Development of a proactive service model for occupational health and environmental medicine in sub-district health promoting hospitals, Pathumthani province

Abstract

          Agricultural workers represent a vulnerable population for pesticide-related occupational diseases. In Pathum Thani Province, pesticide poisoning incidence has risen markedly, while occupational health services at Sub-district Health Promoting Hospitals (SHPHs) remain predominantly reactive and structurally limited. This Research and Development (R&D) study aimed to analyze occupational risk factors and health problems among farmers, develop a proactive occupational and environmental health management model, and evaluate the model's appropriateness and feasibility. The study comprised 358 farmers recruited by simple random sampling and 30 key stakeholders selected by purposive sampling. Data were collected using the pesticide risk assessment tool (NBKH 1-56), blood cholinesterase screening, and an occupational health standards self-assessment form. Quantitative data were analyzed with descriptive statistics; qualitative data underwent content analysis.

          Risk factor analysis revealed that 43.0% of farmers concurrently mixed and sprayed pesticides, and 37.2% did not bathe immediately after spraying. Despite 57.0% having received prior training, 98.9% had never sought medical care even when symptomatic, indicating a significant Knowledge-Practice Gap. Blood cholinesterase screening identified 22.0% at-risk cases. SHPHs met only 18.5% of cumulative occupational health standards. A participatory A-I-C process with stakeholders yielded a four-activity model aligned with all five standard components: health surveillance, mobile screening and monitoring, environmental medicine management, and integrated occupational medicine consultation with systematic referral and health literacy enhancement.

          The developed model was evaluated by four experts as highly appropriate and feasible (86.67%;  = 17.33, S.D. = 0.75), demonstrating strong potential as a replicable framework for improving proactive primary-level occupational health care for agricultural workers.