Agua, sombra, descanso y eficiencia : valoración cualitativa del programa We
Fecha
2020
Autores
Rojas Garbanzo, Marianela
Aragon, Aurora
Soto, Arlen
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad Nacional, Costa Rica
Resumen
Antecedentes:
Aunque no se ha establecido claramente, la enfermedad renal crónica de etiología desconocida (ERCd) ha estado relacionada a exposición a altas temperaturas, trabajo extenuante y mala hidratación, que contribuyen a la disminución de la tasa de filtración glomerular y al riesgo de episodios repetidos de lesión renal aguda (IRA). En un ingenio salvadoreño se ejecutó un programa de intervención basado en el aseguramiento de “Agua, Descanso, Sombra y Eficiencia” (WRS-E).
Objetivo:
Explorar la percepción de los trabajadores sobre la efectividad de cada componente del programa WRS-E, así como la sostenibilidad de la intervención desde la perspectiva de los trabajadores y otros actores clave.
Método:
Se realizó un estudio cualitativo con un diseño emergente mediante análisis temático. Cada componente de WRS-E se evaluó con análisis iterativo y triangulación de investigadores. El estudio se llevó a cabo en dos años consecutivos, previo a la finalización de cada zafra.
Resultados:
La mayoría de los entrevistados estuvo de acuerdo en que WRS-E redujo efectivamente el riesgo de deshidratación, aunque los componentes fueron adoptados en un gradiente de mayor a menor desde Zona 1 a Zona 3. En los casos donde las indicaciones de la implementación fueron mejor adoptadas (Zona 1), los trabajadores experimentaron una mejor salud y un mejor ánimo para trabajar.
En la Zona 3, donde el riesgo de estrés térmico fue muy alto, hubo varias dificultades para la implementación. La aceptación y adherencia al programa se vieron obstaculizadas en el año 2 por la falta de claridad sobre la necesidad de mantener un cumplimiento estricto de los componentes WRS-E, particularmente en esa zona.
Se destacan diferencias históricas, culturales y de condiciones de trabajo, como el trabajo a destajo, que impone un ritmo que interfiere con las pausas para descanso e ingesta de líquidos. También hubo falta de claridad y abastecimiento oportuno para la ingesta diaria de electrolitos. A esto se sumaron los cambios en la calidad de las herramientas y materiales disponibles en el año 2, diferentes a los del año 1.
A pesar de lo anterior, hubo un gradiente de satisfacción con la intervención, y de manera unánime se concluyó que, a pesar de las diferencias, vale la pena sostener el programa.
Conclusión:
Un programa como éste debe ser planificado y ejecutado no solo con un fuerte compromiso de la gerencia, sino también de los mandos medios, quienes deben estar comprometidos con el cambio. Esto debe reflejarse en una dirección clara, apego estricto a los componentes del programa, implementación oportuna, retroalimentación adecuada, apropiación de los objetivos y una estrecha cooperación y flexibilidad de la gerencia e investigadores, para que en conjunto se puedan resolver los cambios inesperados.
Background: Although it has not been clearly established, chronic kidney disease of unknown etiology (CKDu) has been linked to exposure to high temperatures, strenuous work, and poor hydration. These factors contribute to a decrease in glomerular filtration rate and increase the risk of repeated episodes of acute kidney injury (AKI). An intervention program based on the assurance of "Water, Rest, Shade, and Efficiency" (WRS-E) was implemented at a Salvadoran sugar mill. Objective: To explore workers’ perceptions of the effectiveness of each component of the WRS-E program, as well as the sustainability of the intervention from the perspectives of both workers and other key stakeholders. Method: A qualitative study with an emergent design was conducted using thematic analysis. Each WRS-E component was evaluated through iterative analysis and investigator triangulation. The study was carried out over two consecutive years, prior to the end of each harvest season. Results: Most interviewees agreed that the WRS-E program effectively reduced the risk of dehydration. However, the adoption of WRS-E components varied across zones, with a gradient from higher adherence in Zone 1 to lower in Zone 3. In areas where implementation guidelines were best followed (Zone 1), workers reported improved health and morale. In Zone 3—where the risk of heat stress was highest—multiple challenges hindered implementation. In the second year, program acceptance and adherence were further affected by unclear communication regarding the importance of maintaining strict compliance, particularly in Zone 3. Historical and cultural factors, as well as working conditions such as piecework, contributed to a fast-paced work rhythm that interfered with rest breaks and fluid intake. There were also issues with the clarity and timely supply of daily electrolyte intake. Additionally, all zones experienced changes in the quality of tools and materials in year two, which differed from those used in year one. Despite these challenges, there was a gradient of satisfaction with the intervention. Universally, it was agreed that—despite differences and obstacles—the program is worth sustaining. Conclusion: A program like this must be planned and executed not only with strong commitment from upper management but also with the active involvement of middle managers. Their engagement is crucial to driving change. This commitment should be reflected in clear guidance, strict adherence to program components, timely implementation, consistent feedback, ownership of goals, and close cooperation and flexibility between management and researchers to address unexpected challenges collaboratively.
Background: Although it has not been clearly established, chronic kidney disease of unknown etiology (CKDu) has been linked to exposure to high temperatures, strenuous work, and poor hydration. These factors contribute to a decrease in glomerular filtration rate and increase the risk of repeated episodes of acute kidney injury (AKI). An intervention program based on the assurance of "Water, Rest, Shade, and Efficiency" (WRS-E) was implemented at a Salvadoran sugar mill. Objective: To explore workers’ perceptions of the effectiveness of each component of the WRS-E program, as well as the sustainability of the intervention from the perspectives of both workers and other key stakeholders. Method: A qualitative study with an emergent design was conducted using thematic analysis. Each WRS-E component was evaluated through iterative analysis and investigator triangulation. The study was carried out over two consecutive years, prior to the end of each harvest season. Results: Most interviewees agreed that the WRS-E program effectively reduced the risk of dehydration. However, the adoption of WRS-E components varied across zones, with a gradient from higher adherence in Zone 1 to lower in Zone 3. In areas where implementation guidelines were best followed (Zone 1), workers reported improved health and morale. In Zone 3—where the risk of heat stress was highest—multiple challenges hindered implementation. In the second year, program acceptance and adherence were further affected by unclear communication regarding the importance of maintaining strict compliance, particularly in Zone 3. Historical and cultural factors, as well as working conditions such as piecework, contributed to a fast-paced work rhythm that interfered with rest breaks and fluid intake. There were also issues with the clarity and timely supply of daily electrolyte intake. Additionally, all zones experienced changes in the quality of tools and materials in year two, which differed from those used in year one. Despite these challenges, there was a gradient of satisfaction with the intervention. Universally, it was agreed that—despite differences and obstacles—the program is worth sustaining. Conclusion: A program like this must be planned and executed not only with strong commitment from upper management but also with the active involvement of middle managers. Their engagement is crucial to driving change. This commitment should be reflected in clear guidance, strict adherence to program components, timely implementation, consistent feedback, ownership of goals, and close cooperation and flexibility between management and researchers to address unexpected challenges collaboratively.
Descripción
Informe técnicos IRET, n° 41. Parte del proyecto "Estimación de la carga térmica en trabajadores: Un estudio exploratorio para estimar el riesgo bajo condiciones actuales y con el cambio climático 0471-18"
Palabras clave
RIÑONES, ENFERMEDADES DEL APARATO URINARIO, EPIDEMIOLOGÍA, AGRICULTURA, TRABAJADORES AGRÍCOLAS, KIDNEYS, URINARY SYSTEM DISEASES, EPIDEMIOLOGY, AGRICULTURE, AGRICULTURAL WORKERS