sites across the country, facilitated by local, trained health workers. These six sites were chosen to reflect major Mongolian cultural and social groups.


KAP surveys are well represented in the literature, but studies that aim to explore the knowledge, attitudes and practices of a population around NCDs remain scarce. This is despite the growing number of national epidemiological surveys, such as STEPS, which aim to quantify the burden of these diseases but do not explore the level of population-based awareness, understanding, risk-perception and possible motivation for change. Therefore this paper will contribute to building a knowledge base of NCD KAP survey methodology for future use in epidemiology and research worldwide.

Non-Communicable Diseases; KAP survey; Knowledge; Attitudes; Mongolia; Injuries