健康相关生产力影响因素研究

【作者】 黄晓霞；

【导师】 傅华；

【作者基本信息】 复旦大学 ， 社区卫生与健康促进， 2011， 硕士

【摘要】 目的分析工作环境和工作特征等工作场所相关因素对健康相关生产力的影响,为今后促进企业开展工作场所健康促进提供依据。对象与方法本研究为典型案例横断面研究。在知情同意的基础上,对6家类型、规模、所属行业相近企业进行调查,对符合条件的员工进行知情同意后纳入研究。采用统一设计的调查表,由员工自填的方式收集资料。调查内容包括人口学基本情况、工作特征、健康情况、工作场所情况和健康相关生产力。健康相关生产力评价指标为缺勤率和隐性缺勤率。定量资料分析主要采用X2检验、Mann-WhineyU检验、负二项回归模型、零膨胀负二项回归模型和路径分析等统计方法。定性分析主要采用内容分析法,统计工具为stata、Mplus、Atlas. TI软件包。结果共发放问卷2997份,回收有效问卷2743份,回收率91.5%。健康所致的工作时间损失百分比为0.27%±3.18%,健康所致的工作损失百分比为12.02%±21.25%,健康所致的总体工作损失百分比为12.22±21.38%。缺勤率为1.9%(其中男性为1.8%,女性为2.1%),隐性缺勤率为38.7%(其中男性为37.1%,女性为42.9%),健康问题导致的总体生产时间损失率为39.3%(其中男性为37.8%,女性为43.2%)。在过去一周中,2743名员工总体的工作时间损失为15393.00小时,其中缺勤时间合计466.00小时(占总体时间损失的3.03%),隐性缺勤损失的工作时间合计14927.00小时(占总体时间损失的96.97%),导致的总体经济损失为494250.07元,其中缺勤导致经济损失为15707.67元,隐性缺勤导致的经济损失为478542.39元。每人每小时因为健康问题所导致的经济损失达到平均4.11元(其中男性达到3.99元,女性达到4.42元)。在对缺勤时问的路径分析中,一线生产员工(路径系数β=0.02,P=0.02)、执行轮班工作制度的员工(β=0.04,P<0.01)、接触化学性职业有害因素(β=0.03,P<0.001)、物理性职业有害因素(β=0.02,P=0.01)、工效学有害因素(β=0.04,P<0.001)、主动型社会心理工作环境(β=0.04,P=0.001)、被动型社会心理工作环境(β=0.03,P=0.01)、紧张型社会心理工作环境(β=0.07,P<0.001)、不参加企业健康促进活动(β=0.03,P=0.001)通过健康潜变量增加自报缺勤发生的风险,高社会支持(β=-0.01,P<0.001)通过健康潜变量降低自报缺勤发生的风险。在对隐性缺勤时间的路径分析中,一线生产员工(β=0.05,P=0.001)、执行轮班工作制度的员工(β=0.06,P<0.001),接触化学性职业有害因素(β=0.04,P=0.002)、物理性职业有害因素(β=0.04,P=0.003)、工效学有害因素(β=0.06,P<0.001)、主动型社会心理工作环境(β=0.07,P=0.001)、被动型社会心理工作环境(β=0.04,P=0.01)、紧张型社会心理工作环境(β=0.11,P<0.001)、不参加企业健康促进活动(β=0.05,P<0.001)通过健康潜变量增加隐性缺勤发生的风险,4000～8000元月收入(β=-0.03,P=0.047)、其他雇佣形式(β=-0.03,P=0.04)和高社会支持(β=-0.16,P<0.001)会降低隐性缺勤发生的风险,工作岗位在路径分析中未对缺勤和隐性缺勤显示出影响。此外,组织网络、领导层重视、健康促进专业人员配备、经费支持和政府的政策会对企业开展健康促进活动产生影响。结论职业有害因素、社会心理工作因素、企业健康促进活动、工作岗位、月收入、工作制度、雇佣形式通过身体健康、职业倦怠和主观幸福感对健康相关生产力产生影响；此外,机构组织网络、领导层重视、健康促进专业人员配备、经费支持和政府的政策影响企业开展健康促进活动,未来改进工作环境,关注健康相关生产力损失的高危人群,完善机构组织网络、加强领导层重视、配备健康促进专业人员、增加经费支持和完善健康促进相关制度将有助于降低健康相关生产力。更多还原

【Abstract】 Objectives To analyze the impact of work environment and work characteristic risk factors on health related productivity, in order to provide evidence to facilitate the conduction of workplace health promotion in the future.Materials and methods Typical cases study was conducted through cross-sectional epidemiological survey.6 enterprises that are similar in type, size and industry were selected as the cases. All participants were included after signing an informed consent form designed according to Helsinki Declaration. A carefully developed questionnaire was then completed by the participants independently. The questionnaire covers information on demographics, job characteristics, health situation, work environment and health related productivity. Health related productivity was evaluated with absenteeism and presenteeism. Chi-square test, Mann-Whiney test, negative binominal regression, zero-inflated negative binominal regression and path analysis were conducted for quantitative data using stata, Mplus. Content analysis was conducted for qualitative data using Atlas.TI.Results A total of 2743 participants were included. Participation ratio reached 91.5%. The proportion of work time missed due to health was 0.27%±3.18%. Percentage of impairment while working due to health reached 12.02%±21.25%. Percentage of overall work impairment due to health reached 12.22±21.38%. The rate of absenteeism was 1.9%(male 1.8%, female 2.1%), while the rate of presenteeism was 38.7%(male 37.1%, female 42.9%). The rate of total work impairment time was 39.3%(male 37.8%, female 43.2%). The total work impairment time of 2743 employees during the past week was 15393.00 hours, among which absenteeism time accounted for 466.00 hours (made up 3.03% in total work impairment time) and presenteeism time accounted for 14927.00 hours (made up 96.97% in total work impairment time). The overall economic loss was RMB 494250.07 yuan, among which the economic loss due to absenteeism was 15707.67 yuan and the economic loss due to presenteeism was 478542.39 yuan. The economic loss of health-related productivity for each employee per hour arrived at 4.11 yuan (male 3.99 yuan, female 4.42 yuan). In the path analysis for absenteeism, manufacturing workers (path coefficientβ=0.02,P=0.02), shift-work employees (β=0.04,P<0.01), chemical hazards (β=0.03,β＜0.001), physical hazards (β=0.02, P=0.01), ergonomic hazards (β=0.04, P<0.001), active psychosocial work environment (β=0.04, P=0.001), passive psychosocial work environment (β=0.03, P=0.01)、high strain psychosocial work environment (β=0.07, P<0.001), failing to take part in workplace health promotion programs (β=0.03, P=0.001) increase the risk of absenteeism, while high social support (β=-0.01, P<0.001) reduces the risk of absenteeism through health mediating factors. In the path analysis for presenteeism, manufacturing workers (β=0.05, P=0.001), shift-work employees (β=0.06, P<0.001), chemical hazards (β=0.04, P=0.002), physical hazards (β=0.04, P=0.003), ergonomic hazards (β=0.06, P<0.001), active psychosocial work environment (β=0.07, P=0.001), passive psychosocial work environment (β=0.04, P=0.01)、high strain psychosocial work environment (β=0.11, P＜0.001), failing to take part in workplace health promotion programs (β=0.05, P<0.001) show an accessive risk of presenteeism, while monthly incomes ranging 4000～8000 yuan (β=-0.03, P=0.047), other employment types (β=-0.03,P=0.04) and high social support (β=-0.16, P<0.001) show a reducing risk of presenteeism through health mediating factors. Statistically significant results of job position were detected in neither absenteeism nor presenteeism. In addition, network of organization, management style, health promotion professionals, funds and government’s policy also produce impacts on the workplace health promotion according to the qualitative analysis.Conclusion Occupational hazards, psychosocial work environment, workplace health promotion programs, occupations, monthly incomes, work shifting, employment type impact health-related productivity through diseases, burnout and subjective well-being. In addition, network of organization, management style, health promotion professionals, funds and health promotion-related system and government’s policy also produce impacts on the workplace health promotion according to the qualitative analysis. Improving work environment, paying attention to population at risk of impairment of health-related productivity, optimizing network of organization, raising the leader’s attention, providing health promotion professionals, increasing funds and optimizing the system are expected to reduce the impairment of health-related productivity.更多还原