Sorensen Glorian, Nagler Eve M, Pawar Pratibha, Gupta Prakash C, Pednekar Mangesh S, Wagner Gregory R
Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2017 Aug 24;12(8):e0182607. doi: 10.1371/journal.pone.0182607. eCollection 2017.
To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs).
This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation.
While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist's reports.
India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers' experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.
描述针对印度制造业工作场所调整一项整合职业安全与健康（OSH）及健康促进的干预措施的过程，以及实施该措施时面临的挑战；并探讨全球化趋势如何可能影响这些整合方法在印度及其他低收入和中等收入国家（LMICs）的实施。
本研究在印度孟买的22个制造业工作场所开展，调整并实施了一项在美国经过测试的基于证据的干预措施，该措施整合了职业安全与健康及烟草控制。系统的调整过程包括形成性研究和试点测试，以确保经过测试的干预措施适合当地情况。我们使用定性方法和过程评估来评估该干预措施的实施程度，并探讨实施障碍。
虽然参与的工作场所同意实施该干预措施，但在分配到干预条件的10个工作场所中，调整后的干预措施并非所有组成部分都得到了充分实施。我们发现，印度的职业安全与健康基础设施主要侧重于法规合规、医学筛查（二级预防）和伤害治疗。我们观察到，职业安全与健康方面的领导支持和承诺普遍较低，表现为管理层对干预措施的参与极少、不愿与研究团队或工人讨论职业安全与健康问题，以及对工业卫生学家报告提出的建议几乎没有接受度。
印度是一个低收入和中等收入国家的例子，其非传染性疾病负担不断上升，工作中面临的物理和组织危害暴露加剧。我们的经验凸显了塑造工人工作经历及其相关健康结果的国家和全球趋势的重要性。除了单一关注非传染性疾病的预防之外，还需要国家和国际的协调努力，以在明确塑造工人健康结果的工作条件背景下解决工人健康问题。
