Feasibility of Innovative Tools and Methods to Improve Household Surveys in Complex Urban Settings: Multiple Methods Analysis of the Surveys for Urban Equity (SUE) Study in Kathmandu, Dhaka and Hanoi

Background: The methods used in low- and middle-income country (LMIC) household surveys have not changed in four decades; however, LMIC societies have changed substantially. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi, and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. Methods: We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. Findings: We found that a common household definition excluded single adult (46.9%) and migrant headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying (14.3%) adults. Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative one-stage design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. Interpretation: This evidence of unintentional exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning, and underscores the need to modernize survey methods and practices. Funding: UK Medical Research Council and UK Economic and Social Research Council. Declaration of Interest: All authors declare no conflicts of interest. Ethical Approval: Ethics approvals were obtained from the University of Leeds (ref:MREC16-137), University of Southampton (ref:26819), Nepal Health Research Council (ref:1761), Bangladesh Medical Research Council (ref:BMRC/NREC/RP/2016-2019/317), and Hanoi University of Public Health (ref:324/2017/YTCC-HD3).