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Multistage sampling

Article in BMJ (online) · July 2015

DOI: 10.1136/bmj.h4155

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BMJ 2015;351:h4155 doi: 10.1136/bmj.h4155 (Published 31 July 2015)
Endgames
STATISTICAL QUESTION
Multistage sampling
Philip Sedgwick reader in medical statistics and medical education
Institute for Medical and Biomedical Education, St George’s, University of London, London, UK
Researchers investigated the views of the British public on the
National Cancer Registry’s use of personal medical data for
public health research and surveillance without individual
consent. A cross sectional study with a face to face survey was
performed by the Office for National Statistics. Participants
were selected using multistage sampling of adults in the United
Kingdom during March and April 2015. In each month a sample
of postal districts was selected at random, with the probability
of selection proportionate to size. Within each district, a sample
of private households was chosen at random. During March
2762 households were selected with a further 1819 households
in April. At the start of the interview, the interviewer determined
the household composition and selected the respondent from
among all those aged 16 or more. In households with more than
one adult, one person was selected at random. If the person
selected was unavailable or declined to be interviewed it was
recorded as a non-response. Face to face interviews were carried
out with 1703 (62%) adults in March and 1252 (69%) adults in
April. The data were combined for analysis.1
Of the 2955 respondents, 72% (95% confidence interval 70%
to 74%) did not consider any of the following to be an invasion
of their privacy by the National Cancer Registry: inclusion of
postcode, inclusion of name and address, and the receipt of a
letter inviting them to a research study on the basis of inclusion
in the registry. It was concluded that most of the British public
considers the confidential use of personal, identifiable patient
information by the National Cancer Registry for the purposes
of public health research and surveillance not to be an invasion
of privacy.
Which of the following statements, if any, are true?
a) The sampling technique constituted a multistage sampling
method with three stages
b) Multistage sampling meant that resources could be
concentrated in a limited number of areas of the country
c) By definition, multistage sampling constitutes probability
sampling
Answers
Statements a, b, and c are all true.
Correspondence to: P Sedgwick p.sedgwick@sgul.ac.uk
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Page 1 of 2
ENDGAMES
The aim of the study was to seek the views of the British public
on the use of personal medical data by the National Cancer
Registry for the purposes of public health research and
surveillance without individual consent. A cross sectional study
design, described in a previous question,2 was used. Cross
sectional studies are observational in design; the investigators
do not intervene in any way but simply record the health,
behaviour, attitudes, or lifestyle choices of the study participants.
As the name suggests, the purpose of using a cross sectional
study design is to obtain a representative sample by taking a
cross section of the population. The sample in the above study
was obtained using multistage sampling of adults in the UK.
The study was run in two successive months, and a different
sample was obtained in each month.
Multistage sampling entails two or more stages of random
sampling based on the hierarchical structure of natural clusters
within the population. Clusters are natural groupings of
people—for example, electoral wards, general practices, schools,
or households. A different type of cluster is randomly sampled
at each stage, with the clusters nested within each other at
successive stages. The final stage of sampling involves choosing
a random sample of people in the clusters selected at the
penultimate stage. Multistage sampling methods can be used to
recruit participants in experimental or observational studies.
In the above study, the sample was obtained using multistage
sampling with three stages (a is true). The first stage involved
a random sample of postal districts in the UK, with the
probability of selection proportionate to size. Therefore, postal
districts with a greater number of households had a larger
probability of selection. In the second stage, a random sample
of households nested within the selected postal districts was
obtained. At the final stage, an adult was selected at random
within each household and invited to take part in the study. The
postal districts are referred to as the first stage units, the
households as the second stage units, and the adults living within
the households as the third stage units. It would have been
necessary to construct a sampling frame of postal districts—a
list of all postal districts in the UK—and then sampling frames
listing all private households in each selected postal district.
The researchers did not indicate how many postal districts were
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 BMJ 2015;351:h4155 doi: 10.1136/bmj.h4155 (Published 31 July 2015)
selected at the first stage, although the number would have been
fixed in advance.
Multistage sampling was used in preference to simple random
sampling because the population was geographically diverse.
Simple random sampling would have involved obtaining a
random sample of a fixed size from a sampling frame—a list
of all adults in the UK population. Each adult in the population
would have had the same probability of selection. However, it
would have been impractical and too expensive to survey such
a sample because the UK population is geographically diverse.
Multistage sampling meant that resources and efforts could be
concentrated in a limited number of areas of the country, because
the sampling of households was undertaken only in those postal
districts selected at the first stage (b is true).
Multistage sampling and cluster sampling are often confused.
As described above, multistage sampling is based on the
hierarchical structure of natural clusters within the population.
A different type of cluster is randomly sampled at each stage,
with the clusters nested within each other at successive stages.
The final stage of sampling is to choose a random sample of
people in the clusters selected at the penultimate stage. Cluster
sampling, described in a previous question,3 involves a random
sample of clusters from the population. All those people in the
selected clusters are then invited to be in the sample. Cluster
sampling does not involve successive stages of sampling based
on the hierarchical structure of natural clusters in the population.
Cluster sampling can be time consuming, expensive, and
impractical, not least because the clusters will be geographically
diverse. Therefore, cluster sampling sometimes uses a random
sample of clusters from a conveniently selected geographical
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ENDGAMES
region in the population. Cluster sampling is sometimes
combined with stratified sampling, whereby a fixed number of
clusters are selected at random from a stratum within the
population. The strata are often based on, for example,
geographical regions or age groups. An example is given in a
previous question.4
Two types of sampling methods can be used to recruit
participants to a study—random sampling (sometimes called
probability sampling) and non-random sampling (sometimes
called non-probability sampling). Random sampling involves
some form of random selection of the population members.
Simple random sampling (sometimes referred to simply as
random sampling), described above, is the most straightforward
type of probability sampling. By definition, multistage sampling
constitutes probability sampling (c is true). As described above,
multistage sampling entails two or more stages of random
sampling based on the hierarchical structure of natural clusters
within the population. The final stage of sampling involves
choosing a random sample of people in the clusters selected at
the penultimate stage.
Competing interests: None declared.
1 Barrett G, Cassell JA, Peacock JL, Coleman MP. National survey of British public’s views
on use of identifiable medical data by the National Cancer Registry. BMJ 2006;332:1068.
2 Sedgwick P. Cross sectional studies: advantages and disadvantages. BMJ
3
2014;348:g2276.
Sedgwick P. Cluster sampling. BMJ 2014;348:g1215.
4 Sedgwick P. Stratified cluster sampling. BMJ 2013;347:f7016.
Cite this as: BMJ 2015;351:h4155
© BMJ Publishing Group Ltd 2015
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