Development of an Integrated Occupational Health and Safety Model for Caregivers of Dependent Persons: Sustainable Infectious Waste Management in the Long-Term Care System

Abstract

This mixed-methods research and development study aimed to develop and evaluate the effectiveness of the Integrated Occupational Health and Safety Model (SAFE-CARE Model) for caregivers (CG) of dependent persons in the sustainable management of infectious waste within the Long-Term Care (LTC) system. The study was conducted in three phases between October 14, 2025, and March 2026. Phase 1 was a situational analysis using a questionnaire among 340 CG of older adults. Phase 2 was the experimentation of the developed model using a quasi-experimental two-group pretest-posttest-follow-up research design among 154 CG, classified into 78 in the experimental group and 76 in the control group. Phase 3 was the assessment of sustainability in five dimensions and the formulation of policy recommendations. Data were analyzed using descriptive statistics, including mean and standard deviation, and hypothesis testing using the Chi-square test, t-test, McNemar test, and Analysis of Variance (ANOVA), with the level of statistical significance set at 0.05.

The findings of Phase 1 revealed that most participants were female (89.1%), with a mean age of 49.2 years. The level of knowledge regarding occupational health and infectious waste management was at a low level (44.7%), safety practice behaviors were at a low level (37.6%), and ergonomic risk was at a high level. CG (79.1%) reported having experienced at least one type of work-related injury within the previous six months. CG with insufficient personal protective equipment (PPE) had a 2.84 times higher likelihood of injury compared with those with adequate PPE (95% Confidence Interval [CI]: 1.62–4.97). The proportion of correct infectious waste segregation according to standards was only 22.4%, and 81.4% of CG were unaware that used adult diapers are legally classified as infectious waste. Phase 2 revealed that the experimental group had significantly higher scores in knowledge, health literacy, attitudes, and behaviors compared with the control group (Mixed-design ANOVA, p < .001), with effect sizes of Cohen's d = 0.96–2.67. The proportion of correct infectious waste segregation increased from 22.4% to 85.4% (95% CI: 80.0–90.8) and remained at 87.3% at the fourth month after Post-test. The incidence of work-related injuries decreased in all categories (Relative Risk [RR] = 0.22–0.39, p < .05). Phase 3, the assessment of sustainability in five dimensions, revealed that the developed model had the potential for long-term continuity. Two local government organizations incorporated the program into their annual action plans. Five major policy recommendations were proposed: the inclusion of the curriculum in the standard CG training program, the allocation of PPE sets within the LTC benefit package, the establishment of a household infectious waste collection system, the determination of a CG-to-dependent-person ratio not exceeding 1:10, and the incident reporting system. The SAFE-CARE Model is therefore effective in enhancing occupational health and safety, reducing work-related injuries, and improving infectious waste management among caregivers of dependent persons