Iran Occupational Health

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Abstract
Background and aims: Workers are considered the productive force (power) of the society who besides their families account for about one-third of the population. One of the most important factors in increasing productivity and sustainability depends on improving the quality of workforce. This can be achieved by raising the level of workforces’ health and hygiene. Proper health servics would promote public health and increase the potential and actual capabilities of the workforce, and a healthier workforce will contribute more to increased production and economic growth. Workers' health house for workplaces of 50 to 500 people provide an opportunity to promote health in the workplaces. The designed model includes three packages of healthy lifestyle training, evaluation of working lifestyle, management of results and employer's health-centered initiatives, provided by a person called Behban (means health- keeper) at workplace. The purpose of this study is to evaluate the pattern of health promotion in the workplace in order to improve the lifestyle and health of workers and increase productivity.
Methods: The study is carried out in Qazvin province through a case-control method. The effectiveness of workers' health promotion model was evaluated for three intervention packages before and after their implementation in selected workplaces from Abyek (as case) and selected workplaces from Alborz city (as control). At first, 15 work environments were randomly selected from each city for the study. However, workplaces with a small number of workers (less than 50 people), and those which their employers or workers were not satisfied to participate in the study, as well as the workplaces with economic problems were excluded from the study. Having said that, 11 industrial workplaces from Abyek and 10 workplaces from Alborz were included in the study.
In order to carry out the intervention, a responsible person named Behban was selected from each of the industrial units of the case city. A training and orientation workshop was held for the Behbans on how to implement the three service packages of healthy lifestyle training, evaluation of workers' lifestyle and management of results and health-oriented actions of the employer. Also, educational resources including booklets, brochures and educational slides were provided to them after the workshop. In fact, Behban was tasked with educating each staff member about a healthy lifestyle for 20 hours, evaluating and recording each person's health status, and helping the employer create a healthier environment. For the control city, only health interventions continued as usual through the Occupational Health House.
Information about the health literacy of workers in industrial environments, access to and use of existing services, satisfaction with services as well as social support (employer performance related to employees’ health), was collected before and after the intervention, using a questionnaire designed by researchers.  
 
Results: Access to health home after the intervention increased significantly compared to before the intervention (63.6 vs. 50.7, P = 0.001), while this index did not show a significant difference in the control group before and after the intervention (55.1 vs. 62, p = 0.7). Satisfaction with occupational health home health education services in the intervention group increased significantly after the intervention compared to before the intervention (86.8 vs. 63.3, P = 0.001), but there was no significant change in the size of this index in the control group (65.6 vs. 70, P = 0.5).
Satisfaction with the service of referral to a physician and its follow-up by the health house in the intervention group after the intervention increased significantly (78.2 vs. 66.4, p = 0.01). This index in the control group, had no significant change (84.6 vs. 79, p = 0.2). The mean score of social support in the intervention group increased significantly after the intervention compared to before (13.4 vs. 12.2, p = 0.03), while there was no significant change in this index in the control group. (11.9 vs. 12.6, p = 0.08). So, the results show that this model has been able to significantly improve health literacy, satisfaction with basic services including health screening, and feeling of social support in workers (resulting from employer-centered health measures).
Conclusion: The results of this study can be applied to a national model by the Ministry of Labor and Social Welfare and the Ministry of Health and Medical Education. Implementation challenges of this model need to address the low motivation of employers in adverse economic conditions, Behbans' part-time employment, as well as the number of counseling and health units in workplaces with stewardship of different systems (parallel working). Given the undeniable impact of the six macro factors include; political, economic, social, technological, environmental and international on the situation of economic enterprises and consequently the health of workers, it is necessary to simultaneously seek support for priority issues such as improving economic conditions and social capital in the country's highest institutions.

Keywords: Workplace, health promotion, Occupational Health

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