Health Promotion for Thai Garment
Factory workers
Researched and written
By
Phornthip Layanun
EXECUTIVE SUMMARY
Due to an increasing trend
in non-communicable diseases (NCD) among people in developing countries, health
promotion has played an important role in NCD prevention. Managerial
improvement is one of the areas that
need special consideration. Therefore, the main objective of the study was to
develop a managerial health promotion
system in the
garment industry located
in Bangkok Metropolis.
The
methodology of the study was an action research which was divided into two main phases, including a baseline survey and health promotion activities
among 30 textile businesses (weaving and garment
manufacturers) in terms
of individual health, environmental health and health care systems. It was found that workers had poor health
knowledge and poor health promotion behaviour which could lead to an increase in personal
illness and work absence. The environmental aspects were not supportive of a healthy atmosphere because the workplace had concentrated only on mandatory services. Therefore, a health
promotion management system was developed using a system approach model (a
model focusing on the relationships within the five system component of health
promotion in the organization and the
environment interaction) with full
participation from all levels of staff in the situation
analysis,decision-making, planning, implementing, evaluating and feedback.
The
five components of health promotion system consist of management, resources,
economic support, organization structure, and service delivery. These five
components of the health promotion system were analyzed prior to
implementation. The Appreciation
Influence and Control Process (AIC) was selected as an intervention to create
overall participation.
It
is suggested from the study that an effective health promotion management
system using AIC process is a tool of management in developing health promotion
in the workplace can be conducted with full participation of employees
according to the five component system of the health promotion in their working
environment. The designed comprehensive health promotion program (the
combination the Five strategies of Ottawa Charter, namely building healthy work
policies, creating supportive work environment, strengthening community action,
developing personal skill and reorienting occupational health as well as other
health services) was effective and satisfactory to the employees. However, the
success of the program greatly depends on the awareness, acceptance, and
support of top management level and the staffs willingness to participate.
Introduction:
A
comparison of 1995 prevalence of non work-related illnesses and that of 1996
revealed a ten-fold increase (1). Meanwhile, a similar five-fold
increase was observed with regard to occupational injury rates between 1988 and
1996. These changes also resulted in the dramatic increase of both workers
compensation and medical expenses during the past decade (2).
To
improve efficiency of health care service and to reduce health expenditure,
both the World Health Organization (WHO) and International Social Security Association
(ISSA) recommend health promotion as a strategy to reform health care system(3)
.
From
the 1986 Ottawa Charter (5) and recommendations from 3 subsequent
international meetings on health promotion in
The
Appreciation-Influence-Control technique (AIC) has been widely accepted and
implemented by numerous organizations (7). The technique is based on
a fundamental concept that the most influencing factor for organizational
change must stem from within that organization. Therefore, it emphasizes group
meeting where all the stakeholders participate in the planning and
implementation of organization activities, especially those related t quality
management. This technique, thus, has a potential to be an appropriate tool for
the initiation of health promotion activities in the workplace.
Garment
factory offers an ideal workplace environment to deliver health promotion
activities. The work practice itself requires teamwork: three levels of
employees are selected from all section of every management level working on
one task sequentially, thus, the fundamental concept of AIC technique is
already favored. In addition, due to the relatively less hazardous work
environment, the need for general health promotion is more visible among
employees compared to other industry.
General objective
To develop a health promotion
model for garment factory workers which can meet employee needs and
satisfaction under the workplace environment and all stakeholders have the
participation in planning and developing.
Specific objectives
1. To analyze health promotion situation in garment factory
based on health promotion behaviors of employees, workplace environment, and
health promotion system.
2. To create all relevant stakeholders
participation which starts from developing policy, decision making on operating
method, and planning by using AIC technique.
3. To implement the health promotion model in
garment factory regarding the action plan.
4. To evaluate and revise the health promotion
model in garment factory according to Ottawa Charter health promotion
activities to satisfy needs of all level of employees.
Methodology
To achieve such goals, the AIC technique is being introduced and
implemented to successfully develop a comprehensive health promotion
program. The methodology of the study is
enumerated into steps: research design, population and sample selection,
research instrument design, research methodology, data collection and data
analysis.
1)
Research
design
The action research model, a continuous and
systematic program encouraging participation and co-operation
among members of the society, was applied to this study separating the research
into two phases: Pre-development of health promoting management system (Phase I),
a survey of
existing health promotion system in the textile industry; and Development of health promoting system (Phase
II), a study of the effectiveness
of AIC technique under the system approach techniques in the garment factory (Figure 1). The action research was
introduced herein to initiate participation among all concerned parties and
ensure high effectiveness of the system model.
Survey of existing health promotion among textile
industries in Bangkok Metropolis Phase I
Trial of the designed system/Evaluation
and redesigning of the system: Implementing
the activities Monitoring
and controlling Reassessing
every two months Redesigning
the system through AIC workshop Re-implementing
new activities reflectively Evaluation
Achieve an effective management system for
comprehensive health promotion in the
workplace which: meets stakeholders needs utilises a
systematic approach creates a
comprehensive health promotion
program builds up
involvement at all levels builds up
top managements commitment and support
Figure
1. Action research model
2)
Population
and sample selection
The study population of the two phases was not the same group. The population of the Phase I was insured
employees in 30 textile factories located in Bangkok Metropolitan area. These sample factories were selected out of
284 factories by multi-stage sampling techniques. From each factory, 10 workers were listed;
therefore, there were 300 insured workers in total and a few numbers of
executives to participate in the study.
In the Phase II, the population was derived from 22 textile factories
which were mostly garment manufacturers.
Out of them, appropriate factories were cut down to only one
establishment by purposive sampling technique and criteria setting.
3)
Research
instrument design
Interview, observation, a set of questionnaires
and records were used as instruments in this study. There were six sets of questions comprising
the format for the above tools.
-
Set 1 the
interview questions for insured persons on health promotion behaviour
-
Set 2 the questionnaire on satisfaction toward
health promotion
-
Set 3 the questions for environmental assessment
-
Set 4 the interview questions on health promotion
for top management of the industry
-
Set 5 the questions used in the interview of the
staff responsible for health promotion
-
Set 6 the self evaluation form for quality
improvement record
-
Set 7 the questionnaire on participation in health
promotion according to the AIC process
-
4)
Research
methodology
-
For the
Phase I, reviewing theories as well as literature and carrying out a
survey research at the sample company
-
For the
Phase II, applying an action research in the AIC workshops through 4 steps;
preparation, design of the management system, implementation of the health
promotion program in the workplace, and evaluation of the outcome and
performance.
5)
Data
collection
In phase I the research project collects
and studies the baseline data of the existing health promotion over the three
dimensions individual health, environmental health and organizational health
by taking interview and observation with the research instrument set 1 to
5. Also, it explores satisfaction of
staff towards health promotion system in workplaces considering the correlation
of each system component with the overall management system.
In phase II the primary data of the sample business was collected
in three areas by the same collecting team and research instrument in phase I.
For the AIC workshop the questionnaires done by participants were evaluated.
During the implementation program regarding the action plan, there were the
monitoring and controlling method in AIC workshop using a self-test (set 6).
Then, the outcome and performance was evaluated using the interview with a
questionnaire on participation in health promotion according to AIC process
(set 7). Finally, the assessment outcome was done by comparing with the action
plan and interviewing the participation about the change of health promotion
(before and after) by using the research instrument set 1 to 5.
6). Data analysis
With the collected data, it is thoroughly analyzed by the statistical package. The statistics
used in the analysis were descriptive statistics, correlation, one-way anova,
T-test independent samples and Pearsons chi-square. From the correlation
statistics, it was found that the management had the relationship with health
promotion in the workplace and the AIC process also had the high relationship
with health promotion in the workplace.
Results
In this study, the main output obtained was the development of a
health promotion management system in the workplace. The development was undertaken by a system
approach in management on the basis of participation by using AIC
methodology. The
findings highlighted the participative management of stakeholders in changing
the health promotion program, and using government laws on occupational health,
safety, and welfare. The new model was
the comprehensive health promotion model that satisfied the needs of the
employees and was appropriate for the garment businesses. The results
of all four specific project objectives could be achieved as followed.
1. The situation of health
promotion in the garment industry.
Phase I: the baseline data on the position
of health promotion, undertaken by the spinning (8 places) and garment
manufacturing business of the textile industry, was obtained from a survey
conducted among 30 manufactures (22 places), in these aspects including personal traits, environment and health promotion system. It was
found that employees had low education, especially in health promotion related issues. Even though their attitude was positive, their behaviour did not reflect their attitudes. For instance, they had a
tendency to consume junk foods, avoid doing exercises, usually smoked
and drank, ignored using any safety device at work, and managed stress improperly. Even though the work environment was acceptable,
some problems still remained, such as ventilation, drainage, accidents, and
ergonomic problems. It was
also found that the top management carried a low profile of health management
knowledge and experience. The existing health related services, especially
health promotion programs, were provided because
of the Occupational Health and Safety government
policy, not of their own volition. The healthcare expenditures were spent mostly for medical care
(70%) but less for health promotion (30%). Moreover, the health promotion
service model reflected very few activities on education and training about
health behaviour, while most of them were engaged in smoking, drinking and safety
campaigns. When analyzing the components of the existing health promotion
system, it was found that the executives provided some services to a certain
extent, but these
were not directly related to
health promotion services. Since there was no specific health plan ever created
in the workplace, allocation of resources and budget, organizational structure,
and service provision were not available. The employees also revealed low
satisfaction over the existing health promotion model because the management
concentrated mainly on curative services.
When studying the correlation among the system components, the
findings suggested that to the managements perspective the health promotion
management system correlation with health promotion service delivery was the highest
while to the staffs perspective the participative management had most
correlation with the health promotion management system (Table 1). With the findings in
Phase I, it guided how to design an effective health promotion model in the
Phase II.
Table 1. The correlation coefficient between
components of the health promotion system according to operating staff (n=300)
|
Component |
Budget |
Organization |
Resource |
Service |
Total |
|
Management |
.329* (p=.000) |
.566*(p=.000) |
.566*(p=.000) |
.653*(p=.000) |
.824*(p=.000) |
|
Budget |
|
.276*(p=.000) |
.209*(p=.000) |
.229*(p=.000) |
.561*(p=.000) |
|
Organization |
|
|
.467*(p=.000) |
.600*(p=.000) |
.770*(p=.000) |
|
Resource |
|
|
|
.642*(p=.000) |
.744*(p=.000) |
|
Service |
|
|
|
|
.818*(p=.000) |
·
p-value < 0.05
2.
Create all relevant stakeholders participation using AIC technique.
The data derived from Phase I pointed out that the originators of health-related
policy were the top management through a top-down management style. All of them
were informed about the health promotion related information, problems, and
needs of employees, as well as the AIC process technique through workshops that
were proved to be effective in building up the participation among staff. In Phase II, the AIC workshop, one of the research tools, was first introduced
and incorporated into the management system in every step: planning,
implementing, assessing and acting on requests for changes based on the
realistic data. Vision and mission were
formed up accordingly. Through the AIC
process, the team learned about problems and barriers with which would help
improve the system. Nevertheless, the implementation of action plan from the first workshop was not as successful as it encountered a number
of problems such as narrow-spread of information, non-recognition of role among
the team members, lack of participation, unattended meetings due to workload, etc.
This resulted in the second AIC workshop being conducted later. The action plan was reviewed. Some techniques were also applied such as
informal and unscheduled meetings, AIC newsletter and integrated media
channels. Motivations were aroused with
tactics and campaigns such as the bulletin board contest, the one-baht donation
project (the collected money would support the aerobic dance fund), etc. Three months after the second workshop, it
found that the employees were much more satisfied with the health promotion
services (as clearly shown by statistic figures in Table 2).
Table 2 Satisfaction towards health promotion scheme after
taking part in the program (n=300)
|
Items |
Number |
% |
|
Not satisfied |
3 |
1.0 |
|
Neutral |
58 |
19.3 |
|
Satisfied |
202 |
67.3 |
|
Highly satisfied |
37 |
12.3 |
Another AIC workshop was set up by the AIC team under
process C to further design and standardize the health
promotion services. The employees from all levels throughout the company were
asked to join AIC workshops and also the committees responsible for health
promotion activities were appointed.
This formed a stronger framework for resource management and
organization in the location. The
services provided were not only focused on mandatory actions but they became
more relevant to meet the staff needs more closely. Overall, the performance of a comprehensive
health promotion in the workplace could reach the goal according to established
plans, which were drawn up by participation of staff at all levels, so as to
meet the needs and satisfaction of staff under specific circumstances and the
existing environment.
3. Implement the health promotion model
in garment factory regarding the action plan
3.1. Appointment of the Health Promotion and Environment
Protection Committee consisting of twenty-two members from the Occupational
Health and Safety Committee, AIC team members and other relevant persons.
3.2. Feasibility study of the 10-project action plan for
commitment and financial support. The feasible projects, adjustable to the
current situation of the business and applicable to Roemers health promotion
system were selected. Two projects approved for implementation were exercise
for good health (aerobics) and healthy workplaces. A healthy day was also
conducted to provide knowledge and understanding on health promotion as well as
to create the awareness and stimulate proper health behaviors.
3.3. Monitoring and control of project implementation. At
first, the projects were not running as planned resulting from a
lack of involvement. Therefore, the second AIC workshop was held among the
steering team members to resolve the problem. The plans and strategies were
thus reviewed and revised to increase participation such as continual education
(via intercom, boards, knowledge corner, etc.), motivations (through board
contest, etc.), the 1 baht donation for health promotion fund, training for
aerobic instructors, and training on document procedures, etc.
4. Evaluate and revise the health promotion model to
satisfy needs of all level of employees.
After implementing a comprehensive health promotion system in the
garment business, it was found that all participating employees had more
knowledge and positive attitude towards health promotion and less risk behaviours. The surrounding conditions were improved by
applying risk management over noise, dust and chemicals. There were safety
inspections and line marking. A health promotion model in the workplace was adopted according to
the Ottawa five strategies
which included (1) formulating a healthy
work policy; (2) creating a
supportive working environment; (3) strengthening
community activities with the AIC workshops and the one baht donation project; (4)
developing personal skills such as exercise for good health (aerobics),
healthy workplaces, board contests and (5) an integrated health promotion
program in the occupational health and safety plan which was supervised by the
Health Promotion and Environment Protection Committee. Regarding each element
of the health promotion system, it was found that the business offered only
health services limited to legal requirements and it showed
strongly a top-down management
style. Later,
there were some changes in organisation. The style became bottom-up
participative management. This style required the health promotion service to
be responsive to the needs of the employees in their circumstances. The AIC process was
proved to be an effective tool to create participation, which could be related
to the system approach used in both planning and implementing the health
promotion system.
It was concluded that the model introduced earlier had proved appropriate and effective in developing a health promotion management
system in the workplace. The essential
features of the study are
summarised in Figure 2 as follows.
Figure
2 Appropriate model for a health
promotion management system in
the
workplace
Recommendations
The study has finalized a comprehensive health promotion model
using the AIC process to successfully create participation. The researcher believed that the model could
be applied to other workplaces or other types of industries with as much
effectiveness. Other recommendations given here are based on the findings of
the study. The top management should be well aware of the problems as well as
needs of the employees on health promotion and intensively response to
them. The health promotion system in the
workplace should be set up in the workplace and continued with motivations
initiated by the top management. The
Government should play an important role in encouraging and providing knowledge
on health promotion. The AIC process should be promoted to build up a
participative atmosphere and help empower the employees to make decisions of
their own. The health promotion program in the workplace is one of those needs
to be fulfilled and supported from the management. To ensure the fruitful and prolonged success
and smooth operation, after the program being implemented, the researcher
suggested that the workers be aroused continuously with different motivations. Moreover, the concerned government agencies
should act as a supporter and help establish health promotion system in every
workplace.
LESSONS LEARNED
The study has finalized a comprehensive health promotion model
using the AIC process to successfully create participation. The researcher believed that the model could
be applied to other workplaces or other types of industries with as much
effectiveness. It is obligation that the
management has an ear on problems and needs of the employees and intensively
response to them. The health promotion
program in the workplace is one of those needs to be fulfilled and supported
from the management. To ensure the
fruitful and prolonged success and smooth operation, after the program being
implemented, the researcher suggested that the workers be aroused continuously
with different motivations. Moreover,
the concerned government agencies should act as a supporter and help establish
health promotion system in every workplaces. However, the suggestion for future study
should include the following issues.
1. There should be assessments of the impact of health promotion in
the workplace after health promotion had been implemented. This is to examine
the change in health behaviour, absenteeism, and cost effectiveness.
2. A follow-up should be made on the aerobic dancing course in the
workplace if it continues to
be popular and it maybe appropriate for other garment business of every scale.
3.
The health
promotion management model that is the output of this research could be applied to other types of the industry and the
variances and degree of success
in these other industries should be studied.
4.
Further research should be conducted on the comparison of health promotion behavior
between employees in the Bangkok Metropolitan area,
and those in the provinces, before and after the implementation of the health promotion
system.
References:
1. Office of Social Security System, 1996
Annual Report.
Security System, Ministry of Labor and
Social Welfare; 1996:25.
2.
Public Health
Development Planning Committee (1996). Public health
development during the national economic
and social development. (8th
ed.).
3. Zimalis EJ. Health Promotion and Health
Education under health Care
Schemes,
Permanent Committee on Medical Care and Sickness Insurance;
4
Veera Niyomwan et al.
Manpower Development Technique under the 8th National Development Plan. Nonthaburi: Bureau of
technical Assistant, Department of
Health, Ministry of Public Health; 1997.
5.
World Health
Organization. Health
Promotion Sante Chaste dOttawa Charter.
6.
Surakiat Achananuparp. Evolution
of International Health Promotion. Nonthaburi: Health System Research
Institute; 1998:35-141.
7.
Orapin Sopchokchai. Enhancing
Participation for Community Development.
Annexes:
.
Agenda of AIC implementation seminar
|
09.00-09.30 AM |
Registration |
|
|
Guest speaker introduction. Introduction
to object and ice breaker activity |
|
10.00-10.30 AM |
Health promotion in our company in the
present (A1) |
|
10.30-10.45 AM |
Break |
|
|
Health promotion in our company In the
present (A1) |
|
|
Lunch |
|
|
Health promotion in our company in the
future (A2) |
|
|
Brain- storming idea for health promotion
activities in the future and priority setting of that activities. |
|
09.00-09.30 AM |
Registration |
|
|
Review Picture of collective vision of
previous day |
|
10.00-10.30 AM |
Finalize the whole picture |
|
10.30-10.45 AM |
Break |
|
|
Assign responsibility |
|
|
Develop plan for each activities |
|
|
Lunch |
|
|
Develop plan for each activities |
|
|
Break |
|
|
Present developing plan to top management |
Health
promotion system model.
|
Conventional
model |
Developed
model |
|
|
|
Management
|
Management
|
|
Leadership Instruction |
Leadership democratic |
|
Decision making comply with rule, regulation |
Decision making participative approach |
|
Rule, regulation comply with laws |
Rule, regulations drawn up in collaboration |
|
Information distributed intermittently no feed back |
Information distributed continuously, and receiving unit of
feedback is available |
|
|
|
|
Resources |
Resources |
|
Human resource no responsible person |
Human resource deploying by participative approach |
|
Places first aid section was available |
Places allocated by participative approach |
|
Instruments allocated by request from the personnel division |
Instruments procured as need |
|
Technology no knowledge on health promotion management |
Technology
organize training on management and health promotion activities |
|
|
|
|
Organization |
Organization |
|
Organization not undertaking |
Organization horizontal holistic organization |
|
Coordinating top-down style |
Coordinating intersected style |
|
|
|
|
Economic support |
Economic support |
|
Budget allocation by mandatory tasks |
Budget participative approach |
|
|
|
|
Service delivery |
Service delivery |
|
1. Safety and
occupational health |
1. Build healthy
work policy |
|
- Determining danger zone, non-smoking area, and non-alcoholic areas |
2. Created
supportive work environment 3. Strengthen community
action 4. Develop
personal skills |
|
- Annual physical
examination |
5. Reorient
occupational health services to be
occupational health and safety, and health
promotion |
|
2. Welfare |
|
|
- First aid clinic
- Provide training on health
occasionally |
|