健康教育模式对汽车制造业噪声作业工人知信行干预效果研究

Intervention effect of health education mode on knowledge,attitude and practice of noise-exposed workers in automobile manufacturing industry

目的评价健康教育模式对噪声作业工人噪声性听力损失(noise induced hearing loss,NIHL)及防护知识、信念、行为的干预效果,为制定NIHL防护策略提供科学依据。方法采用整群抽样方法,选取广州市3家汽车制造企业中3900名噪声作业的工人为研究对象,将研究对象随机分为对管理人员开展健康教育的管理人员健康教育组(1300人)、对工人开展健康教育的工人健康教育组(1300人)和不采取任何干预措施的对照组(1300人)。分别于基线和干预结束时通过职业健康监护系统和自行设计的调查问卷对3组工人的NIHL、知信行变化及企业职业卫生管理情况进行调查分析。结果本次调查共发放问卷3900份,最终完成干预调查者3825人(管理人员健康教育组1280人,工人健康教育组1288人,对照组1257人)。干预前后,3组组内、组间NIHL情况差异无统计学意义(P>0.05);与干预前比较,管理人员健康教育组在知识知晓率、态度和行为持有率三个方面上升幅度最大的分别是:知识方面,噪声作业工人对"上岗前需进行职业健康检查"的知晓率从97.7%上升至99.5%;态度方面,对"正确佩戴防护用品可预防NIHL的发生"的持有率从97.3%上升到98.9%;行为方面,对"能全程佩戴防护用品"的持有率从79.1%上升到83.0%。工人健康教育组在知信行三个方面上升幅度最大的分别是:知识方面,噪声作业工人对"NIHL尚无法治疗,预防是最好的方法"的知晓率从92.2%上升至96.0%;态度、行为方面,对"正确佩戴防护用品可预防NIHL的发生"、"能全程佩戴防护用品"的持有率上升幅度最大。干预后,管理人员健康教育组对提供质量合格的防护用品、定期进行健康知识培训、实施轮岗换岗制度、隔离噪声源、提供安静休息区、维护和润滑机械设备6个条目的持有率均显著提高,差异均有统计学意义(P<0.05)。结论干预后噪声作业工人NIHL防护知识、态度、行为的知晓水平明显提高,且针对不同对象的健康教育模式是一种有效的干预模式,在改善工作场所环境以及提高企业工人的健康知识、态度和行为方面起积极作用。

Objective To evaluate the intervention effect of health education mode on noise induced hearing loss(NIHL)and prevention-related knowledge,attitude and practice(KAP)of noise-exposed workers,and to provide a scientific basis for formulating NIHL prevention strategy.Methods A cluster sampling method was used to select 3,900 noise-exposed workers from 3 automobile manufacture enterprises in Guangzhou City to serve as the research subjects.They were randomly divided into the health education group for managers(n=1,300),the health education group for workers(n=1,300)and the control group without any intervention measures(n=1,300).Occupational health monitoring system and a self-designed questionnaire were used to survey and analyze NIHL and changes of KAP of the participants in the three groups and occupational health management of the enterprises before and after the intervention.Results A total of 3,900 questionnaires were distributed,and 3,825 participants(including 1,280 managers,1,288 workers and 1,257 controls)completed the intervention.Before and after the intervention,no statistically significant differences were found in the prevalence of NIHL in each group as well as among the three groups(P>0.05).Compared with before the intervention in the health education group for managers,the noise-exposed workers’awareness rate of knowledge about the necessary occupational health examination before posts increased from 97.7%to 99.5%,the holding rate of attitude towards NIHL prevention through correct wearing protective equipment increased from 97.3%to 98.9%,and the holding rate of behavior regarding wearing protective equipment in the whole process increased from 79.1%to 83.0%.As for the health education group for workers,the awareness rate of knowledge about there was no therapy for NIHL and prevention as the best method increased from 92.2%to 96.0%,and the holding rates of NIHL prevention through correctly wearing protective equipment and wearing protective equipment in the whole process increased the most.After the intervention in the health education group for managers,the holding rates of six items were all significantly increased(P<0.05),including the provision of qualified protective equipment,regular training of health knowledge,implementation of job rotation system,isolation of noise sources,provision of quiet rest place,maintenance and lubrication of machinery and equipment(P<0.05).Conclusions After the intervention,the awareness levels of NIHL prevention knowledge,attitude and behavior of the noise-exposed workers are significantly improved,and the health education mode based on different subjects is an effective intervention mode,which plays a positive role in making workplace environment better and improving health knowledge,attitude and behavior of the enterprise workers.