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研究生:林家平
研究生(外文):LIN, CHIA-PING
論文名稱:泰國本土與移民工人之間比較其工作壓力、社會支持與健康風險行為之關係
論文名稱(外文):Relationship between work stress, social support and health risk behaviors among domestic and migrant Thai workers
指導教授:蔡奉真蔡奉真引用關係
指導教授(外文):TSAI, FENG-JEN
口試委員:蔡奉真烏斯馬
口試委員(外文):TSAI, FENG-JENMathuros TipayamongkholgulUsman Iqbal
口試日期:2021-01-11
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:全球衛生暨發展碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:英文
論文頁數:73
中文關鍵詞:外來勞工職業衛生工作壓力社會支持健康風險行為
外文關鍵詞:migrant workeroccupational healthwork stresssocial supporthealth risk behavior
ORCID或ResearchGate:orcid.org/0000-0002-0275-0118
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背景:過去幾個世紀,泰國在東南亞移民是重要的匯集處,但是泰國移民議題的延伸在與台灣之間的國際研究合作上稍顯不足。基於保障外國移工在臺的健康狀況,因此本研究探討兩地區工人的健康危險因素與其職業健康之間的關係,以協助了解工作場所之現況與差異。這項研究主要目的是在比較泰國工人在工作壓力、人際社會支持(ISS)與他們在不同環境背景下健康風險行為(HRBs)之間的關係,確定臺灣與泰國工人之間的差異與相關趨勢。

方法:本研究採用橫斷面研究方法比較兩地在工作壓力、社會支持及健康風險行為之相關性與差異。在兩地採用便利性與滾雪球非隨機抽樣,研究收案為自填式問卷,問卷使用標準化且以封閉式問題回答為主,並於2019年10月至2020年10月期間,分別從兩地製造業工廠完成泰國與台灣泰籍工人的收案。

結果:與泰國的本土工人相比,在台灣工作的移工人際社會支持較低,而工作壓力相對較高。就健康風險行為而言,過去一年中,泰國本土工人相對於移工,有較高比例的性行為,但在不安全性行為的比較上沒有差異。另一方面,在抽菸與喝酒的行為上,兩地的盛行率沒顯著差異,但移工在飲酒的頻率上顯著高於泰國本土工人。此外,在高壓力工作的調整模型結果顯示,兩地工人、人際支持與工作支持有統計上顯著。移民從事高壓力工作的風險是本土工人的3.7倍;人際支持差的工人高於人際支持高的1.7倍;而低工作支持的工人也比高工作支持的高2倍。最後,在控制相關混雜因子後,健康風險行為模型中,僅性別與教育達統計上顯著,男性相比女性有38倍的風險健康風險行為較高;而在教育方面,低教育程度工人如高中或國中以下相比大學或以上程度的工人有較高的健康風險行為,其風險分別為3.7與4.5倍。

結論:本研究表明,泰國移工工作壓力相對其在本土國家工人高,主要與環境與社會支持程度相關。然而兩地工人之間在健康風險行為沒有地域上的差異,主要與他們個人的教育程度相關。基於本研究結果,健康風險行為的強調,應著重於工作場所之健康促進計畫,以提升健康風險與行為認知。另外在健康風險行為中菸酒消費稅與不同環境的探討,需要未來的研究針對政府政策做進一步的探討。
Background:
Thailand has been a migration crossroads in South East Asia for centuries, but there are deficiencies between Thailand and Taiwan in international collaboration and research networks involving countries of origin and reception. Based on protecting the health status of migrant workers from foreign countries, the relationship between the health risk factors of workers in both areas and their occupational health was studied to help understand the follow-up health involvement in the workplace. The main objective of this study is to compare Thai workers among work stress, interpersonal social support (ISS), and their health risk behaviors (HRBs) in distinct environments to determine the correlation, differences and trends between Taiwan and Thailand.

Methods:
Cross-sectional study was used to determine the link between workers’ work stress, social support, and health risk behaviors after collecting the self-reported survey. The survey was conducted using a standardized, majority closed-ended questionnaire for the convenience and snowball sampling in Taiwan and Thailand to identify relevant factory workers in the manufacturing industry between October 2019 and October 2020.

Results:
Thai workers employed in Taiwan had lower ISS and relatively higher stress in work than domestic workers in Thailand. In terms of health risk behaviors, results in sexual risk showed that Thai domestic workers have a greater percentage of people who have been sexually active than migrants in the past year, but do not differ in unsafe sex behaviors. On the other hand, health risk behaviors among workers, migrants had higher frequency of alcohol intake than domestic workers, but there was no statistical difference in smoking and drinking behavior. For the forecast adjusted model of high stress, factors among workers, ISS and workplace social support (WSS) showed statistical significance. Migrants were 3.7 times higher risk of having high-stress work than domestic workers; workers with weak ISS were 1.7 times higher than strong-ISS workers; low-WSS workers were 2 times higher than high-WSS workers. Additionally, after controlling confounding factors, the adjusted odds of HRBs were considered statistically significant only for sex and education. Male workers were almost 38 times more likely to have high HRBs than female workers. Likewise, high school and lower level education workers were 3.7 and 4.5 times, respectively, more likely to have high HRBs than bachelor or higher-level workers.

Conclusions:
This study displayed that work stress is relatively high for migrants and is mainly related to the environment and social support, there is no geographical difference in HRBs between workers, but it is linked to their individual characteristics, particularly their education. In the context of health promotion programs in the workplace, suggestions for further research are made and emphasis is placed on the need to the awareness of HRBs. Further studies on excise tax and HRBs in different environments are also worth of discussion through governments policies.
Table of Contents
Abstract ...... I
Acknowledgement ...... III
Table of Contents ...... IV
List of Figures ...... VII
List of Tables ...... VIII
Chapter 1 Introduction ...... 1
1.1 Background ...... 1
1.2 Research questions on the gap between Thai workers ...... 3
1.3 Problem statement ...... 3
1.4 Significance of the study ...... 4
1.5 Objectives ...... 5
Chapter 2 Literature Review ...... 6
2.1 Definition of domestic and migrant workers ...... 6
2.2 Occupational health of migrant workers ...... 7
2.3 Occupational stress models ...... 7
2.4 Health risk behavior ...... 9
2.5 Relationship between work stress and health risk behavior ...... 10
2.6 Conceptual framework ...... 11
Chapter 3 Study Design and Methods ...... 13
3.1 Research design ...... 13
3.2 Study population criteria ...... 13
3.3 Data Collection ...... 14
3.4 Measurement strategies ...... 15
3.4.1 Determining personal social support ...... 15
3.4.2 Determining work stress ...... 16
3.4.3 Determine health risk behaviors ...... 17
3.5 Reliability and Validity ...... 19
3.6 Data analysis ...... 20
3.7 Ethics approval ...... 21
Chapter 4 Result ...... 22
4.1 Participant recruitment ...... 22
4.2 Sample characteristics ...... 23
4.2.1 General characteristics ...... 23
4.2.2 Working conditions ...... 25
4.2.3 Scale scores for the ISS ...... 26
4.3 Work stress and scale scores for the JCQ ...... 27
4.4 Scores of STIs knowledge and sexual risk behaviors ...... 29
4.5.1 STIs knowledge scores ...... 29
4.5.2 Sexual risk behaviors ...... 32
4.5 Tobacco Smoking and Alcohol Used ...... 33
4.6 Association between work stress and health risk behavior ...... 34
4.7.1 Model 1: High stress with other factors ...... 36
4.7.2 Model 2: HRBs with other factors ...... 37
Chapter 5 Discussion ...... 39
5.1 Key findings ...... 39
5.2 Mixed factors among Thai workers from different environments ...... 40
5.2.1 Determinants of sample characteristics ...... 40
5.2.2 Determinants of working conditions ...... 40
5.2.3 Determinants of interpersonal social support ...... 42
5.2.4 Determinants of work stress ...... 42
5.2.5 Determinants of health risk behaviors ...... 43
5.3 Factors associated with high-stress work and HRBs ...... 44
5.4 Strengths of our study ...... 46
5.5 Limitations ...... 46
Chapter 6 Conclusions and suggestions ...... 48
Chapter 7 References ...... 49
Appendix ...... 56
Appendix I Survey questionnaire in Thai version ...... 56
Appendix II Information Sheet and Informed Consent Form in Thai version ...... 64
Appendix III Approval of proposal from TMU-JIRB and MU-PHIRB ...... 71
Appendix IV Difference of 22-JCQ core questions between domestic and migrant Thai workers ...... 73

List of Figures
Figure 1. The description of workplace Karasek's Job DC model (1979) ...... 9
Figure 2. A model of stress at work by Cooper et al. (1976) ...... 11
Figure 3. Conceptual framework for this study ...... 12
Figure 4. Flow chart of participants ...... 22
Figure 5. Stressful coping strategies between domestic and migrant ...... 25
Figure 6. Distribution of STIs knowledge scores among domestic and migrant Thai workers ...... 31

List of Tables
Table 1. Calculation formulas and score ranges for the JCQ scores ...... 17
Table 2. Index scoring of health risk behaviors (HRBs) ...... 18
Table 3. General characteristics among domestic and migrant Thai workers by Chi-square analysis ...... 24
Table 4. Working conditions among domestic and migrant workers ...... 26
Table 5. Interpersonal Social Support score among domestic and migrant workers ...... 27
Table 6. Job content questionnaire among domestic and migrant workers ...... 28
Table 7. STIs knowledge among domestic and migrant workers ...... 30
Table 8. Sexual risk behaviors among domestic and migrant workers by Chi-square analysis ...... 32
Table 9. Tobacco smoking and alcohol used among domestic and migrant workers by Chi-square analysis ...... 34
Table 10. Correlation matrix between domestic and migrant Thai workers ...... 35
Table 11. Factors associated with high stress among workers by logistic regression model ...... 36
Table 12. Factors associated with HRBs among workers by logistic regression model ...... 38
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