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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 16
| Issue : 3 | Page : 444-447 |
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Association of social determinants on well-being of rural construction workers of Central India: A cross-sectional study
Prashil Jumade1, Abhishek Joshi1, Najnin Khanam2, Abhay Mudey1
1 Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra, India
2 Department of Community Medicine, SSIMS, Bhilai, Chhattisgarh, India
| Date of Submission | 29-Jan-2021 |
| Date of Decision | 30-Jun-2021 |
| Date of Acceptance | 25-Jul-2021 |
| Date of Web Publication | 12-Mar-2022 |
Correspondence Address:
Dr. Abhishek Joshi
Department of Community Medicine, JNMC, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_41_21
Background: Social determinants of the health (SDH) arise from the social and economic condition in which they are living and their interaction produces direct impact on the health. Wider socioeconomic context, social exclusion, poverty, etc. are considered as the SDH. Objectives: This study was conducted to assess sociodemographic profile, job characteristics, and the association of the social determinants on the well-being of rural construction workers. Materials and Methods: It was cross-sectional study carried out among the rural construction workers employed at one of the medical institutes in Central India. Results: About more than half of the study participants belonged to the lower class of socioeconomic status by Modified B. G. Prasad classification 2017. Sixty-three percent participants were laborers, followed by 32% in assistance services. Musculoskeletal pain was the most common self-reported health issue, whereas near about 3/4th of study participants were found to have low or no risk on Kesseler's Distress Scale. The association between education and socioeconomic condition with well-being of rural construction workers was not found to be statistically significant. While, the association between Kesseler's Distress Scale and the presence of addiction was found to be statistically significant. Conclusion: Maximum study participants belonged to lower socioeconomic class, and musculoskeletal pain was the most common self-reported illness. The association between well-being and Kesseler's Distress Score and addiction was found to be statistically significant.
Keywords: Job characteristics, Kesseler's Distress Scale, rural construction worker, social determinants of health, well-being
How to cite this article:
Jumade P, Joshi A, Khanam N, Mudey A. Association of social determinants on well-being of rural construction workers of Central India: A cross-sectional study. J Datta Meghe Inst Med Sci Univ 2021;16:444-7 |
| Introduction | |  |
With an expected population of 11.6 million construction staff in India, intervention to foster safety and well-being is of utmost importance.[1] “Social determinants of health” (SDH) derive from the social and economic environments under which people function and these variables interfere with each other to have a significant impact on well-being and to estimate the largest proportion of the difference in health status. The Commission on SDH (CSDH) was founded by the World Health Organization (WHO) on the premise that SDH intervention is the most efficient way to enhance the well-being of all people and minimize inequalities.[2]
A variety of reasons have been defined as SDH and these typically include: the wider socioeconomic context; inequality; poverty; social exclusion; income; public policies; health services; employment; housing; transportation; and health habits or activities − eating, smoking, and alcohol (substance abuse); and psychosocial factors − the social and group networks and emotional management viewpoint on a life cycle offers a context for recognizing how such SDHs form and affect the well-being of an person from birth to old age.[3] The SDH are the circumstances under which individuals are born, develop, function, live, and age, and the larger range of forces and processes that form the circumstances of everyday life. Such powers and structures involve economic and institutional laws, strategies for growth, societal values, social policy, and political processes.[4] WHO's CSDH said progress on SDH is the most successful means of enhancing all people's well-being and raising disparities.[2]
Many rural construction workers are involved in unorganized sector of construction industries. In this unorganized sector, workers usually do not have adequate knowledge on hazards related to works; they are temporarily recruited with insufficient experience.[5] Quality of life is a common concept conveying an overall feeling of well-being, covering elements of pleasure, and life satisfaction as a whole. In the present study, the well-being was assessed by the modifying the questionnaire of core healthy day measures.[6]
Study conducted by Ridhi Bhatt and others showed that only 2% of participants were having extreme high stress but, maximum of 85% of participants were having high stress. Furthermore, unmarried participants had more significant high stress (48/82, 58.5%, X2 = 5.81, P < 0.05) than married participants. Stress level among the study participants was not found to be statistically significant with age, sex, and literacy level.[7] Tiwari et al. in their study done at urban areas of Kolkata showed that 96.5% were males by gender and 60.7% were married. Furthermore, out of all study participants, 58.4% had nuclear type of family and the remaining 41.6% had adopted joint type of family system, and most of them (48.2%) were helpers and 57.2% were earning <Rs. 5000.[8] Again study conducted by Adsul et al. showed that about 7.4% were belonged to below the poverty line. Furthermore, the average health problems were found to be 1.41. About 23.11% study population were suffering from fever and 12.6% were having respiratory infections. While, about 19% of study participants were asymptomatic. The association between health status was statistically significant with occupation (P = 0.03) and not found to be statistically significant with education (P = 0.12), socioeconomic status (P = 0.44).[9]
Aim
Assessment of association of social determinants on well-being of rural construction worker working in the premises of one of the esteemed medical institute of central India.
Objectives
- To evaluate the sociodemographic and job characteristics of the construction workers
- To assess the association of social determinants on well-being.
| Materials and Methods | | |
Study design and area
It was a cross-sectional study carried out in the premises of one of the medical institutes of Central India.
Study participants and sampling
The study participants were the construction worker working in the premises of one of the medical institutes of Central India. Universal sampling method was used. The list of all construction workers working at various construction sites in the premises of institute was obtained from the civil engineer and was contacted and interviewed at the working site. A total of 214 workers were enrolled at the civil engineer's office, out of which 200 workers gave consent for the study. Hence, the final sample size was 200 construction workers by the universal sampling method. The total study duration was 6 months starting from October 2017 to March 2018, wherein first 3 months were for data collection and next 3 months for compilation of results and preparing the report.
Data collection tools and process
The interview was conducted with a semi-structured questionnaire that was divided into the following parts, namely (1) sociodemographic characteristics, (2) job characteristics including work type, nature, and duration, and (3) psychological distress using Kessler's Psychological Distress Scale consisting ten questions on nonspecific psychological distress and is about the level of anxiety and depressive symptoms a person may have experienced in the most recent 4-week period. The response for each of the ten items is categorized using a Likert scale 1–5; ten items are summed to give scores ranging between 10 and 50 to classify as low risk (score 10–15), medium risk (score 16–29), and high risk (score 30–50).[10]
The civil engineer was contacted, and the list of all workers was obtained from him. A meeting was conducted with construction workers with the help of civil engineer, and the purpose of the study was explained to the workers. The data were collected with the help of predesigned, pretested semi-structured questionnaire in the evening after working hours were over.
Study analysis
Recorded data are stored in the sheets of Microsoft Excel. The statistical study was rendered using Epi info/OpenEpi Program, which is accessible free of charge in the public domain. To explain socioeconomic and work features, concise figures were used, and the association was evaluated using the Chi-square method.
Ethical issues
The ethical approval was taken from the Institutional Ethics Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University) (DMIMS [DU]). The topic of research was approved with ref no. DMIMS (DU)/IEC/2017-18/7085 on dated January 10, 2018. Written informed consent in language understood to study participants was obtained from each study participant before the start of interview.
| Observations and Results | | |
[Table 1] shows that roughly 54.5% of research participants belonged to the lower level of socioeconomic standing by the 2017 Updated BG Prasad classification led by 33.5% lower-middle-class study participants. Furthermore, about 3% of study participants were belonging to upper-middle class. While, when asked for their job characteristic, about 63% of study participants were laborer, whereas 16%, 14.5%, and 6.5% of study participants were assistance service providers, plumber/electricians, and carpenters, respectively. | Table 1: Socioeconomic status and job characteristics of study participants
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[11]
About 48.5% of study participants complained about musculoskeletal pain, whereas 24.5% of study participants did not report any physical illness. Furthermore, out of all females (n = 67), about 43.2% of females reported menstrual problems in the form of dysmenorrhea, menorrhagia, etc [Table 2]. | Table 2: Self-reported physical illness and psychological distress among the study participants
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Almost 3/4th (71%) study participants were found to have low or no risk of psychological distress according to Kesseler's Psychological Distress Scale. While, 24.5% and 4% of study participants were found to have medium and high risk of psychological distress, respectively.
From [Table 3], we came to know that out of all whose well-being was affected, about 65.7% belonged to lower socioeconomic class, followed by 22.9% belonged to lower-middle class by Modified BG Prasad classification 2017. However, the association socioeconomic classification and well-being were not statistically significant (P = 0.283).
When compared well-being with Kesseler's Distress Scale, 54.2% of well-being affected subjects were having medium psychological distress risk, whereas 22.9% affected study participants were having low and high risk each. The association between the well-being of study participants and Kesseler's psychological distress score was statistically highly significant (P < 0.001).
Furthermore, out of all whose well-being was affected, about 57.1% were illiterate followed by 22.9% educated up to primary and 20% educated up to secondary school indicating more is the education less is the well-being affected. However, the association between well-being and education was not statistically significant (P = 0.403).
While, of all whose well-being was affected, 91.4% of study participants were having some kind of addiction, and the association between well-being and the presence of addiction was found to be statistically significant (P = 0.003).
| Discussion | | |
In the present study, maximum 54.5% of study participants were belonging to the lower class of socioeconomic status according to the modified BG Prasad classification, followed by 33.5% in the lower-middle class. This means that the per capita income of more than 85% of study participants ranges from <Rs. 938–1875. These results are similar to the results of Tiwari et al.[8] where 57.2% of study participants were earning <Rs. 5000/month. Furthermore, about 63% in the present study were laborers, whereas 16% of study participants were assistance service providers or helpers which is contrary to the results of Tiwari et al.[8] where majority 48.2% were helper class. This difference in the result may be due to the difference in the work type or requirement of work in that study area setting. In the present study, when asked for the self-reported physical illness, maximum of 48.5% of study participants reported about the musculoskeletal pain as their problem which similar to the results of Tiwari et al.[8] whereas, the study conducted by Adsul et al.[9] showed that 23.11% were suffering from fever, followed by 12.6% having respiratory infection. This difference in the study results might be because in our present study, we assess the self-reported physical illness while the study conducted by Adsul et al.[9] were conducted with provision of comprehensive health services to the study population in the form of health checkups. In the present study, maximum of 71.5% of study participants were having low or no risk of psychological distress, whereas 24.5% were having medium, and 4% study participants having high risk of psychological distress. Furthermore, the association between well-being and Kesseler's psychological distress score was found to be statistically significant (P < 0.001). In the present study, the association between well-being and the presence of addiction was found to be statistically significant (P = 0.003), while association between well-being andamp; education and socioeconomic status were not found to be statistically significant (P = 0.403, 0.283 respectively). These results were contrary to the results from study conducted by Bhatt other where almost 85% of participants have high stress and 2% of participants have extreme high stress. Study did not found significant association of stress level with age, sex, and literacy level.[7] While study conducted by Adsul et al.[9] showed that association between health status was statistically significant with occupation (P = 0.03) and not found to be statistically significant with education (P = 0.12) and socioeconomic status (P = 0.44).
| Summary and Conclusion | | |
Maximum 66.5% of study participants were male, and maximum study participants were in the age group of 31–35 years. Of all construction workers in the study, maximum of 54.5% were belong to lower socioeconomic status according to modified BG Prasad classification 2017 followed by 33.5% in lower-middle-class socioeconomic status. About 63% study participants were laborers, whereas all the study participants were having 8 h of working duration and all were provided with the safety equipment at working site when necessary. When asked about self-reported physical illness, about 48.5% of study participants complaints about the musculoskeletal pain, whereas 24.5% of study participants did not reported any physical illness. Furthermore, 71.5% of study participants were found to have no or low risk for psychological distress, and 4% and 24.5% of study participants were having high and medium risk for psychological distress. The association between well-being and Kesseler's Distress Score and addiction was found to be statistically significant. While, the association between well-being and socioeconomic status, education was not found to be statistically significant.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 2. | World Health Organization. Report from the commission on social determinants of health. In: Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva: WHO; 2008.  |
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| 6. | Measuring Healthy Days – Population Assessment of Health-Related Quality of Life U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health; 2000. Available from: https://www.cdc.gov/hrqol/pdfs/mhd.pdf. [Last accessed on 2021 Feb 08]. |
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| 8. | Tiwari G, Gangopadhyay PK, Biswas S, Nayak K, Chakraborty D, Halder LC. Psychological stress of the building construction workers. Hum Biol Rev 2013;2:207-22. |
| 9. | Adsul BB, Laad PS, Howal PV, Chaturvedi RM. Health problems among migrant construction workers: A unique public-private partnership project. Indian J Occup Environ Med 2011;15:29-32. [ PUBMED] [Full text] |
| 10. | The Kessler Psychological Distress scale (K10). Department of Health. Population Research and Outcome Studies. Brief Reports. Number; 2002-14. |
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[Table 1], [Table 2], [Table 3]
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