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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Micro&#44; small&#44; and medium enterprises &#40;MSMEs&#41; plays a dominant role in Indonesian economic&#46; A report on 2013 the number of MSMEs in Indonesia is growing by 13&#37; annually<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a>&#59; followed by the absorption of the labour force in MSMEs&#44; which according to Bank Indonesia &#40;2016&#41; is 7&#37; per year of the total workforce&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Regardless of the level of work formality&#44; safety is among the pivotal factors in the workplace&#46; Employees&#8217; ignorance about how to perform their job safely&#44; factors causing the occurrence of accidents in the workplace&#44; documentation and reporting systems are problems faced by MSMEs&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Workplace accidents occur at higher rates in small industries than in larger ones&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; in practice&#44; MSMEs need to pay more attention to the issue&#44; since it has become a centre of attention due to the limited number of human resources and the low level of understanding about occupational health and safety&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Occupational health and safety management systems aim to handle and identify risks related to health and safety at work to prevent accidents&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> The main objective of occupational health and safety management systems is to reduce or prevent accidents that could potentially results in injuries or losses&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a> However&#44; these injuries cannot be fully mitigated due to some factors affecting them&#44; such as ways of thinking and behaviour&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The occupational health and safety factors of MSMEs need to be formulated in detail&#46; One way to do this is by studying practices in both developing and developed countries&#46; Therefore&#44; this study aims to analyze factors related to occupational health and safety management systems that can be formulated and developed in the MSME sector&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This systematic review is an exploratory study which aims to describe and analyze previous findings concerning pivotal factors in the implementation of OHSMS in MSMEs&#46; This study was conducted in several steps&#44; which consists of literature search&#59; literature selection&#59; evidence quality appraisal&#59; evidence extraction and synthesis of the higher quality evidence&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In terms of the literature search&#44; several online databases were selected as our literature sources&#46; Google scholar&#44; Science Direct&#44; SpringerLink&#44; JStor&#44; Proquest&#44; Taylor and Francis&#59; as well as hand searching from various local journals&#59; books and e-books which can be fully accessed through the Library of Universitas Indonesia were chosen&#46; Our search strategy used a combination of two keywords that refer to the population and exposure variables in the PROSPERO &#40;Prospective Register of Systematic Reviews&#41; approach by using the &#8220;AND&#8221; strategy&#46; Those keywords were defined as below&#58;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Population</span>&#58; Micro&#44; Small and medium enterprises&#59; OR&#44; MSMEs&#59; OR Small businesses&#59; OR Informal Sector&#59; OR Small Firms&#59; AND</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exposure</span>&#58; Occupational health and Safety Management System&#59; OR OHS-MS&#59; OR Occupational Safety Management&#59; Occupational Health Management</p><p id="par0050" class="elsevierStylePara elsevierViewall">Each literature goes through a selection stage with the following conditions&#58; first&#44; the inclusion criteria are that the literature has to be written in either English or Bahasa Indonesia&#59; second&#44; the literature must be published between the year 2000 and 2020&#59; and third&#44; the literature must be published as a research article&#44; literature review&#44; research report&#44; article review&#44; or peer-reviewed paper&#46; The exclusion criteria include newspapers&#44; opinions&#44; news from print and digital media&#44; news&#44; editorials&#44; conference info&#44; case reports&#44; and conference articles&#46; In the next selection stage&#44; the literature must go through the title review selection stage&#44; then abstract and full text review for evidence quality appraisal&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A checklist developed by the Critical Appraisal Skill Programme &#40;CASP&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; for risk of bias assessment was used for the evidence quality appraisal&#46; The checklist consists of 10 questions to investigate the three main issues of a research paper systematically&#44; which are&#58; the validity of the study results&#44; the study results itself and the usefulness of the evidence locally&#46; Only good and moderate quality evidence were included in this study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0060" class="elsevierStylePara elsevierViewall">From the Google Scholar&#44; Science Direct&#44; SpringerLink&#44; JStor and Proquest databases and additional 45 books&#44; e-books and local journals&#59; a total of 1&#44;708&#44;465 online books and local articles as the initial number of studies were found&#46; The subsequent phase of the study was selection from the databases based on year and language&#44; which resulted in 225&#44;213 articles&#46; This selection was narrowed down to 147 articles which were highly relevant based on the title and research questions&#46; From 147 papers&#44; 23 studies that were found duplicated&#44; leaving 124 articles that were proceeded to the eligibility evaluation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the first stage of eligibility evaluation&#44; 40 articles were excluded after screening the accessibility&#44; leaving 84 articles&#46; From these 84 papers&#44; 71 were chosen based on the consistency between the research objectives&#44; methods&#44; and questions&#46; Next&#44; we left out 21 articles that did not correspond to the criteria&#46; Subsequently&#44; a full text review of the 50 articles was conducted to understand the objective and content of the papers &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Finally&#44; after the careful and thorough review process&#44; 37 papers&#44; books&#44; online books and local articles were selected which were of sufficiently qualified and with a low level of bias &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The rejected articles demonstrated less or no relevance and did not document factors related to the implementation of occupational health and safety in MSMEs&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The following table presents the results of data extraction from 37 publications that were included in this study &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">From the data extraction&#44; we classified the pivotal factors for OSH implementation MSMEs into three downstream categories&#44; middle stream&#44; and upstream&#46; Downstream factors are classified into several following categories which are awareness on regulation&#44; the involvement of senior management&#44; quality of OSHMS commitment towards safety and health&#44; intervention programme&#44; social relation at work&#44; risk management and risk assessment&#44; OSH structure and policy&#44; knowledge and information&#44; OSH training&#44; technology and communication&#44; human and economic resources&#44; reward&#44; worker involvement&#44; interest&#44; inspection&#44; competition&#44; planning and internal control &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Middle stream factor includes the support from third parties&#46; Upstream factors refer to the support from government&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">As can be found in other studies&#44; implementation of OHSMS at MSMEs can be challenging due to perception that OSH risk at MSMEs are low&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;8</span></a> short term benefits are not clear and do not outweigh the invested cost<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> which lead to lack of interest and motivation in OSH implementation&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">10&#8211;12</span></a> This study aimed to identify pivotal factors in promoting OSH implementation at MSMEs through a systematic literature review&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">After the selection and evaluation process&#44; 37 literatures were obtained for this study&#46; The findings from those studies were extracted and synthesized to describe the most important variables in promoting the implementation of OSH at MSMEs&#46; In general&#44; there are 3 inter-dependent parties which all contribute to this common goal&#44; specifically MSME employers and employees&#44; the government and third parties &#40;consultants&#44; associations&#44; unions&#44; etc&#46;&#41;&#46; Numerous promoting factors were identified and based on the designated party&#44; these factors were classified as downstream&#44; middle stream and upstream factors&#46; Downstream factors are those which need to be established at the MSMEs&#44; middle stream factors are those which need to be present at third parties and upstream factors are at the government level&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Downstream factors</span><p id="par0095" class="elsevierStylePara elsevierViewall">According to the extracted data&#44; there are 19 factors which need to be established at the enterprise level&#46; The top six factors which are most commonly deemed as important for OSH implementation are OSH training&#59; Commitment&#44; Quality of OHSMS&#44; Resources&#44; Risk assessment and management&#59; Communication&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">OSH training aims to improve the level of knowledge and awareness on OSH for both the employee and employer&#46; P33 found that training and coaching where direct and face-to face interaction occurs are more effective&#44; though other studies suggested online training instead&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">12&#44;13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Commitment could motivate the implementation of OSH in its presence or hinder it in its absence&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;15</span></a> OSH policy or lack thereof can be a major indication of commitment&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">16&#44;17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">The quality of OSHMS is another major factor in MSMEs&#46; The OSHMS which are found in small businesses are usually formulated by third parties&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> The most important thing when developing an OSHMS for a small business is to consider its various internal characteristics<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a>&#44; including the risks associated with its line of work&#44; while at the same time&#44; it should be as simple and cost effective as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Risk Assessment and Management affects the quality of the OSHMS<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> and safety performance of small businesses&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> Hence&#44; it is crucial to create tailored risk assessment tools which are suitable for the type of MSMEs&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Communication&#44; both verbal and non-verbal&#44; inter-organization and intra-organization&#44; is found to influence the OSH performance at MSMEs&#46; Adequate communication between related parties e&#46;g&#46; government to company&#44; employer to employee&#44; etc&#46; is essential to ensure effective flow of information&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Middle stream factors</span><p id="par0125" class="elsevierStylePara elsevierViewall">The support from third parties &#40;associations&#44; trade unions&#44; consultants&#41; is hugely beneficial in promoting OSH implementation at MSMEs&#46; A study from Arocena &#40;2010&#41; found that businesses not involved in any union are less likely to implement any OHS systems&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> Consultation with third parties has also become a driving factor for OSH implementation at small businesses&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;24</span></a> Trade unions and associations have become important drivers for OSH implementation&#44; as well as sharing and harmonizing OSH practices&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;25</span></a> Since third parties play an important role in supporting OSH at MSMEs&#44; consultants should be competent and qualified on OSH&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Upstream factors</span><p id="par0130" class="elsevierStylePara elsevierViewall">The role of the government to encourage OSH implementation at MSMEs is vital&#46; Due to the informal characteristics of MSMEs&#44; simple&#44; proactive and functioning OSH regulation for MSMEs need to be established&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">14&#44;25&#44;26</span></a> Caparros&#44; et al&#46; &#40;2020&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> and Masi and Cagno &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> recommends guidance for compliance rather than bureaucratic and stringent regulations&#46; A computational experimental study<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> showed that punishment strategies&#44; formulation of OSH standards and supervision of service agencies are recommended interventions which can be adopted by government&#46; The role of the local government in terms of regulation enforcement and training provision are also key factors in promoting OSH implementation at MSMEs&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Model of OSHMS at MSMEs</span><p id="par0135" class="elsevierStylePara elsevierViewall">The establishment of an integrated management system for OSH implementation in MSMEs was proposed&#46; This system allows for more efficiency in terms of avoiding redundant similar procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> However&#44; the certification for IMS implementation is opposed by small businesses due to its excessive capital requirement&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;9</span></a> The adoption of IMS in Thailand MSMEs requires extensive support from the government and third parties&#44; especially to communicate its benefits&#44; organize OSH education and awareness sessions and financial assistance&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In Bouan China&#44; a model of Basic Occupational Health and Services &#40;BOHS&#41; has been successful and well accepted by society&#44; employee&#44; employers and government&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> Involvement of the local government&#44; including Bureau of Health&#44; Finance&#44; Industry&#44; Labour&#44; Human Resources&#44; Administration of Work Safety&#44; Social Security and trade union showed a significant improvement in the implementation of OSH programmes such as training and education&#44; workers and workplace health surveillance&#44; risk assessment and control&#44; and inspection of occupational health&#46; The cost from the BOHS was borne partly by the employer and partly by the government&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Various pivotal factors in promoting OSH implementation at MSMES were shown by literatures&#46; Those factors are inter-related and can be seen as role of MSMEs actors &#40;employer and employee&#41;&#59; third party and government&#46; Reinforcing those factors is proposed to be able to enhance the implementation of OSH-MS at MSMEs&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "identificador" => "xack576323"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">This study was made possible through the support of the Ministry of Reearch and Higher education of Republic of Indonesia for funding this study through <span class="elsevierStyleItalic">Penelitian Dasar Unggulan Perguruan Tinggi</span> &#40;PDUPT&#41; Grant &#40;Contract number&#58; NKB-1581&#47;UN2&#46;R3&#46;1&#47;HKP&#46;05&#46;00&#47;2019&#41;&#46; The author would also like to thank Ms&#46; Astuti and Ms&#46; Amelia Anggarawati Putri who contributed to this study&#46;</p>"
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Conflictos de interés

Los conflictos de interés pueden ser laborales, de investigación, económicos o morales. Los/las autores/as deben indicar si existe alguno de estos conflictos. Una descripción más detallada sobre los conflictos de intereses se encuentra disponible en las normas éticas de Gaceta Sanitaria.

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Are you a health professional able to prescribe or dispense drugs?