工作场所健康促进赋权增能模式研究

【作者】 李霜；

【导师】 李涛； 李朝林；

【作者基本信息】 中国疾病预防控制中心 ， 劳动卫生与环境卫生学， 2013， 博士

【摘要】 目的健康促进中的赋权增能是指“使人们获得控制影响其生活和健康影响因素的能力的过程”,这已成为健康促进领域公认的核心策略。从促进和加强我国职业人群健康的角度来说,引进赋权增能理论和实践模式是非常必要的,但在我国应用需要考虑其跨文化的普适性和本土化的问题。本研究旨在探索和解读基于我国社会、经济、文化背景的工作场所健康促进领域中的赋权增能内涵、要素和作用机制,构建适合我国国情的工作场所健康促进赋权增能模式,为进一步推进和发展我国工作场所健康促进工作提供理论指导。方法本研究首先采用文献法,在国内、外相关文献数据库和网站查询资料,对收集到的信息进行查阅、鉴别、整理与分析,研究赋权增能理论的内涵、要素和已有模式的优缺点。然后采用质性研究方法,将工作场所健康促进领域拥有相关信息最丰富的人群作为抽样目标人群,通过目的抽样、滚雪球抽样选取20名人员进行深度访谈,将访谈录音转换成文稿,提取要点并与受访者确认,而后进行访谈资料的分析和提炼,形成赋权增能模式框架。最后,在2家不同规模、不同性质的企业中开展实证研究,采用“全国工作场所健康促进试点企业”项目统一制订的基本情况调查表、McLean’s职业紧张调查表、Goldberg普通健康调查表、心理赋权量表和以身作则问卷,结合访谈法和观察法,对赋权增能干预各层面结果进行测量。通过理论构建和实践发展,最终形成基于我国国情现状的工作场所健康促进赋权-参与-增能模式。结果第一部分：解释了将empowerment翻译为“赋权增能”的理由,批判式分析了现有的赋权增能模式的优缺点,深度探讨了该理论在目前中国社会经济转轨时期应用的意义和可行性,并综合理论研究和我国国情,提出了建立自上而下外力赋权和自下而上主动增能相结合的我国工作场所健康促进赋权增能模式总体思路。第二部分：探索和解释了那些影响到工作场所健康促进的经济、政治、社会和文化的因素,理解相关群体如何自我解读工作场所健康促进赋权增能的要素、优先领域和职业人群应具备的基本职业健康素养,并结合理论研究结果,提炼出制度、文化、心理和技术作为自上而下赋权的4个领域：健康意识、知识、技能、自我效能、自我决定、拓展社会支持网络以及通过个人或集体行动来对他人、决策或环境产生影响的能力等,作为增能的内容。初步提出了以对员工和组织进行赋权为前提、以员工和组织增能为目标、以员工参与为增能主要手段的工作场所健康促进赋权-参与-增能模式。第三部分：两家企业在组织领导、健康相关部门和人员设置、经费场所保障、沟通协调机制、民主管理方式、监督管控、信息／教育／医疗资源的提供等方面进行制度赋权；将健康安全的理念植入企业文化,积极倡导并融入各项活动,进行文化赋权；在内、外部专业人员的引导、协调、参与和服务下,借助技术工具,进行技术赋权；在制度、文化、技术赋权中,重视员工对赋权措施的心理体验,使其达到一定水平的心理赋权。通过赋权和有效参与,员工掌控影响其生活和健康影响因素的能力得到了不同程度的提高。问卷调查结果显示,两家企业分别有98.9%和93.2%的员工能够利用所学的健康知识应用于生活和工作中；77.8%和59.8%的员工认为自己获取健康知识的能力得到了提高；56.2%和32.5%的员工在健康相关问题的处理上具备了一定的批判式思维。两家企业员工心理赋权平均得分率分别为68.71%和65.60%,自我效能维度的平均得分率均大于74%;专业人员心理赋权平均得分率分别为77.50%和72.14%,在工作意义和自我效能两个维度的得分率均在80%以上。干预后员工体检异常指标也有部分改善。企业内部的安健环部门和医务室,藉由整个项目过程的参与,转变了服务意识、提升了服务能力,能够主动发掘员工的健康需求,采用了更加入性化和个体化的方式为员工提供健康服务和发展工作场所健康促进项目。通过实证研究,认识到社会、政治、经济、文化和环境的大背景对健康促进乃至企业发展的影响,将其补充到质性研究中提出的模式框架,提出最终的工作场所健康促进赋权-参与-增能模式。第四部分：对所提出的模式进行解析和说明。结论工作场所健康促进赋权-参与-增能模式赋予了赋权增能理论的中国特色内涵,丰富了工作场所健康促进理论,为我国工作场所健康促进工作的发展和全面推进提供了有效的理论模式和实践范例。更多还原

【Abstract】 ObjectiveEmpowerment is defined as the process of empowering people to control factors that impact on life and health. It has been the core strategy of health promotion. In terms of promoting the right for health of occupational population, it is necessary to introduce empowerment theory and practice model to China. However, to apply empowerment theory in China we need to think about the applicability and localization issue. The research is aimed to explore and interpret the contents, elements and action mechanism of empowerment in workplace health promotion against the backdrop of society, economy and culture in China; establish a workplace health promotion empowerment model that is fit for China and to provide theoretical guidance for further developing workplace health promotion in China.MethodBibliographical research is first conducted. We have gathered information from databases and websites at home and abroad, read, identified and sorted out the available information and studied the contents, elements and merits and demerits of existing models. We have used qualitative study as the second method. We have set population with rich information related to workplace health promotion as target groups for sampling and selected20people for intensive interview through purposive sampling and snowball sampling. These interviews are converted into texts with key points confirmed with the interviewees. Then by analyzing interview materials, we have come up with a framework for empowerment model. The third and last method is to carry out empirical study at two enterprises of different scales and in different sectors. We have used the basic information questionnaire, Mclean’s work stress questionnaire, Goldberg’s general health questionnaire, psychological empowerment scale and leading by example instrument and measured the empowerment intervention effects at all levels by connecting the means of interview and observation. Based on theoretical building and practice development, workplace health promotion empowerment-participation-ability improvement model that is fit for China is finally created.ResultsThe first part interprets why empowerment is rendered into“赋权增能”in Chinese, criticizes the merits and demerits of existing empowerment models and discusses the significance and feasibility of empowerment theory in the economic and social transitional period of China. The first part also proposes the outline of workplace health promotion empowerment model which combines top-down external empowerment and bottom-up active empowerment.The second part explores and interprets the economic, political, social and cultural factors that exert impact on workplace health promotion, discusses how related groups interpret the elements, priority areas and basic health literacy of occupational population from the perspective of workplace health promotion empowerment. Based on theoretical research results, the second parts sorts out four areas of top-down empowerment:namely system, culture, psychology and technology. The contents of empowerment involve health awareness, knowledge, skills, self-efficacy, self-determination, expanded social supporting network as well as the ability to exert impacts on others, decision-making or environment through individual or collective behaviors. The second part proposes a workplace health promotion model of empowerment-participation-ability improvement strengthen that is premised on empowerment for employees and organizations, aimed to strengthen the capacity of employees and organizations and focused on employee participation as the main method of empowerment.In the third part, the two enterprises have carried out system empowerment in terms of organizational leadership, health related departments and staff settings, fund and venue, coordination mechanism, democratic management, monitoring and control as well as supply of information/education/medical resources. The two enterprises have integrated the philosophy of health and safety into enterprise culture, advocated plenty of activities to promote cultural empowerment. Under the guidance, coordination, participation and help of internal and external experts, the two enterprises have conducted technological empowerment. In the process of system, cultural and technological empowerment, emphasis is given to the psychological experiences of employees so that they will reach a certain level of psychological empowerment. Through empowerment and effective participation, employees have improved their abilities of controlling factors that impact their life and health to varying degrees. The questionnaire survey shows that98.9%and93.2%respectively of the two enterprises can adopt what they have learned about health knowledge into work and life;77.8%and59.8%of employees believe their ability of acquiring health knowledge have been enhanced and56.2%and32.5%of employees are capable of some critical thinking in dealing with health related issues. The psychological empowerment ratios of the two enterprises’ employees are68.71%and65.60%respectively,and that of the professionals are77.50%and72.14%respectively. Post-intervention physical examination also shows that abnormal index have improved to some extent. The internal EHS department and clinic, by participating in the whole project, have shifted service awareness and improved ability. They have started to discover health demand of employees, provided them with health service in a more personalized and humane approach and developed workplace health promotion projects. By empirical study, the impacts of social, political, economic, cultural and environmental development on health promotion and enterprise development is first analyzed and then complemented to the model framework of qualitative study. By doing so, a final workplace health promotion empowerment-participation-ability improvement model is created.The fourth part elaborates on the proposed model.ConclusionWorkplace health promotion empowerment-participation-ability improvement model adds Chinese characteristic contents into empowerment theory, enriches workplace health promotion theory and provides effective theoretical model and best practices for advancing workplace health promotion in an all-round manner in China.更多还原