衛生行政機關人員的職場社會心理特質、職場暴力經驗與其健康狀態之相關研究

Abstract

研究背景與目的：衛生行政機關人員需與民眾互動且需執行強制性工作，因此屬於職場暴力之風險族群。國外已有研究探討公共衛生人員於COVID-19疫情全球大流行時期的工作與健康狀況，並發現有長工時以及健康狀況較差等現象，然而國內在此方面仍較少有實證研究。本研究探討衛生行政機關人員的職場社會心理特質、職場暴力經驗與健康狀態，包括職場暴力類型、來源、相關因素及其健康影響。 研究方法：於2022年3月9日至16日進行網路問卷調查。研究對象為20歲至65歲，於衛生福利部及其所屬衛生行政機關及各縣市衛生局所任職一年以上人員。問卷內容包括過去一年的職場暴力經驗、上週工時、工作負荷（分為工作心理負荷與工作體力負荷）、工作控制、職場正義、自評健康、心理健康與個人疲勞等。本研究問卷總共發放500份，回收有效樣本492份。 研究結果：衛生行政機關人員於過去一年曾遭遇肢體、言語、心理或性騷擾任一形式職場暴力的盛行率為48.17%；以言語暴力最普遍(43.50%)，心理暴力次之(31.71%)，肢體暴力與性騷擾的比例則小於3%。言語與心理暴力的最主要來源以上司比例最高，其次為服務對象，再其次為同事。服務於基層衛生所者、上週工時超過48小時者、工作心理負荷高者、有工作體力負荷者以及工作控制低者與職場正義低者，都有較高之任一形式職場暴力、言語暴力及心理暴力盛行率。複羅吉斯迴歸分析發現，職場正義低落為任一形式職場暴力、言語暴力及心理暴力之主要相關因素；若將言語暴力及心理暴力按內外部來源區分，則可發現職場正義低落為內部言語暴力及內部心理暴力（來自上司、同事、部屬）之主要相關因素，而例行工作會與民眾直接互動為外部言語暴力及外部心理暴力（來自服務對象及其他第三方）之主要相關因素。此外，本研究亦發現衛生行政機關人員有工時偏長、工作負荷較高以及健康狀態較差之現象。衛生行政機關人員自評健康不佳的比例有22.97%，高程度個人疲勞的比例有25.20%，心理健康不佳的比例有63.41%。在控制性別、年齡、工作心理負荷、工作體力負荷以及工作控制後，曾遭遇任一形式職場暴力、言語暴力或心理暴力的衛生行政機關人員，其自評健康不佳、心理健康不佳以及高程度個人疲勞之風險顯著較高。內部的言語暴力及心理暴力相較外部的言語暴力及心理暴力，對衛生行政機關人員的自評健康、心理健康以及個人疲勞影響較大。 結論：相較於先前的受僱者調查資料，本研究發現衛生行政機關人員的職場暴力盛行率偏高，亦有工時偏長、工作負荷較高以及健康狀態較差之現象。本研究並發現曾遭遇職場暴力的衛生行政機關人員，其健康狀態較差之風險顯著較高。衛生行政機關人員的職場暴力問題及其工作與健康狀態是主管機關應重視的議題。

Background and objectives: Workers of the public health administration agencies are at risk of workplace violence because their routine work requires interacting with the public and carrying out enforcement duties. Several recent studies have examined the work and health conditions of public health workers in other countries during the COVID-19 pandemic, in which heavy workloads and poor health conditions were reported. However, few studies have been conducted in Taiwan. This study aimed to investigate the psychosocial work characteristics, workplace violence experiences, and health status among workers of the public health administration agencies in Taiwan. The types, sources and correlates of workplace violence and its associations with health status were examined among workers of the public health administration agencies in Taiwan. Methods: An online survey was conducted from March 9, 2022 to March 16, 2022. Participants were 20-65 years of age and had been working in the Ministry of Health and Welfare, its subordinate agencies, the departments of health and public health centers for more than one year. Their experiences of workplace violence over the past year, working hours in the last week, job demands (psychological job demands and physical job demands), job control, workplace justice, self-rated health (SRH), mental health and personal burnout status were assessed by a self-administered questionnaire. A total of 500 questionnaires were distributed and 492 valid questionnaires were available for analysis. Results: Of all participants, 48.17% had experienced any type of workplace violence (physical, psychological, verbal or sexual) over the past year. Verbal violence was the most common type of workplace violence (43.50%), followed by psychological violence (31.71%), and the prevalence of physical violence and sexual harassment were less than 3%. Supervisors were the most common source of verbal violence and psychological violence, followed by clients and colleagues. The prevalence of any type of workplace violence, verbal violence, and psychological violence were higher among workers of public health centers, those whose working hours were more than 48 hours in the last week, and those who had physical job demands, high psychological job demands, low job control and low workplace justice. Results of the multiple logistic regression analysis showed that low workplace justice was most significantly associated with the risk of any type of workplace violence, verbal violence, and psychological violence. When violence was separated by their sources, low workplace justice was found to be most significantly associated with the risks of having internal verbal violence and internal psychological violence which were from supervisors, colleagues and subordinates, while interaction with the public was found to be most significantly associated with the risks of external verbal violence and external psychological violence which were from clients and other third parties. Furthermore, long working hours, high job demands, and poor health status were also found in this study. The percentage of poor self-rated health was 22.97%, the percentage of high level of personal burnout status was 25.20%, and the percentage of poor mental health was 63.41%. After adjustment for gender, age, psychological job demands, physical job demands and job control, respondents who had experienced any type of workplace violence, verbal violence or psychological violence had significantly higher risks of poor self-rated health, mental health and higher personal burnout status. When compared with external verbal and psychological violence, internal verbal and psychological violence were more strongly associated with poor health. Conclusions: As compared to the findings from a previous survey among general employees, this study found that workers of the public health administration agencies had higher risks of workplace violence, longer working hours, higher job demands, and poor health status. Respondents who had experienced workplace violence were at higher risks of poor health status. Workplace violence, work conditions and health status among workers of the public health administration agencies should be of concern by the authorities.