Abstract
Background
Informal wood furniture workers face various occupational health and safety risks that may impact their health and quality of life (QOL). Improving health literacy (HL) could help mitigate these risks. This study aims to assess HL levels and their relationship to QOL among this group in Thailand.
Methods
This cross-sectional study was conducted in 2023 and involved 175 informal wood furniture workers employed in Ban Ma, Lamphun province, Thailand. Data collection instruments comprised the Occupational Health Literacy Questionnaire (TOHLS-IF) and a questionnaire assessing informal workers' QOL. Analysis encompassed descriptive statistics alongside partial correlation analysis (p < 0.05).
Results
Respondents demonstrated high overall health literacy (2.34 ± 0.45). Considering eight dimensions of QOL in the sample, some variables, such as insufficient income, debt, and underlying disease, were prevalent at high percentages and seemed to diminish workers' QOL. After adjustment for gender, age, level of education, and work experience, most QOL dimensions correlated positively with workers' HL levels (p < 0.05); significant variables included career goal setting (rs = 0.27, p < 0.001), conflicts in workplace (rs = 0.20, p = 0.009), environmental satisfaction (rs = 0.41, p < 0.001), readiness to use internet (rs = 0.28, p < 0.001) and applications (rs = 0.29, p < 0.001), coworker's respect (rs = 0.15, p = 0.003), and goal setting to advance career (rs = 0.28, p < 0.001). No significant relationship was observed between prevalent QOL-diminishing factors and health literacy.
Conclusion
The observed link between HL levels and multiple dimensions of QOL among informal wood furniture workers underscores the need for targeted interventions. Policymakers and social initiatives should focus on promoting health literacy and relevant skills to enhance QOL within this population.
Keywords: Health literacy, Informal wood furniture workers, Quality of life, Thailand
1. Introduction
In many developing countries, like Thailand, informal workers are vital for economic and social progress. In 2021, informal employment in Thailand reached 19.6 million, constituting 52% of the workforce, and surpassing formal employment [1].
Informal workers in the wood furniture industry have played an important role in driving economic development as the wooden furniture industry in Thailand has experienced remarkable growth in the past few years. Between 2020 and 2022, the export value of this industry grew by 25.27%, to 16,849.58 million THB [2]. However, unsafe working environments and working conditions are common for this population of workers. According to one study done in Thailand, dangerous or substandard working conditions pose potential health risks for informal wood furniture workers [3]. The occupational hazards that are prevalent among this group include machine-related hazards, hazards due to wood dust, hazards related to handling, and hazards due to chemical products, in addition to ergonomic and psychosocial hazards [3,4].
The consequences of these hazards are possible illness or injury. In a study among informal wood furniture workers in Cameroon [4], the most frequent consequences of work hazards were wounds, heat stroke, and infections. In Thailand, the most common work-related illnesses among 180 informal wood furniture workers were musculoskeletal pain, such as waist pain (82.78%) or back pain (70.56%), and work-related stress (51.67%) [3]. Work-related injuries were nonfatal injuries (86.57%), and injury causation was related to striking one's body parts against an object (47.77%) or being cut by sharp objects (36.56%), while injured body parts included hands and fingers (36.57%). The above work-related illnesses and injuries have a serious impact on informal wood furniture workers' health and may have negative effects on their quality of life (QOL) [3].
QOL is an essential aspect of human health and is embedded in a physical, mental, and social context. Poor QOL has been found to be strongly associated with reduced work performance and early retirement [5]. Different occupations demonstrate different levels of QOL which can be influenced by multiple factors [6,7]. In order to effectively address QOL among informal wood furniture workers, it is important to consider their QOL and the health intervention measures that maintain or improve their QOL [6].
Moreover, there is also a growing body of evidence supporting the impact of inadequate health literacy on individuals' health [8]. Health literacy (HL) is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [9]. According to empowerment theory, enhancing HL can empower individuals to make informed decisions regarding their health and lead to improved health outcomes and overall well-being [10], thus improving QOL. This is consistent with the World Health Organization regarding their view that HL is critical to empower people to make decisions about personal health, and it is closely related to health status and QOL [11].
A study among waste collectors in the Northeast of Thailand found adequate to excellent levels of HL were significantly associated with good QOL [12]. Furthermore, a study in Iran demonstrated a statistically significant and direct relationship between HL and QOL among nurses working in teaching hospitals [13]. Also in Iran, a study among nurses working in the largest heart center of the Northwest in Tabriz, a significant relationship was observed between HL and QOL among this group [14]. Despite the important role of informal wood furniture workers as the largest proportion of their respective economic sector and their effect on driving economic development, there have been no comprehensive studies focusing on the relationship between HL and QOL among this group in Thailand.
The current study aimed to explore the correlation between QOL and HL among informal wood furniture workers in Thailand. The findings derived from this investigation hold potential significance in informing interventions aimed at enhancing both QOL and HL within this demographic cohort. By elucidating the interplay between these constructs, the study endeavors to provide actionable insights that could guide the development and implementation of targeted interventions tailored to the specific needs of informal wood furniture workers. Consequently, the implications of this research extend beyond theoretical discourse, fostering practical applications conducive to fostering improved well-being and health outcomes among this population subset.
2. Materials and methods
2.1. Study design and setting
The study comprised a descriptive cross-sectional survey conducted between February 17 and April 23, 2023, among informal wood furniture workers in Ban Ma, a prominent furniture village renowned for producing various wooden furniture types in Lamphun province, Northern Thailand [15].
2.2. Participants
The participants, as mentioned above, were informal wood furniture workers working in Ban Ma, Lamphun province, Thailand. They were working in an informal sector that is unorganized, both at the employers' and workers' levels. Sample size calculation was carried out using Krejcie and Morgan's table [16]. From a population of 320 informal wood furniture workers, a sample size of 175, as recommended by Krejcie and Morgan, were needed to represent a cross-section of the population. In order to determine an adequate sample size, Cohen's statistical power analysis [17] was used. We predetermined the effect size of r = 0.30 (medium), a significant alpha = 0.05, and a statistical power of .80. The desired sample size was 85 [18], ensuring that the 175 respondents recommended by Krejcie and Morgan were sufficient to perform the statistical analysis.
From the population of 320, 175 individuals were selected via simple random sampling by drawing their name cards from a box. In this method, every individual had an equal chance of being selected in the sample from the population, resulting in an unbiased and impartial selection method [19]. Inclusion criteria encompassed informal wood furniture workers with over one year of experience and a willingness to participate in the study.
2.3. Data collection
Data collection utilized a questionnaire comprising three sections. The initial segment focused on gathering demographic information from participants, encompassing details such as age, gender, and other pertinent demographic characteristics.
The second section included the Occupational Health Literacy Questionnaire (TOHLS-IF), developed by Suthakorn et al. (2020) (Thai language version), which is a valid and reliable instrument for assessing Thai informal workers' OHL [20]. The questionnaire contains 38 items across 4 components, which include 1) ability to gain access (7 items); 2) understanding (15 items); 3) evaluation (4 items); and 4) use of occupational health and safety information (12 items). The scores for each item were calculated in the form of three-choice questions with scores of 3, 2, or 1, where a score of 3 indicated the worst status and 1 indicated the best status. The mean scores for each component were interpreted into HL levels as follows:
Mean scores of 2.34 – 3.00 indicate high HL.
Mean scores of 1.68 – 2.33 indicate moderate HL.
Mean scores of 1.00 – 1.67 indicate low HL.
The third section included the quality of informal worker's life questionnaire (Thai language version), developed by the Office of the Permanent Secretary for the Ministry of Labor. This questionnaire has been used with different groups of informal workers, and its validity and reliability have been confirmed in various studies [21]. It assesses eight dimensions: 1) economic, 2) social, 3) health, 4) safety, 5) environment, 6) work, 7) availability and capacity of informal employed workers, and 8) other [22].
To identify the relationship between QOL and occupational HL, QOL was a dichotomous variable (yes/no) measured through the eight dimensions.
2.4. Statistical analysis
Descriptive statistics, such as frequencies, means, and standard deviations, were employed to summarize the characteristics of the study participants. The relationship between QOL and occupational HL was examined using partial correlation analysis to avoid statistical confounding. For instance, existing inequalities of individuals, such as gender, age, level of education, and work experience, can impact whether people can easily develop and use HL [11]. Therefore, partial correlation analysis used gender, age, level of education, and work experience as control factors. All statistical analyses were conducted with a significance level set at p < 0.05. The data analysis was performed using the IBM SPSS Statistical Package for Windows (Version 22.0).
2.5. Ethical considerations
This research was approved by the Ethics and Human Subject Committee (No. 2565-EXP083). Participants were fully informed about the objectives of the study, the process of data collection, and the principle of confidentiality. They were informed of their rights to withdraw from the study at any time. All participants gave informed consent to participate in this study. Then, anonymous questionnaires without any first names and surnames were distributed among the participants. The researchers tried to stay with the participants at the time of completing the questionnaires to assure the accuracy of the participants' answers. At the same time, the researchers tried to justify the importance of the study topic for the participants to increase the response rate.
3. Results
Out of the 175 questionnaires distributed, 172 were completed in full (98.28% response rate). Over half of the participants were male (51.7%), while the mean (SD) age of all participants was 50.53 (7.6) years. More than half of them had graduated from primary school (54.0%). Almost 50% of those surveyed worked in general employment (48.8%), and more than 80% were employed as a primary occupation. Between one-third and one-half had never worked or pursued another occupation before (40.7%). Informal wood furniture workers who had worked in the system before had switched to the informal sector mainly due to their need for autonomy, followed by working in a system that was not worth the wages or income that they earned. More than half of the surveyed workers cited the need for work protection benefits (50.6%). Table 1 shows the frequency distribution of the informal wood furniture workers participating in this study.
Table 1.
Frequency of the informal wood furniture workers participating in the study (N = 172)
| Variable | Category | Frequency n (%) |
|---|---|---|
| Gender | Male | 89 (51.7) |
| Female | 83 (48.3) | |
| Age (years) | <35 | 24 (13.9) |
| 36–40 | 20 (11.7) | |
| 41–45 | 12 (6.9) | |
| 46–50 | 18 (10.5) | |
| 51–55 | 26 (15.1) | |
| 56–60 | 26 (15.1) | |
| 61–65 | 26 (15.1) | |
| >66 | 20 (11.6) | |
| Level of education | Primary education | 93 (54.0) |
| Secondary education | 37 (21.5) | |
| Associate degree | 16 (9.3) | |
| Bachelor degree | 26 (15.1) | |
| Employment status | General employment | 84 (48.8) |
| Proprietor | 27 (15.7) | |
| Family business | 41 (23.8) | |
| Other | 20 (11.6) | |
| Secondary occupations | Yes | 25 (14.6) |
| No | 147 (85.4) | |
| Work experience (years) | <5 | 58 (33.7) |
| 6–10 | 43 (25.0) | |
| 11–15 | 23 (13.4) | |
| 16–20 | 26 (15.1) | |
| 21–25 | 4 (2.3) | |
| 26–30 | 11 (6.4) | |
| >31 | 7 (4.0) | |
| Worked another occupation before | Yes | 102 (59.3) |
| No | 70 (40.7) | |
| Need for work protection benefits | Yes | 87 (50.6) |
| No | 85 (49.4) |
3.1. Quality of life of informal workers
1) Economics: Over half of informal wood furniture workers did not have enough income for household spending (51.2%), while almost half of them were in debt (48.8%). Formal loans were the reason for debt among 93.4% of those surveyed. 2) Social: More than half of the respondents had their own residences with no installments needed (59.9%), and most of them worked without encountering any problems at work (94.7%). 3) Health: 90.7% of informal workers surveyed were in normal physical condition, and only 9.3% had a disability. More than half of them had no underlying disease (54.0%), but 45.9% had health problems from work, such as muscle aches or pains. 4) Security: Most of the respondents had never been injured during their work operations (78.5%) and had never experienced any adverse events (93.0%). 5) Environment: On average, respondents lived about 1.4 kilometers from their workplace and were satisfied to very satisfied with their environment (71.5%). 6) Work: Most of the sample group had no problems in their occupations (80.8%). 7) Availability and capacity: The respondents had the highest level of readiness to use Thai, and could not use another language at 70.9%. 8) Others: Additionally, the study revealed that, on average, participants worked for 7.55 hours per day, with a relaxation period averaging 7.05 hours. Furthermore, the majority of participants reported never experiencing insults or nonacceptance at their workplace (94.8%).
The survey details assessing the quality of life of informally employed workers are shown in Table 2.
Table 2.
Quality of life of the informal wood furniture workers (N = 172)
| Quality of life dimensions | n (%) |
|---|---|
| Economics | |
| Enough income | |
|
84 (48.8) |
|
88 (51.2) |
| In debt | |
|
84 (48.8) |
|
88 (51.2) |
| Worth working | |
|
113 (65.7) |
|
59 (34.3) |
| Career goal setting | |
|
66 (38.4) |
|
106 (61.6) |
| Social | |
| Own residence with no installments needed | |
|
103 (59.9) |
|
69 (40.1) |
| Conflicts in workplace | |
|
9 (5.3) |
|
163 (94.7) |
| Health | |
| Normal physical condition | |
|
156 (90.7) |
|
16 (9.3) |
| Underlying disease | |
|
79 (46.0) |
|
93 (54.0) |
| Health problems from work | |
|
79 (45.9) |
|
93 (54.1) |
| Safety | |
| Work accidents and injuries | |
|
37 (21.5) |
|
135 (78.5) |
| Work incident | |
|
12 (7.0) |
|
160 (93.0) |
| Environment | |
| Very satisfied | 58 (33.7) |
| Satisfied | 65 (37.8) |
| Neutral | 37 (21.5) |
| Dissatisfied | 7 (4.1) |
| Very dissatisfied | 5 (2.9) |
| Work | |
| Occupational problems/problems at work | |
|
33 (19.2) |
|
139 (80.8) |
| Availability and capacity | |
| Readiness to use Thai | |
|
171 (98.86) |
|
1 (1.14) |
| Readiness to use another language | |
|
54 (29.1) |
|
118 (70.9) |
| Readiness to use internet | |
|
132 (76.6) |
|
40 (23.4) |
| Readiness to use any applications | |
|
114 (66.3) |
|
58 (33.7) |
| Others | |
| More time for leisure | |
|
147 (93.7) |
|
25 (6.3) |
| Balance between personal and professional life | |
|
164 (95.35) |
|
8 (4.65) |
| Disrespect from coworkers | |
|
9 (5.2) |
|
163 (94.8) |
| Set workplace goals to advance career | |
|
102 (59.5) |
|
70 (40.5) |
3.2. Health literacy of informal wood furniture workers
Overall, respondents exhibited high levels of health literacy (HL), with a mean score of 2.34 ± 0.45. Examination of HL dimensions revealed high levels of understanding and information application among respondents (mean scores of 2.53 ± 0.42 and 2.38 ± 0.49, respectively), while accessibility and assessment demonstrated moderate levels (mean scores of 2.19 ± 0.53 and 2.23 ± 0.70, respectively) (see Table 3).
Table 3.
Health literacy level of informal wood furniture workers (N = 172)
| Dimensions | Mean score () | S.D. | Health literacy level |
|---|---|---|---|
| Accessibility | 2.19 | 0.53 | Moderate |
| Understanding | 2.53 | 0.42 | High |
| Evaluation | 2.23 | 0.70 | Moderate |
| Information application | 2.38 | 0.49 | High |
| Overall | 2.34 | 0.45 | High |
3.3. The relationship between quality of life and health literacy of informal wood furniture workers
Considering the relationship between each dimension of QOL and the level of HL in the studied workers after adjustment for gender, age, level of education, and work experience, most dimensions of QOL (except health, safety, and problems at work) were positively correlated with the workers HL levels. Regarding the variables of each dimension, there were significance in some variables, including career goal setting (rs = 0.27, p < 0.001), conflicts in the workplace (rs = 0.20, p = 0.009), environmental satisfaction (rs = 0.41, p < 0.001), readiness to use internet (rs = 0.28, p < 0.001) and applications (rs = 0.29, p < 0.001), coworker's respect (rs = 0.15, p = 0.003), and goal setting to advance career (rs = 0.28, p < 0.001) (see Table 4).
Table 4.
The relationship between quality of life and health literacy (N = 172)
| Quality of life dimensions | Health literacy level | p |
|---|---|---|
| Economics | ||
|
0.07 | 0.330 |
|
-0.10 | 0.193 |
|
-0.14 | 0.116 |
|
0.27 | <0.001 |
| Social | ||
|
0.03 | 0.615 |
|
0.20 | 0.009 |
| Health | ||
|
-0.04 | 0.534 |
|
0.10 | 0.236 |
|
-0.17 | 0.057 |
| Safety | ||
|
-0.02 | 0.724 |
|
-0.05 | 0.472 |
| Environmental satisfaction∗ | 0.41 | <0.001 |
| Work | ||
|
0.01 | 0.887 |
| Availability and capacity | ||
|
0.15 | 0.053 |
|
0.03 | 0.635 |
|
0.28 | <0.001 |
|
0.29 | <0.001 |
| Others | ||
|
-0.08 | 0.251 |
|
-0.01 | 0.974 |
|
0.15 | 0.043 |
|
0.28 | <0.001 |
Notes. Adjusted variables: gender, age, level of education, and work experience.
Significant difference was found (p < .05).
4. Discussion
The purpose of this study was to investigate the relationship between QOL and occupational HL of informal wood furniture workers in Thailand. There were two major findings in this study. Firstly, the respondents demonstrated a high overall health literacy level. Secondly, most QOL dimensions were positively correlated with the workers HL levels (p < .05). Prevalent factors such as insufficient income, debt, and underlying diseases appeared to lower their QOL, but there was no significant relationship observed between prevalent QOL-diminishing factors and health literacy.
Regarding the high overall health literacy level among the respondents, this is consistent with the results of an investigation by Pholpark et al. (2022) which examined HL levels across informal occupation groups, including general laborers, agricultural laborers, and retailers [23]. A study conducted by Phosrikham and Laohasiriwong (2020) examined HL levels of Thai municipal waste collectors, reporting that more than half of the respondents had inadequate to problematic levels of HL [12]. These results, however, are inconsistent with the present findings. Possible reasons for these differences include the type of statistical population, the occupation of the study population, and the type of tool used. This was also concluded by Pholpark et al. (2022), namely, that different informal occupation groups have different levels of HL [23].
Considering the eight dimensions of QOL in this sample group of workers, variables such as insufficient income (51.2%), being in debt (48.8%), no career goal setting (61.6%), having underlying disease (46.0%), work-related health problems (45.9%), and inability to use another language (70.9%) can be considered as the factors resulting in their decreased QOL as each had a negative association with QOL and existed at high percentages. In this regard, Sindecharak and Kwanyou (2021) also showed that informally employed workers considered that the most important factors related to their QOL were income and welfare [21]. Thus, it could be noted that the quality of informal workers' lives can be similarly considered among the factors affecting their everyday life, functioning, and work efficiency.
Regarding the relationship between participants' QOL and HL, the relationships between each dimension of QOL and the overall level of HL were considered. The results showed that most dimensions of QOL had a positive, significant relationship with the level of workers' HL reflecting the impact of HL on improving QOL. This is consistent with studies among healthcare workers regarding nurses conducted by Yusefi et al. (2019) [13] and Kheiri et al. (2019) [14]. However, a study conducted by Eisapareh et al. (2022) that measured the relationship between industrial workers' health literacy and quality of work life found that it was insignificant [24]. This difference may be due to the study population and the types of HL instruments and QOL instruments used.
In the present study, the QOL variables for each dimension, such as insufficient income, debt, and underlying disease, were shown to be at high percentages, appearing to diminish workers' QOL. However, no significant relationships were found between those variables and HL levels. The reason for this may be that, among this group of participants, high HL levels, which lead to better access and understanding of health information and making appropriate health decisions [9], were not directly related to increasing workers' income or decreasing the number of people with underlying or chronic diseases. However, it should be noted that HL has been recognized as an important index of health status and illness in all types of workers [8,11] while inadequate HL can lead to reduced work performance, induce occupational harms, decreases income, and subsequently, causes debt. As a result, there is a need for a better approach toward managing workers with low HL.
Cloonan et al. (2013) have suggested strategies to address people with low HL including (a) using the teach-back method; (b) using jargon-free verbal communication; (c) using simple illustrated written materials; (d) continuing phone calls or text-targeted messages; and (e) involving family and significant others. In addition, some workers may require very detailed, personalized assistance (e.g. health coaches, interpreters, and/or navigators, picture cards, or individualized hands-on teaching by health professionals) to assist them in overcoming barriers to understanding, navigating, and using the health system [25]. Occupational health and safety personnel workers can assist individual employees in reaching their HL potential and lead organizational initiatives to address HL challenges.
This study has some limitations, the first of which is in regard to the study design used. We used a self-report style for collecting data with the questionnaires; therefore, we cannot refute the potential influence of reporting and/or recall bias. Another limitation of this study is generalizability. All of the informal wood furniture workers who participated in this study were working in one location, Ban Ma, Lamphun province. Hence, this study may not include different perspectives from informal wood furniture workers who work in other provinces or countries, as well as informal workers working in other sectors, each of which have their own unique context.
In conclusion, the occupational HL of most of the informal workers who were studied was at a desirable level. However, there were many factors prevalent at high percentages, and these seemed to diminish their QOL. Regarding the relationship between QOL and occupational HL, most QOL dimensions had a positive, significant relationship with participants' HL levels. This issue highlights the importance of greater focus on occupational HL as a relatively new concept in health promotion programs, and subsequently, QOL in informal wood furniture workers. Therefore, policies and socially applied projects are required to increase HL and its relevant skills in order to improve QOL among informal wood furniture workers.
CRediT authorship contribution statement
Patcharin Chaisurin: Writing – review & editing, Writing – original draft. Weeraporn Suthakorn: Writing – review & editing. Kunlayanee Tantranon: Data curation. Anon Wisutthananon: Data curation.
Ethical statement
This research was approved by the Research Ethics Committee of the Faculty of Nursing, Chiang Mai University (No. 2565-EXP083).
An authorship statement
All authors have agreed on the final version and meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors.
Funding
This research was supported by the Thai Health Promotion Foundation.
Conflicts of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acknowledgments
The authors are grateful to the informal wood furniture workers who contributed to our study.
Footnotes
The authors have disclosed that they have no significant relationships with, or financial interaest in, any commercial companies pertaining to this article.
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