รูปแบบการจัดการภาวะสุขภาพและการเจ็บป่วยจากการทำงานของลูกเรือพาณิชย์

บทคัดย่อ

Objectives The purpose of this research was to identify risks, to study work-related illnesses
and to develop a management model of health status and illness among maritime commercial
crews in the eastern sea boundary of Thailand.
Materials and Methods A research and development method was used. 18,458 crew members
working on merchant ocean liners in the eastern sea boundary of Thailand were enrolled in
this study. 114 crews were selected based on the following criteria: 1) the risk analysis and
study of diseases which occurred while working on board, 2) the development of a health
management model and 3) the evaluation of that model. The tools used in this study included
health records, health assessment and questionnaires of risk behaviors related to work-related
illnesses. Data underwent statistical analysis for frequency, percentage, mean and standard
deviation. Qualitative data was analyzed on a content analysis basis.
Results The study found that most of the maritime commercial crews were made up of males
(67.54%), with an average age of 30.8 ± 5.08 years. In the past year, ergonomic health problems
resulting from both working conditions as well as the manner of work included shoulder pain
(89.47%), arm/elbow/wrist/hand pain (85.96%), thigh/calf pain (79.82%) as well as anxiety/
stress from long periods on board (77.19%). The results of environmental analysis and working
conditions found that most of the crew had unsafe working conditions. Ranking these working
conditions includes being subjected to falling (80.70%), followed by the ergonomics of manual
handling such as lifting, moving while lifting up, lifting down, pushing, pulling and dragging on
a regular basis (68.42%). Likewise, contact with gases/vapors of chemicals such as solvents,
acids and alkalis (57.89%), was identified as a work-related risk. The safety behaviors of the
commercial crew were estimated at a moderate level (x =3.62, S.D. = 0.83) while working with
concerns for security and following, at all times, the regulations of the highest of all safety
behaviors. The model for the health management of commercial crews focused on participation
in 4 co-operative parts, namely: co-planning, co-operating, co-observing and co-reflecting. This

participatory health management model consisted of 7-steps, i.e.: 1) to first identify health
issues related to work with a pre-occupational health assessment, to evaluate job characteristics
associated with potential risk to health and workplace injury, to assess health status and health
behavior during work, to assess risk and control of risk for seafarers and identify all health
problems related to work on board; 2) to analyze the causes of problems and match solutions
to the crew’s needs and lifestyles; 3) to plan and coordinate activities and projects towards
managing health problems; 4) to implement the developed health management plan; 5) to
evaluate the plan and its implementation; 6) to continuously improve upon the plan, and
finally; 7) to create safe work habits from the continuous practice of the developed health
management plan. The results of the evaluation of this model were found to be appropriate
and applicable at the highest level (x = 4.88, S.D. = 0.70).
Conclusion Thai maritime commercial crews currently work in unsafe working environments
with high risks of work-related illnesses. Their current safety behavior is at a moderate level.
Therefore, this model of health management shall be promoted to help identify and prevent
future work-related illnesses among maritime commercial crews