基于整群随机对照试验的中小型企业农民工职业健康安全行为干预及其成本效果分析

Worker’s occupational health and safety is not only crucially important to individuals and families, but also an essential prerequisite for the economic development and productivity of a country. How to improve worker’s occupational health and safety is a global challenge. The available literature and our previous investigations show that China faces an extremely arduous task of improving occupational health and safety. Although pilot studies of basic occupational health services have been conducted in China, the coverage and effectiveness of the pilot program are limited. Numerous small-and medium- sized enterprises with a work force comprised primarily of migrant workers lack occupational health and safety awareness and behavior. It is crucially important to improve the occupational health and safety behavior of migrant workers in small-and medium- sized enterprises by utilizing effective interventions. However, there is still lack of research on the factors that promote healthy workplace behaviors and interventions that can improve the health of migrant workers in small-and medium- sized enterprises. The current research plan builds on previous findings, literature reviews, and is informed by contextual factors of small-and medium- sized enterprises in Guangdong Province. The aim of the study is to develop an intervention package which aims to improve the occupational health and safety behavior of migrant workers, and evaluate the effectiveness and cost-effectiveness of the intervention package. A cluster randomized controlled trial will be implemented within 54 small-and medium- sized enterprises in Guangdong Province. At baseline and after the launch of the intervention for seven months, evaluation surveys will be carried out in the treatment and control enterprises to measure the improvement of occupational health and safety behavior of migrant workers by questionnaire interviews and field monitoring. Generalized estimating equations and linear mixed effects models will be used to analyze the impact of the intervention package on the occupational health and safety behavior of migrant workers, in addition, cost-effectiveness analysis will be used to evaluate whether this intervention improves the occupational health behavior of migrant workers while also being a low cost intervention. Findings of the current research could provide evidence for improving the health and safety of migrant workers in small-and medium- sized enterprises and promoting the harmonious development of economy and society in China.

工人的职业健康安全不仅对个人和家庭至关重要，也决定了国家生产力水平和社会发展潜力。如何提高工人的职业健康安全是全球性的巨大挑战。我们的前期调查和文献都显示，我国的职业健康安全防护任务十分艰巨，虽然开展了基本职业卫生服务试点项目，但项目的覆盖面和效果有限，众多的中小型企业和以农民工为主体的工人仍然缺乏职业健康安全意识和行为，亟需有效的改善措施。但目前我国尚缺乏针对中小型企业农民工职业健康安全行为的影响因素和干预措施的研究。本研究拟基于前期发现和文献复习，根据广东省中小型企业的实际情况，针对提高中小型企业农民工职业健康安全行为，设计干预方案。通过整群随机对照试验，在广东省54家中小型企业中进行为期7个月的干预，通过问卷调查和现场监测收集数据，运用广义估计方程和线性混合效应模型评价干预效果，并对其成本效果进行分析。研究结果不仅可以保障广大中小型企业农民工的健康和安全，也有利于经济社会的和谐发展。

农民工是我国劳动力的重要组成部分，他们的健康关系着国家的生产力水平和社会发展潜力。既往研究表明，在中小型企业工作的农民工面临很高的职业健康风险。缺乏职业人个人防护行为、知识和态度是影响中小型企业农民工职业健康的主要因素。但我国缺乏针对该人群的职业个人防护行为、知识和态度的干预措施。.. 本研究首次基于行为改变理论模型、文献资料和定量及定性调查，系统全面地设计了旨在提高中小型企业中农民工有效使用个人呼吸防护用品（RPPE）和相关知识态度的干预方案。方案包括低强度干预（职业健康培训和移动健康教育）和高强度干预（“低强度干预”+同伴教育）。在此基础上，通过为期7个月（企业干预1个月+农民工干预6个月）的三臂整群随机对照试验（CRCT）对干预效果进行评估。试验在广东省广州市60家涉及有机溶剂作业的中小型企业开展。60家企业随机分为3组，20家企业（含符合纳入排除标准的农民工368名）接受高强度干预、20家企业（390名农民工）接受低强度干预、20家企业（453名农民工）为对照（不接受干预）。试验主要终点为农民工自报最近一周有效使用RPPE，次要终点为农民工个人职业防护知识和态度。相较干预前，干预结束后，高、低强度干预组和对照组农民工RPPE有效使用率分别上升20.2%、12.0%和-0.7%。与对照组相比，干预组农民工有效使用RPPE的可能性更高（高强度组：ORad: 2.99, 95%CI: 1.75-5.10, p<0.001; 低强度组: 1.91, 1.17-3.11, p=0.009）。成本效果分析显示，相较于对照，高、低强度干预组RPPE有效使用率每提升一个百分点，需分别多花费2290.9元和2763.8元，高强度干预成本效果更优。.. 本研究首次设计了适合在中小型企业开展的农民工个人防护行为干预方案，并基于人群干预中证据级别最高的CRCT，通过在60家中小型企业进行试验，证实了干预方案的可行性和有效性。研究成果可为中国乃至其他国家和地区开展中小型企业工人职业防护行为干预提供急需的理论依据和实际操作经验。此外，研究期间课题组累积了丰富的研究经验，扩大了学术影响（发表论文和会议报告），培养了青年科研人员。

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