Iran Occupational Health

Abstract

Background and aim: The lack continuous and correct use of this equipment causes many respiratory problems. Hence, providing safety educations by using the models identifying and strengthening the effective factors is an essential. Thus, this study was conducted to evaluate the effect of educational intervention based on the theory of planned behavior on the use of masks in the Isfahan Atlas Flour Factory workers.

Nowadays, respiratory diseases caused by work can be prevented to a large extent. Excessive exposure to respiratory dust is one of the most common environmental hazards in the workshops, which can have a harmful impact on the health of workers. Excessive exposure to this group of contaminants causes irritation and discomfort of the respiratory system, and in some cases, it causes disabling and malignant diseases such as lung cancer. There is no accurate estimate of the burden of lung disease caused in workplace in the world. Limited estimates reported on the burden of work-related diseases suggest that the respiratory disease is among the most common job diseases with a contribution of 14.1%. Accordingly, timely identification of respiratory symptoms in workplace and their proper management can play major role in reducing worker-related diseases and death of workers. Studies suggest that most of chronic respiratory diseases, which occur often due to the negligence and ignorance, lack of knowledge, and unsafe behaviors of workers, can be prevented by simple measures such as using mask during work. Flour dust is one of the factors involved in chronic respiratory diseases in the workplace. A large number of workers in various jobs such as flour industries, silo workers, bakers and workers of confectionery industry, are exposed to flour dust and this dust can cause respiratory asthma in airways and other lung illnesses. The results of some studies have indicated that exposure to flour dust increases the susceptibility of people to these diseases and causes allergy in the eyes, nose, and airways of the respiratory system.

Respiratory equipment is considered as the last solution for respiratory protection against workplace contaminations. However, studies suggest that most workers do not use this equipment properly and continuously. It should be noted that the use of personal respiratory protection equipment is not adequate, but they should be also used properly. Thus, it is necessary to explain the factors affecting the use of respiratory masks, especially in flour industry workers, using appropriate models and theories. One of these comprehensive models used to explain and change the health-promoting behaviors is the theory of planned behavior. Based on this theory, behavior related to human health is based on their intention to perform it. Behavioral intention is affected by attitudes, normative beliefsand perceived behavioral control. Attitude is a negative or positive personal evaluation on performing a behavior.

The normative beliefs are based on the fact that individuals are influenced by different people in society. Perceived behavioral control shows that to what extent a person feels that his behavior is under his voluntary control.

Despite its predictive value, this theory has been used very limitedly in explaining and even changing the preventive behaviors in terms of safety and safe behaviors related to workplace among workers. In general, limited number of studies has evaluated the impact of educational interventions on changing flout industry workers' behaviors on increasing the use of respiratory protective equipment. As effectiveness of the theory-based educational interventions in the job health and safety area has been proven, the objective of this study was to evaluate the effect of educational intervention based on the theory of planned behavior on the use of respiratory protection equipment.

Methods

This quasi-experimental study was conducted on all workers of Isfahan Flour Atlas Factory in 2017. Using census method, 50 workers were assigned into two work shifts (each contained 25 workers). One shift was randomly selected as the intervention group and the other shift was selected as control group. A researcher-developed questionnaire was used to collect the data. The questionnaire was developed based on a previous studies' questionnaire. The tools for assessing the questionnaire information included 7 demographic questions (age, employment history, marital status, educational level, monthly income level and two questions about respiratory problems and educations received before on respiratory diseases). The questions of the theory of planning behavior structure include the indirect assessment of attitude structures (9 questions of behavioral beliefs and 9 questions of evaluation of the outcomes), normative beliefs (8 questions of normative beliefs and 8 questions of adherence motivation), perceived behavioral control (13 questions of control beliefs, 13 questions on the effect of control beliefs), and behavioral intention (2 questions: One question on previous behavior of the use of a protective mask and one question of the behavior of use in next month).

Validity of the questionnaire was analyzed by a panel of experts, included a set of health experts, health education expert and psychologist. After calculating the content validity ratio (CVR) at an acceptable range of 0.75-1, content validity index (CVI) was calculated 0.81. To determine the reliability of the questionnaire before the study, 20 staff members randomly completed the questionnaire. The Cronbach's alpha coefficient was calculated 0.873 for the entire structures. For each section, it was calculated as follows: behavioral beliefs 0.810, evaluation of outcomes 0.918, normative beliefs 0.735, adherence motivation 0.842, control 0.774, and the effect of control beliefs 0.924. At the beginning of the study, participants were invited to participate in the research project in different parts of the factory. After informing about the goals and obtaining their consent, they entered the project. The first stage of the questionnaires was completed by the two groups. After obtaining information from pre-test questionnaires, educational sessions were designed and educational interventions were provided for 2 months, 4 sessions per hour (15 days each) for the participants of the intervention group.  The aim of these sessions was to provide knowledge for workers with respiratory diseases caused by lack of using of masks, behavior of continuous use of masks, as well as increased behavioral beliefs, normative beliefs, adherence motivation, and reduced control beliefs. For this purpose, various teaching methods such as lectures, group discussions, brainstorming, practical presentation, role play, and the invitation of relevant professionals as well as teaching aids (boards, slideshows, booklets, pamphlets, posters and educational laminates) were used.

The educational sessions was provided in this way: in the first session, s definition was provided on heath and one's mission in maintaining the heath and protective strategies against the most common respiratory diseases in flour companies with the aim of increasing the behavioral beliefs to maintain personal health and self-care against respiratory problems.  The second session was provided with the aim of stabilizing the positive attitude and increase the behavioral beliefs of using masks and reducing control beliefs about not using the mask by inviting the physician and lecturing on the respiratory diseases and the complications of not using respiratory mask and the emergence of job-related respiratory diseases, and symptoms of these diseases.  The third session was provided with a focus on subjective norms and with the aim of identifying the role of key people in maintaining health and creating a healthy environment at work. In this session, the role of a professional health experts and safety officer as an important contributor to the health and safety of people was explained.   In this session, all participants were involved in the subject by holding a group discussion. In this session, the use of various respiratory masks used by the personnel of various units was trained using slideshows for the workers. In addition, the way of using it was displayed for them.  In the fourth session, all the contents of the 3 previous sessions were reviewed. In this session, questions and answers were given to the group to discuss on all the questions in group. After completing the questionnaires, the data were entered into the software and analyzed using independent t-test, Fisher, Mann-Whitney, ANOVA and Chi-square tests.

Results: The results also showed that there was no significant difference between the two groups in the mean of the scores of TPB constructs . there was a significant difference in all the TPB variables between the two groups (after intervention, P < 0.001).

of statistical observation and recording of observational behaviors showed that there was a significant increase in the use of mask in the intervention group immediately (P = 0.02) and 3 months after the intervention (P = 0.04). Also, all the structures of the planning behavior  theory ()In the intervention group, it increased in two periods. (P >0/05)

Conclusion:

 The results of this study showed that educational intervention based on the theory of planned behavior was effective in improving the behavior of using masks. Therefore, using this model is recommended for creating safe behaviors.

The results of this study revealed that providing educational intervention based on the model of planned behavior caused change in behavioral beliefs structures and evaluation of outcomes, normative beliefs, adherence motivation, control beliefs and its impact on the behavior of using masks in the intervention group. Based on the results of this study, it can be concluded that intervention in the form of planned behavior is effective in behavior of using the mask. Given the high density of flour particles in air of some parts, clinical examinations of workers are recommended to identify and treat patients with respiratory tract infections as soon as possible. In order to provide appropriate health conditions in workplace to protect the health of workers, flour factory owners are recommended to use proper ventilation systems, to oblige workers to use respiratory masks and periodic measurements of inhaled particles by plant officials. These measures can play major role in reducing respiratory diseases. 

Keywords:

worker, mask, educational intervention, planned behavior model