Iran Occupational Health Journal

fa شناسایی و رتبه بندی راهکارهای ارتقای رفتار بهداشت حرفه ای در بین کشاورزان Identification and ranking of approaches to promote occupational health behavior among farmers ایمنی Safety پژوهشي Research زمینه و هدف: کشاورزی بهعنوان یکی از خطرناکترین صنایع در سراسر جهان شناخته شده و با خطرات نسبتا زیاد آسیب، ناتوانی و مرگ همراه است. با توجه به اهمیت رفتار در بروز حوادث و آسیبهای ناشی از کار، جهت پیشگیری و کاهش حوادث و جراحات باید روی رفتارهای افراد متمرکز شد. زیرا اقدامات پیشگیرانه قبل از بروز آسیب و جراحات در مرحله قبل از رویداد، بیشترین توانایی را برای کاهش آنها دارد که از جمله اقدامات پیشگیرانه میتوان به ارائه راهکارهای ارتقادهندهی رفتار اشاره کرد. لذا هدف این تحقیق، شناسایی و رتبهبندی راهکارهای ارتقای رفتار بهداشت حرفهای کشاورزان میباشد. روش بررسی: مطالعه حاضر یک پژوهش ترکیبی (کیفی- کمی) از نوع متوالی اکتشافی بود که در بازه زمانی تیرماه 1395 تا آبان ماه 1397 انجام پذیرفت. در بخش کیفی از روش تحلیل محتوا استفاده گردید. مشارکت کنندگان در این بخش شامل 47 نفر (اعضای هیأت علمی، کشاورزان نمونه، کارشناسان جهاد کشاورزی و بهداشت حرفهای استان کرمانشاه) بودند که از طریق نمونهگیری هدفمند و نظری انتخاب شدند. دادهها با استفاده از مصاحبه عمیق جمعآوری گردید و از طریق کدگذاری مورد تجزیه و تحلیل قرار گرفتند. در بخش کمی جامعه آماری شامل 14 نفر (اعضای هیأت علمی، بهورز خانه بهداشت، کارشناسان جهاد کشاورزی و بهداشت حرفهای استان کرمانشاه) بود و از طریق نمونهگیری هدفمند و نظری انتخاب شدند. از پرسشنامه جهت گردآوری دادهها استفاده گردید. بهمنظور بررسی روایی کیفی محتوایی و صوری از چهار نفر از متخصصان درخواست گردید که پرسشنامه را مطالعه و نظرات خود را بیان نمایند. پس از جمعآوری ارزیابی متخصصین، تغییرات لازم در ابزار اعمال شد. بهمنظور بررسی پایایی پرسشنامه، از نرخ ناسازگاری که روش رایج در سنجش پایایی در تحلیل سلسله مراتبی است بهره گرفته شد. نرخ ناسازگاری قضاوتها در رتبهبندی زوجی تا 1/0 قابل قبول می‌باشد که این مقدار برای پرسشنامه 02/0 بود. برای آنالیز دادهها از نرم افزار SPSS نسخه 16، Expert Choice11 و آزمونهای آماری مناسب بهره گرفته شد.   یافتهها: براساس یافتههای حاصل از این مطالعه شش راهکار "آموزش"، "الزامات ایمنی تولید کنندگان ادوات و نهادهها"، "حمایت و پشتیبانی"، "اطلاعرسانی و رسانهای"، "تعاملات و ارتباطات سازمانی" و"ارزیابی و نظارت" در زمینه ارتقای رفتار بهداشت حرفهای کشاورزی استخراج گردید. از نظر متخصصان، راهکار آموزش در رتبه اول و راهکار رسانهای و اطلاعرسانی در رتبه آخر قرار گرفت. نتیجه گیری: نتایج تحقیق بیانگر این است که راهکارهای متعددی در زمینه ارتقای رفتار بهداشت حرفهای کشاورزی وجود دارد که باید در سطح کلان و در برنامهریزیهای میان مدت و بلندمدت در نظر گرفته شود و مورد اجرا قرار گیرد. همچنین، همه نهادها و ارگانها که به نوعی با صنعت کشاورزی یا با کشاورزان در ارتباط هستند، باید خود را متولی ارتقای بهداشت حرفهای در میان این قشر بدانند، چون ارتقای این امر مهم، نیازمند رهیافتها و همکاریهای چندگانهای است. بنابراین با توجه به گستردگی و پراکندگی مزارع کشاورزی، تعداد و تنوع کشاورزان شاغل (سن، جنس، سواد و...) در این بخش، واحد ترویج کشاورزی و یا بهداشت حرفهای بهتنهایی قادر به ارتقای رفتار بهداشت حرفهای و یا سایر مباحث مربوط به بهداشت حرفهای در میان کشاورزان نخواهد بود. و دستیابی به هدف مهم ارتقای بهداشت حرفهای در میان کشاورزان، نیازمند تعامل و همکاری تولیدکنندگان ادوات و نهادهها، ارگانها و نهادهای مربوطه میباشد. Background and Aims: Agriculture is the most important and essential part of providing human needs. The imagination of developed world is not possible without agriculture. Agriculture is one of the main sources of employment and income generation in many countries, especially in developing countries and in this regard is responsible for providing food security and safety as a national target. But, in order to achieve this goal, farmers must be healthy. That's while agriculture is known as a high-risk sector all around the world and farmers are exposed to a wide range of occupational hazards by doing hard work. Agricultural injuries are reported from all around the world. Of a total of 335,000 work-related incidents worldwide about 170,000 deaths happen among agricultural workers per year. Occupational disease is particularly relevant to agriculture and has an incidence rate similar to that of other sectors. In Iran, in spite of the importance of agricultural areas and the agricultural workforce, there are not enough statistics about injuries and work-related accidents in this sector and limited epidemiologic research has evaluated the health status and potential occupational hazards among farm workers and most of farmers are not covered by occupational health. So farmers are faced with many challenges in relation to agricultural occupational health. Among the many factors that cause accidents and injuries, behavior has been identified as one of the most important factors. In other mean, Behavior has been identified as the most important factor that cause accidents and injuries and which, in turn, has an important role in reducing exposure to work-related damage. So, considering the importance of behaviors in accidents and work-related injuries, to prevent and reduce accidents and injuries, the focus on individual behaviors is necessary. Because preventive activities before hurt and injuries have the greatest ability to reduce them. Strategies for promoting behavior is one of the preventive activities. Investigated show that, so far, no study has been done about improving the occupational health behaviors among Iranian farmers. So the purpose of this research is to identify and rank approaches for promoting farmers’ occupational health behaviors. Methods: The study was conducted based on a mixed method (qualitative-quantitative) approach. It was conducted between July 2016 to November 2018. In qualitative section content analysis method was used. The study population in this part included faculty members of agricultural science and occupational health of medical science, agriculture experts, occupational health experts, and the farmers. This study used purposive and snowball sampling methods to select the sample. At the beginning of the sampling, a number of experts were selected purposefully and then they were asked to introduce other people who had enough information in this field to participate in interview. The data from the interview reached saturation through in-depth individual interviews with 47 participants. All the participants of the study were interviewed by a trained researcher who conducted the interviews on their farms or in their residences in Kermanshah province in western Iran. Data were gathered through in-depth interviews, observations and group discussion. Unstructured interviews were performed with follow-up questions with group discussion until “reaching saturation”. Also, Coding technique was used for analyzing the data. To this end, the transcribed interviews were studied and analyzed after each interview session. Then, data coding procedure was performed. To have open coding, texts relevant to each interview were carefully studied line by line and elements containing a point related to the main research question were identified and labeled with the same theme. The output was extracted themes related to the subject of the study. Then, the resulting themes were carefully examined and compared in terms of similarities and differences. After that, themes of the same nature or with relevant meaning were classified as categories. After identifying the categories, their features and aspects were specified to thoroughly distinguish them from each other and to determine their exact nature. In the next step, the main categories and sub-categories were linked. In order to ensure reliability and validity in quantitative research, prolonged contact with the participants was used for gathering and analyzing data. Also, multiple methods were used for gathering data. The coded interviews were reviewed. After coding the interviews, part of it was returned to participants to ensure implementation of the codes with their experiences. In this research, intended to do the sampling with the greatest diversity. To ensure consistency in the process of analyzing data, some colleagues were asked to review and revise the codes. The text of interviews, codes and categories gathered were sent to people familiar with qualitative research for investigation and their opinions about the validity of the analysis and interpretations were obtained. Also, when coding each interview, we investigated previous coded data. To increase generalizability, the researchers tried detailed descriptions and meaningful research process to provide follow-up research process to others. The quantitative research section of this study, in order to select the best strategies and determine the importance and weight of each of the strategies, and finally rank them, among the methods (coefficient of variation, Mean Rank, Friedman test, Hierarchical analysis, etc.) are used for ranking, Analytical Hierarchy process was selected. Hierarchical analysis is the most suitable method for comparing paired ratings. This method helps decision makers to combine group members' decisions with each other so that optimal decision-making involves the opinions of all members. The study population included experts in field of agricultural occupational health. Purposeful and theoretical sampling method were used to select samples. At the beginning of the purposeful sampling, referred to several experts, then they were asked to provide other people with sufficient information in this field to complete the questionnaire, a total of 14 people were identified and examined. The data were collected through questionnaire that was designed according to the extracted categories related to the qualitative part of this research. In order to evaluate the content and face validity of the questionnaire, four experts were asked to study the questionnaire and express their opinions. After collecting the assessment of experts, the necessary changes were implemented in the tool. In order to verify the reliability of the questionnaire, an inconsistency rate was used. This is a common method of measuring reliability in hierarchical analysis. The incompatibility rate of judgments in paired rankings is up to 0.1, which is 0.02 for the questionnaire. SPSS version 16, Expert Choice11 and appropriate statistical tests were used to analyze the data. Results: According to the findings, the factors such as educational, safety requirements of agricultural machinery and inputs manufacturers, supporting and entities, information and media, interactions and organizational communication and also monitoring and evaluation were extracted as approaches for promotion of farmer's occupational health behavior. From the specialists’ perspective educational factors and information and media were in the first and last ranks, respectively. Conclusion: The results of the research indicate that there are several strategies for promoting the occupational behavior of agricultural industry which should be considered at macro level and in the medium and long term planning. Also, all the institutions and organizations that are in some way associated with the farming industry or with farmers, should consider themselves to be promoting occupational health behaviors among farmers, because promoting occupational health requires multiple approaches and partnerships. Considering the extent and distribution of agricultural farms and the number and variety of employed farmers, the unit of Agricultural Extension and Education or Occupational Health cannot lonely promote the farmers’ occupational health behavior. Achieving to this important goal requires the interaction and collaboration of the producers of agricultural equipment and the relevant organizations and institutions. Considering the educational strategy as the first way to promote farmers’ occupational health behavior from the perspective of participants, agricultural occupational health and safety education should be put in formal and informal training. In formal education planning at relevant faculties and departments, occupational safety and health, as in other developed countries, should have a definite position in which students who will somehow be associated with farmers in the future can play a role in promoting farmers’ safety and occupational health. In informal training, by making the needs assessment and designing various training programs we can attract farmers' attention to educational programs. The last rank of media and information strategy, means the less media activities in promoting agricultural occupational health behavior. But given the availability of appropriate infrastructure and by using of these potentials, media can play a tangible role in this regard.   آموزش, تحلیل محتوا, رفتار بهداشت حرفه ای, کشاورزان Content analysis, Farmers, Occupational health behavior, Training. 1057 1071 http://ioh.iums.ac.ir/browse.php?a_code=A-10-2715-1&slc_lang=fa&sid=1 somayeh moradhaseli سمیه مرادحاصلی s.moradhaseli@modares.ac.ir 13600319475328460038283 13600319475328460038283 No Faculty of Agriculture دانشکده کشاورزی Homaun Farhadian همایون فرهادیان homauon.farhadian@modares.ac.ir 13600319475328460038284 13600319475328460038284 Yes Faculty of Agriculture دانشکده کشاورزی Enayat Abbasi عنایت عباسی enayat.abbasi@modares.ac.ir 13600319475328460038285 13600319475328460038285 No Faculty of Agriculture دانشکده کشاورزی Fazlolah Ghofranipor فضل اله غفرانی پور ghofranf@modares.ac.ir 13600319475328460038286 13600319475328460038286 No Faculty of Medical Sciences دانشکده علوم پزشکی