Presenteeism Behaviour: Current Research, Theory and Future Directions 3030972658, 9783030972653

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Presenteeism Behaviour Current Research, Theory and Future Directions

Alisha McGregor Peter Caputi

Presenteeism Behaviour

Alisha McGregor · Peter Caputi

Presenteeism Behaviour Current Research, Theory and Future Directions

Alisha McGregor Wollongong, NSW, Australia

Peter Caputi Wollongong, NSW, Australia

ISBN 978-3-030-97265-3 ISBN 978-3-030-97266-0 (eBook) https://doi.org/10.1007/978-3-030-97266-0 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover credit: © Harvey Loake This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

The productivity of workers is a key priority for organisations especially in today’s highly competitive, technologically advanced and fast-paced work environment. An employee’s productivity can be conceptualised on a continuum from zero productivity (e.g., if he or she is absent from work) to fully productive work engagement. According to researchers, such as Johns (2010, 2012) and Miraglia and Johns (2016), presenteeism represents an important and understudied phenomenon that exists in the grey area between these two extremes (Johns, 2010). Research into presenteeism dates back to the mid-1950s with Canfield and Soash’s (1955) early work on absence control. However, it is only more recently that there has been a surge in research related to presenteeism. For example, a Google Scholar’s search for the term ‘presenteeism’ returned 92 hits for the period 1950 to 1995 and over 19, 500 for the period 1996 to 2021 (July, 2021). Despite the increased interest over the past couple of decades, there is still more to learn about presenteeism. This book presents a concise and contemporary account of theory and research on presenteeism. In particular, the book provides a thorough overview of the presenteeism literature focusing on key areas such as the definition, prevalence, costs, causes and consequences of presenteeism. This is followed by a discussion of how presenteeism is measured including descriptions of relevant scales and their psychometric properties. Theoretical and empirical models of presenteeism are then discussed, focusing on how they have been used to explain presenteeism behaviour v

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in the workplace. An overview of presenteeism interventions and suggestions for future interventions is provided; the book concludes with several recommendations for future research studies on presenteeism. Alisha McGregor Wollongong, NSW, Australia Peter Caputi Wollongong, NSW, Australia

References Canfield, G., & Soash, D. (1955). Presenteeism a constructive view. Personnel Journal, 34, 94–97. Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior, 31(4), 519–542. Johns, G. (2012). Presenteeism: A short history and cautionary tale. In J. Houdmont, S. Leka, & R. R. Sinclair (Eds.), Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice. John Wiley and Sons. Miraglia, M., & Johns, G. (2016). Going to work ill: A meta-analysis of the correlates of presenteeism and a dual-path model. Journal of Occupational Health Psychology, 21(3), 261–283.

Contents

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An Overview of the Presenteeism Literature 1.1 The Definition of Presenteeism 1.2 The Prevalence of Presenteeism and Its Associated Costs 1.3 Antecedents of Presenteeism 1.3.1 Contemporary Research 1.4 Consequences of Presenteeism 1.5 Chapter Summary References

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Measuring Presenteeism 2.1 Why is Measurement Important? 2.2 Two Sides of the Presenteeism Coin 2.3 Measuring the Act of Presenteeism 2.4 Measuring Productivity Loss 2.4.1 Stanford Presenteeism Scale 2.4.2 Work Limitations Questionnaire 2.4.3 Endicott Work Productivity Scale 2.4.4 World Health Organisation Health and Work Performance Questionnaire 2.4.5 Work Productivity and Activity Impairment Questionnaire 2.5 Final Comments on the Measures of Presenteeism 2.6 Chapter Summary References

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CONTENTS

Conceptualising Presenteeism 3.1 Understanding Presenteeism: Adoption of Existing Models and Frameworks 3.1.1 Demands-Control-Support Model 3.1.2 Conservation of Resources Theory 3.1.3 Effort-Reward Imbalance Model 3.1.4 Person-Environment Fit 3.1.5 Effort-Recovery Theory 3.1.6 Transactional Theory of Stress 3.1.7 Social Cognitive Theory 3.1.8 Job Demands-Resources Model 3.2 Synopsis of the Models Adopted to Understand Presenteeism 3.3 Towards a Theory of Presenteeism 3.3.1 John’s (2010) Framework for a Dynamic Model 3.3.2 A Dialectical Approach to Understanding Presenteeism 3.3.3 An Adaptive Framework of Presenteeism 3.4 Future Considerations 3.5 Chapter Summary References Presenteeism Interventions 4.1 Existing Presenteeism Interventions 4.2 Recommendations for Future Presenteeism Interventions 4.3 Chapter Summary References Suggestions for Future Research Studies on Presenteeism 5.1 Suggestions for Future Research on Presenteeism 5.1.1 Poor Health, Presenteeism and Burnout 5.1.2 The Effects of Different Types of Presenteeism on Key Work and Health Outcomes 5.1.3 Applying the Revised JD-R Model 5.1.4 Work-Environment Factors, Presenteeism and Unsafe Decision-Making 5.1.5 Other Research Suggestions

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CONTENTS

5.2 Chapter Summary References Index

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List of Figures

Fig. 3.1 Fig. 3.2

Johns’ (2010) conceptual model (Adapted from Johns 2010, p. 532) Karanika-Murray and Biron (2020)’s Presenteeism Framework based on the relationship between health and performance

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CHAPTER 1

An Overview of the Presenteeism Literature

Abstract This chapter provides a comprehensive overview of the literature on presenteeism. The chapter begins with a discussion of the two main definitions of presenteeism, followed by an overview of its prevalence and costs. A thorough outline of the key antecedents of presenteeism are presented including mental and physical health conditions, job demands, personal and job resources and job attitudes. Recent research on the influence of leader presenteeism, transformational leadership, presenteeism climates, attendance cultures, labour markets and the distinction between different types of job demands is discussed. The consequences of presenteeism in the workplace are also addressed; in particular, the negative outcomes, such as poorer health, reduced productivity and absenteeism as well as some of the potential benefits that might be gained by working through an illness, such as improved self-esteem, organisational citizenship behaviour and a sense of accomplishment. Finally, some comments about the lack of longitudinal studies on presenteeism are noted. Keywords Health · Job demands · Job and personal resources · Leadership · Presenteeism climate and culture · Productivity loss

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 A. McGregor and P. Caputi, Presenteeism Behaviour, https://doi.org/10.1007/978-3-030-97266-0_1

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1.1

The Definition of Presenteeism

There are many definitions of presenteeism used in the literature, which can be grouped into two main categories (Ruhle et al., 2020). The first category defines presenteeism as a behaviour—that is, presenteeism is described as the behaviour of attending work while ill (Hansen & Andersen, 2008; Johns, 2010). The second category defines presenteeism in terms of the consequences of attending work while ill—for example, presenteeism is commonly defined as health-related productivity loss. In North America, the second category is most often used (Hemp, 2004; Roy et al., 2011; Turpin et al., 2004), while the behavioural definition is more commonly used across Europe (Aronsson & Gustafsson, 2005; Hansen & Andersen, 2008). Johns (2010) argues for the utility of the behavioural definition of presenteeism, positing that the productivity loss definition conflates cause with effect. In an extension of Johns’ work, a recent meta-analysis confirmed that definitions of presenteeism that combine both the behaviour and consequences of presenteeism can artificially inflate the observed effect sizes (McGregor et al., 2017). This is arguably due to the behaviour and the consequences of presenteeism being themselves related (Miraglia & Johns, 2016), increasing the risk of spurious correlation with other variables in the literature, and hence greater artificial inflation in effect sizes (McGregor et al., 2017).

1.2

The Prevalence of Presenteeism and Its Associated Costs

Presenteeism is very prevalent in today’s workplace. In a large study conducted across 34 European countries, presenteeism was reported among 40% of the workers (Eurofound, 2012). A recent systematic review indicated prevalence rates for presenteeism between 35 and 97% across 24 studies (Webster et al., 2019) with occupation type having the greatest impact on prevalence. The researchers suggested that those working in the healthcare sector, and specifically physicians and nurses, were at a higher risk of engaging in presenteeism than other job types (Webster et al., 2019). Similar findings can be found across other studies, emphasising the widespread culture of presenteeism among health care professionals (Allemann et al., 2019; Chambers et al., 2017; Kaldjian et al., 2019; Mitchell & Vayalumkal, 2017; Mosteiro-Díaz et al., 2020; Pei et al., 2020; Rainbow, 2019) as well as other helping professions such as teachers (Dudenhöffer et al., 2017; Kinman & Wray, 2018).

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Research into presenteeism suggests that it accounts for at least four times more productivity loss than absenteeism (Evans-Lacko & Knapp, 2016; Iverson et al., 2010; Nagata et al., 2018; Vänni et al., 2017) and costs the Australian economy between $25 and $34 billion dollars per year (Medibank, 2011). Similar expenses have been found in the United Kingdom, where presenteeism reportedly costs the economy £15 billion pounds per year (Centre for Mental Health, 2011). In other countries, such as the United States, that have larger populations and different healthcare systems and leave entitlements, the costs associated with presenteeism are considerable, ranging from $150 to $250 billion dollars annually (Hemp, 2004; Prater & Smith, 2011). Specifically, within the area of mental health, presenteeism reportedly costs the Australian economy $6.1 billion dollars per year which is nearly twice that of absenteeism (Price Waterhouse Cooper, 2014).

1.3

Antecedents of Presenteeism

The literature clearly points to a strong link between employee health and presenteeism, including both mental health (e.g., depression, stress, fatigue, anxiety and burnout) and physical health (e.g., general ill health, head colds, arthritis, allergies) (Burton et al., 2004; Cocker et al., 2011; Conway et al., 2014; Ferreira et al., 2019; Gosselin et al., 2013; Johns, 2011; Johnston et al., 2019; Krpalek et al., 2014; Leineweber et al., 2012; Monzani et al., 2018; Pei et al., 2020; Rainbow et al., 2020). Meta-analytic findings emphasise the importance of employee health in the determination of presenteeism, particularly depression, stress, emotional exhaustion (a component of burnout) and general ill health (Miraglia & Johns, 2016). Chronic health conditions, such as mood disorders, arthritis, migraines, lower back pain and allergies, are also commonly associated with presenteeism; arguably because continuing to work when ill may be the only choice for workers who regularly struggle with their health (McGregor et al., 2017; Munir et al., 2008; Schultz & Edington, 2007; Serrano et al., 2013). Other factors beyond employee health have also been linked with presenteeism. A recent meta-analysis conducted across 109 samples and

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175,965 employees examined the correlates of presenteeism1 (Miraglia & Johns, 2016). The findings indicated that strict absence policies had the largest meta-analytic correlations with presenteeism (ρ = 0.39). In other words, employees are more likely to attend work while ill if their organisation enforces strict absence policies, such as medical certification for every spell of absence. In terms of job demands, workload (ρ = 0.28) and understaffing (ρ = 0.25) exhibited the strongest meta-analytic correlations with presenteeism, followed by time pressure (ρ = 0.16), and to a lesser extent, job insecurity (ρ = 0.08) (Miraglia & Johns, 2016). These findings suggest that employees are more likely to attend work when ill if (i) they are concerned about their work ‘piling up’ while they are away, (ii) they are worried about a lack of staff available to cover their shift, (iii) their work is subject to tight deadlines or (iv) they are fearful of possible job loss. In other words, presenteeism could be considered a coping strategy to manage these job demands. Alternatively, job demands have been linked with stress and poorer health (Bakker et al., 2004; Schaufeli & Taris, 2014), which could increase the worker’s likelihood of presenteeism (Kinman & Wray, 2018; Miraglia & Johns, 2016). Other more recent studies also found job demands (e.g., high workloads, time pressure and job insecurity) to be positively associated with going to work when ill (Allemann et al., 2019; Baeriswyl et al., 2016; Kim et al., 2020; Wang et al., 2018). Miraglia and Johns (2016) reported on the relationship between presenteeism and several job and personal resources. Optimism had the highest meta-analytic correlations with presenteeism (ρ = −0.22), albeit in the opposite direction than expected. The researchers argued that an optimistic and positive outlook may buffer the experience of stress and associated health impairments, which in turn, reduces the likelihood of working when ill. Negative meta-analytic correlations between presenteeism and organisational support (ρ = −0.17), supervisor support (ρ = −0.10) and co-worker support (ρ = −0.07) were also noted. These findings suggest that working for a supportive organisation or having a supportive supervisor/co-workers might provide employees with the confidence to take time off work to recuperate from an illness if needed. 1 Some of the key antecedents of presenteeism reviewed in Miraglia and John’s (2016) meta-analysis are discussed in this book. It was beyond the scope of this book to discuss all of the antecedents. Please refer to the original paper for the full battery of results.

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Similarly, recent research demonstrates a negative relationship between workplace support and presenteeism (Baeriswyl et al., 2016; Cho et al., 2016; Côté et al., 2021; Dudenhöffer et al., 2017; Janssens et al., 2016; Kinman & Wray, 2018). Quality leadership also reported a negative metaanalytic correlation with presenteeism (ρ = −0.13), suggesting that, like optimism and support, it may be a protective factor that can be used to discourage presenteeism (Miraglia & Johns, 2016), though quality leadership may not be a suitable protection strategy for workers with lower health status (Leineweber et al., 2011). Finally, the results from Miraglia and Johns’ (2016) meta-analysis reported little effect on presenteeism for job control (ρ = −0.01) or conscientiousness (ρ = 0.05). Attitudes about one’s job were also investigated in Miraglia and Johns’ (2016) meta-analysis. Affective commitment exhibited the largest metaanalytic correlation with presenteeism (ρ = 0.20), followed by work engagement (ρ = 0.13) and job satisfaction (ρ = 0.12). These findings suggest that positive attitudes about work, including feeling engaged, committed, and satisfied might motivate employees to work through an illness (Miraglia & Johns, 2016). Positive job attitudes among employees are important in the workplace and have been linked with improved wellbeing and performance (Demerouti et al., 2010; Faragher et al., 2013). However, these results suggest that decision-makers should be mindful of potential downsides associated with high levels of work engagement, commitment and satisfaction, such as increased presenteeism behaviour. Miraglia and Johns (2016) provide valuable insights into the factors that influence presenteeism. In addition to average mean correlations, other important indices such as 80% creditability intervals (CI) that report on the between-study variation across the observed effect sizes can be examined. Miraglia and Johns’ (2016) analysis indicates a significant amount of variability across the relationships between presenteeism and the job demands, job and personal resources and job attitudes (see Miraglia & Johns, 2016, Table 1). Except for workload which had very little between-study variation (80% CI 0.25, 0.27), most of the other antecedents reported quite substantial variability. For example, strict absence policies had an 80% CI that ranged from 0.29 to 0.49, job insecurity ranged from −0.02 to 0.17, understaffing ranged from 0.11 to 0.37, and time pressure ranged from 0.07 to 0.25. In terms of job and personal resources, job control had quite extensive between-study variation with an 80% creditability interval ranging from −13 to 0.11. Variability was also noted for quality leadership (80% CI −20, −0.06), supervisor support

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(80% CI −17, −0.02), co-worker support (80% CI −14, −0.01), optimism (80% CI −31, −0.14) and conscientiousness (80% CI −0.01, 0.11). No credibility intervals were reported for work engagement; however, a considerable amount of between-study variation was noted for the other two job attitudes—affective commitment (80% CI 0.01, 0.39) and job satisfaction (80% CI −0.08, 0.32). Two antecedents of presenteeism in particular—job control and job satisfaction—had large amounts of between-study variation as indicated by both the size of the 80% CI and that the 80% CI included zero2 (Miraglia & Johns, 2016). These findings are not unexpected as mixed results are noted between presenteeism and job control and job satisfaction in the literature. For example, many studies have found that job control is negatively related to presenteeism in that people who are more ‘in control’ at work are less likely to feel pressure to attend when unwell (Gosselin et al., 2013; Karlsson et al., 2010; Kinman & Wray, 2018; Leineweber et al., 2011; Miraglia & Johns, 2016). However, there are other researchers that have found higher job control to be associated with increased presenteeism (Johansson & Lundberg, 2004; Leineweber et al., 2012; Schreuder et al., 2013), arguing that employees with more control are likely to work through sickness as they are better equipped to modify their work tasks, reduce their cognitive and physical effort or take more rest breaks to accommodate their illness-related limitations (Kinman & Wray, 2018). In another study across four European countries, perceived job control was unrelated to presenteeism, with Spain, Sweden and the United Kingdom reporting weak non-significant negative associations and Belgium reporting a weak non-significant positive association (Claes, 2011). Furthermore, no relationship between job control and presenteeism was evident among a representative sample of workers in Canada (Jourdain & Vezina, 2014) and South Korea (Cho et al., 2016). Recently, some clarity on the relationship between job control and presenteeism has been reported in the literature. Gerich (2019), in a study of Austrian workers, found a curvilinear relationship between job control and presenteeism where an increase in job control at low or moderate levels was associated with reduced sickness presenteeism, while a rise in job control at higher levels was related to more sickness presence. 2 The larger the range between the upper and lower limit of the 80% CI, the greater the amount of between-study variation in the observed effect sizes. If the 80% CI includes zero, then the range includes both positive and negative effect sizes.

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Therefore, for those workers with a high amount of job control, such as managers and professional staff, the provision of more job control made it even easier for these workers to modify and adjust their tasks when ill (i.e., encouraging presenteeism); whereas more job control among workers with lower level positions, such as office clerks and assistants, might make them feel more powerful and less susceptible to the pressure to attend work when unwell (i.e., discouraging presenteeism) (Gerich, 2019). Mixed results are also evidenced in the literature on job satisfaction and presenteeism. For example, Miraglia and Johns (2016) found a positive relationship between job satisfaction and presenteeism, arguing that employees are more likely to be motivated to attend work while unwell when they enjoy their job. However, many studies have found a negative association between job satisfaction and presenteeism in that being at work while sick and lower job satisfaction are likely to co-exist (Allemann et al., 2019; Baker-McClearn et al., 2010; Caverley et al., 2007; Cho et al., 2016; Côté et al., 2021; Gosselin et al., 2013; Rantanen & Tuominen, 2011). In a cross-cultural study on British and Chinese workers, researchers reported a negative relationship between job satisfaction and presenteeism; however, the relationship was only significant among the British sample (Lu, Cooper, et al., 2013). Finally, a longitudinal study, investigating job satisfaction and presenteeism demonstrated a weak non-significant negative relationship when compared at baseline; a weak non-significant positive relationship when baseline presenteeism and job satisfaction two months later were compared and when both presenteeism and job satisfaction were compared two months later a significant negative relationship was reported (Lu, Lin, et al., 2013). 1.3.1

Contemporary Research

In Sect. 1.3, we discussed many antecedents of presenteeism that are commonly reported in the literature, focusing in particular on some key findings from Miraglia and Johns’ (2016) meta-analysis on presenteeism. In this section on contemporary research, we discuss some novel antecedents of presenteeism that have been more recently published, such as the role of leadership including leader presenteeism and transformational leadership, presenteeism climates, attendance cultures, labour markets and the distinction between different types of job demands. In a longitudinal study of German leaders and their team members, Dietz et al. (2020) found that leader presenteeism was positively related

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to employee presenteeism which, in turn, lead to an increased rate of employee absenteeism. In line with social learning theory (Bandura, 1986), these findings suggest that employees might emulate their leaders’ behaviour by drawing upon behavioural cues from their ill leader to adjust their own attendance behaviour when sick. Therefore, if leaders regularly engage in presenteeism, then a ‘trickle-down effect’ is expected among staff as they are likely to model this behaviour (Dietz et al., 2020). In another longitudinal study, Nielsen and Daniels (2016) found that transformational leadership was linked to increased presenteeism among staff, which in turn, increased their risk of future absences. Transformational leaders create a common vision and goal that may encourage workers to self-sabotage for the benefit of the group. Thus, when sick, workers may choose to continue working (for the interest of the group) rather than resting and recuperating, resulting in more absences over time (Nielsen & Daniels, 2016). The importance of social norms and values within an organisation, and their ability to collectively affect presenteeism behaviour have been recently raised. For example, presenteeism climates, defined by Ferreira et al. (2019) as the perceived institutional pressure to keep employees working beyond the time necessary for efficient performance at work and despite being ill, are predicted to develop within organisations when there is (i) a high level of competitiveness among employees; (ii) a shared belief that those who work longer hours are more productive; and (iii) a high level of perceived irreplaceability. Ferreira and colleagues (2019) examined the effect of presenteeism climate on distributive justice and work–family conflict in a diverse sample of Latin and non-Latin workers. As expected, the researchers found that the positive relationship between presenteeism climate and work–family conflict was mediated by distributive justice. Drawing upon equity theory (Adams, 1965), Ferreira et al. (2019) argued that employees are more likely to continue working regardless of their contracted hours or illness if they perceive that workplace resources are fairly distributed. This would likely increase the time they devote to the organisation, which may lead to an imbalance in their work–home life. Mach and colleagues (2018) also investigated the impact of presenteeism climates in their study of hospital workers in Lebanon. A notable finding from their research is the existence of a positive relationship between presenteeism climate and the number of days the hospital workers engaged in presenteeism in a 6-month period. This finding suggests that presenteeism may be higher in certain organisations

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compared to others because an overarching presenteeism climate could be influencing employees above and beyond any individual or task-related predictors (Mach et al., 2018). Recently, a more holistic conceptualisation of the social norms and values that influence attendance has been proposed. For instance, Ruhle and Süß (2020) present a qualitative analysis of attendance culture accounting for employees’ perceived legitimacy of both absence and presence in the face of illness. Three specific archetypes of sickness attendance cultures are proposed, based on employee’s categorisation of the perceived legitimacy of absenteeism versus presenteeism: (i) healthfocused, (ii) presentistic and (iii) individual decision (Ruhle & Süß, 2020). A health-focused culture is argued to occur when employees perceive that sickness absence is legitimate and sickness presenteeism is illegitimate; a presentistic culture is apparent within a workplace when employees perceive that sickness presence is legitimate and absence is deemed illegitimate; and an individual decision culture is expected when employees perceive both attendance behaviours as legitimate. Drawing upon these archetypes, if the negative consequences of absenteeism, such as the costs of replacing an absent worker and reductions in productivity, are common language within an organisation than it is likely that an underlying assumption that absence should be avoided at all costs may develop, leading to a presentistic culture that discourages absenteeism and encourages presenteeism among workers (Ruhle & Süß, 2020). Similar to Dietz et al. (2020), a presentistic culture may also develop through role modelling if managers continue to work through illness. Presenteeism will again be viewed as legitimate and absence as illegitimate based on the behaviour role modelled to employees. Differences in presenteeism across countries have been reported in the literature. For example, Lu, Cooper, et al. (2013) reported higher rates of presenteeism and levels of strain among a sample of Taiwanese workers compared to a sample of British workers. Other contexts which might affect employees’ tendency to engage in presenteeism, such as the labour market that they are embedded in, have more recently been investigated (Reuter et al., 2021). For example, in a large-scale study across 232 regions in Europe, unemployment rates were found to be positively associated with presenteeism. In other words, presenteeism was higher among the European regions with higher unemployment rates. The findings were also more pronounced among workers with lower skills and salaries, and for healthcare and industrial workers (Reuter et al., 2021).

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These findings are interesting as they emphasise the role that societal or contextual factors outside the employees’ immediate work environment can have on presenteeism. Job demands have traditionally been thought to trigger a stress response, leading to poorer health and a range of negative work outcomes (Bakker et al., 2003, 2004; Demerouti et al., 2009). However, some researchers have investigated job demands more thoroughly, further categorising them into challenge and hindrance demands. For example, challenge demands are predicted to stimulate workers and provide them with a sense of accomplishment and pride, such as high workloads, time pressure and complex tasks, whereas hindrance demands are thought to act as a barrier preventing employees from achieving their work goals, such as organisational red tape, role ambiguity and conflict and workplace bullying (Cavanaugh et al., 2000; Podsakoff et al., 2007; Van den Broeck et al., 2010). Through a meta-analysis, Podsakoff and colleagues (2007), demonstrated that challenge demands can actually make a positive contribution in the workplace, leading to increased job satisfaction, organisational commitment, motivation and job performance. Recently, some studies have researched the differential effects of challenge versus hindrance demands on presenteeism, albeit using presenteeism-related productivity loss (Deng et al., 2019; Yang et al., 2017). For example, Yang et al. (2017) reported differences between challenge and hindrance demands in that challenge demands where positively related and hindrance demands were negatively related to affective commitment. Furthermore, hindrance demands were found to be positively related to presenteeism while challenge demands were unrelated. One study reported on the differential effects of challenge versus hindrance demands on the behaviour of attending work when ill (Vinod Nair et al., 2020). The findings from this study emphasised, to some degree, the usefulness of challenge demands within the workplace (conceptualised as work overload) in that work overload was found to be positively related to work engagement, whereas hindrance demands (conceptualised as role ambiguity and role conflict) were negatively related to work engagement. However, there were no differences between the challenge and hindrance demands in relation to presenteeism with all job demands reported to be positively associated with presenteeism (Vinod Nair et al., 2020). Given the interesting differences between challenge and hindrance demands in the staff turnover and job performance literature (Podsakoff et al., 2007), it would be worthwhile to continue exploring this distinction in relation to presenteeism.

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Consequences of Presenteeism

While there are many factors that may influence or impact presenteeism, the literature also highlights the consequences of this phenomenon. A range of negative health outcomes, such as physical and mental health conditions and burnout are associated with working while ill as well as negative work outcomes, such as increased rates of short- and long-term absenteeism and reduced productivity (Bergstrom et al., 2009; Collins et al., 2018; Gustafsson & Marklund, 2011; Rainbow, 2019; Skagen & Collins, 2016; Taloyan et al., 2012; Widera et al., 2010). In terms of health-related consequences, continuing to work while experiencing an illness, such as the common cold or influenza, is likely to result in widespread contamination among employees especially within indoor office spaces or where employees work close to one another (Widera et al., 2010). Attending work when unwell is even more problematic when considering the COVID-19 virus, and how transmittable it is from person to person (Eisen, 2020). Other non-infectious illnesses, such as coronary heart disease, have been shown to rise following presenteeism. For example, unhealthy workers who took no absence days in the three years prior were twice as likely to experience serious coronary events compared to unhealthy workers with moderate levels of sickness absence (Kivimaki et al., 2005). More broadly, presenteeism also seems to negatively impact employees’ overall perceptions of their health (Dellve et al., 2011; Gustafsson & Marklund, 2011; Skagen & Collins, 2016; Taloyan et al., 2012). In a nationally representative sample of Swedish workers, Taloyan and colleagues (2012) found that higher rates of presenteeism were predictive of suboptimal self-rated health two years later. Other studies have reported significant relationships between presenteeism and poorer mental health including mental illnesses and burnout. For example, a study of pharmacists found that engaging in presenteeism was associated with increased rates of depression and anxiety as well as more errors at work (Niven & Ciborowska, 2015). In a two-year followup study in Denmark, researchers also found that eight or more days of sickness presence was predictive of depression among workers (Conway et al., 2014). Among other variables, Demerouti et al. (2009) investigated the association between burnout and presenteeism in a sample of Dutch nurses over 18 months. The researchers found that depersonalisation (a component of burnout) was an outcome of engaging in presenteeism over time, while emotional exhaustion (a component of burnout) and

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presenteeism had a reciprocal relationship in that exhaustion leads to more presenteeism and attending work while ill results in more exhaustion over time (Demerouti et al., 2009). In terms of work-related consequences, the relationship between presenteeism and absenteeism has received attention in the literature. On the day of a health event, presenteeism and absenteeism are mutually exclusive in that an employee either decides to be present or absent. However, when presenteeism and absenteeism are measured retrospectively over a given period (i.e., in the past 6 or 12 months), the research evidence largely suggests that the two phenomena are actually positively related. This is possibly because unwell workers are likely to alternate between presence and absence depending on the severity of their condition on the day. In other words, they are likely to engage in both absenteeism and presenteeism (Aronsson et al., 2000; Barber & Santuzzi, 2015; Deery et al., 2014; Gosselin et al., 2013; Krpalek et al., 2014; MacGregor et al., 2008). Presenteeism has also been shown to predict increased absence behaviour over time as continuing to work while ill does not allow the worker time to rest and properly recover (Bergstrom et al., 2009; Hansen & Andersen, 2009; Janssens et al., 2013; Taloyan et al., 2012). For example, in a prospective study of Swedish workers, Taloyan et al. (2012) found that baseline presenteeism was related to the number of days absent two years later. Similarly, Janssens and colleagues (2013) found higher rates of presenteeism at baseline (greater than five days) to be a significant predictor of short and long-term absence for both males and females one year later. Other workplace outcomes, such as productivity and performance are related to presenteeism, albeit to varying degrees. For example, some research has demonstrated moderate to strong negative associations between presenteeism and self-rated job performance and work productivity (Beaton et al., 2010; Tang et al., 2009) and work and life productivity (Brod et al., 2006). However, other studies have reported smaller effects, such as the relationships between presenteeism and objective productivity (Albensi, 2003), medical performance (Schaufeli et al., 2009) and job performance (Lu, Lin, et al., 2013). While much of the presenteeism literature focuses on the negative implications of the phenomenon, some scholars claim that there might actually be some benefits gained from working through an illness. For example, Karanika-Murray and Biron (2020) outline several studies which show a link between presenteeism and positive outcomes, such

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as performance-based self-esteem (Love et al., 2010), a sense of accomplishment (Biron & Saksvik, 2010), supporting a gradual return-to-work (Howard et al., 2009) and organisational citizenship behaviour (Snir & Harpaz, 2012). Ruhle and colleagues (2020) also discuss presenteeism from a positive perspective, such as the benefit of engaging in presenteeism in terms of successful workplace rehabilitation programmes (Baker-McClearn et al., 2010; Whysall et al., 2018), maintaining quality relationships and sustaining job control (Biron & Saksvik, 2010). In a comprehensive review of the presenteeism literature, Lohaus and Habermann (2019) indicate several positive effects of attending work while ill, such as a boost to employee’s self-esteem and increased chances of rewards and promotions as a result of being perceived by supervisors and co-workers as hard working. Miraglia and Johns (2016), in their metaanalysis of presenteeism, also discuss the importance of presenteeism for certain groups of people; arguing that the act of going to work while ill for those with chronic illnesses, such as depressive mood and migraines, may help increase their self-esteem (Johansen et al., 2014). Karanika-Murray and Biron (2020) present a strong case for the adaptability of presenteeism. In particular, they argue that presenteeism can be a sustainable choice for maintaining performance under impaired health if the workplace is supportive and provides adequate resources, such as job autonomy, flexible work arrangements, social support and rewards to aid adaptation. Under these conditions, Karanika-Murray and Biron (2020) argue that presenteeism is a suitable option benefiting both the employer and employee. Recently, Lohaus et al. (2021) examined the positive effects of presenteeism in a sample of working adults. Twenty-four positive outcomes of presenteeism were included and further categorised into seven factors using principal components analysis (namely, economic orientation, financial advantages, endurance, side benefits, social norms, team spirit and completing one’s work). The results indicated that three of the seven factors were significantly related to presenteeism. These factors were (i) economic considerations, such as not wanting to be a burden on the social security system and contributing to the achievement of the organisation’s goals; (ii) financial advantages, such as gaining/maintaining income; and (iii) endurance, such as demonstrating capacity to myself, recovering from health impairments and not wanting to let sickness get me down. Building upon earlier conceptual studies (Karanika-Murray & Biron, 2020; Lohaus & Habermann, 2019; Ruhle et al., 2020), empirical evidence from Lohaus and colleagues (2021) emphasises the benefits that

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can be attained if organisations actively support employees that continue to work through an illness. While most literature on presenteeism has been cross-sectional in design, some research has investigated the antecedents and consequences of presenteeism over time (Bergstrom et al., 2009; Demerouti et al., 2009; Dietz et al., 2020; Jensen et al., 2019; Karlsson et al., 2010; Lu, Lin, et al., 2013; Nielsen & Daniels, 2016). Time lagged research designs are important as baseline effects can be accounted for, causality can be investigated, and the sequential order of a theoretical model tested. As the number of longitudinal studies on presenteeism grows, a more thorough understanding of the relationships that exist between presenteeism and the factors associated with the phenomenon will unfold.

1.5

Chapter Summary

In this chapter the definitions of presenteeism were discussed including some considerations about their usage. Next, the high rates of presenteeism among workers, especially nurses, doctors and teachers, as well as the costs of presenteeism were presented. Presenteeism antecedents, such as general ill health, depression and stress were discussed along with some of the key job demands, job and personal resources and job attitudes that are related to presenteeism. The considerable amount of variability across the observed effect sizes, especially for the relationships between presenteeism and both job control and job satisfaction, was addressed. We also highlighted the relevance of contemporary research of interest, such as the impact of leader presenteeism, transformational leadership, presenteeism climates, attendance cultures, labour markets and differences between challenge and hindrance demands, to the understanding of presenteeism. Finally, the consequences of presenteeism were discussed including both the negative consequences, such as poorer physical and mental health, burnout, absenteeism, and productivity loss as well as potentially positive consequences, such as organisational citizenship behaviour, self-esteem and return-to-work outcomes. In the next chapter, we provide an overview of presenteeism measures including descriptions of the scales and their psychometric properties.

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Van den Broeck, A., De Cuyper, N., De Witte, H., & Vansteenkiste, M. (2010). Not all job demands are equal: Differentiating job hindrances and job challenges in the Job Demands-Resources model. European Journal of Work and Organizational Psychology, 19(6), 735–759. Vänni, K., Neupane, S., & Nygård, C.-H. (2017). An effort to assess the relation between productivity loss costs and presenteeism at work. International Journal of Occupational Safety and Ergonomics, 23(1), 33–43. Vinod Nair, A., McGregor, A., & Caputi, P. (2020). The impact of challenge and hindrance demands on burnout, work engagement and presenteeism. A cross-sectional study using the Job Demands—Resources model. Journal of Occupational and Environmental Medicine. https://doi.org/10.1097/jom. 0000000000001908 Wang, Y., Chen, C.-C., Lu, L., Eisenberger, R., & Fosh, P. (2018). Effects of leader–member exchange and workload on presenteeism. Journal of Managerial Psychology, 33(7/8), 511–523. Webster, R., Liu, R., Karimullina, K., Hall, I., Amlôt, R., & Rubin, G. (2019). A systematic review of infectious illness presenteeism: Prevalence, reasons and risk factors. BMC Public Health, 19(1), 1–13. Whysall, Z., Bowden, J., & Hewitt, M. (2018). Sickness presenteeism: Measurement and management challenges. Ergonomics, 61(3), 341–354. Widera, E., Chang, A., & Chen, H. L. (2010). Presenteeism: A public health hazard. Journal of General Internal Medicine, 25(11), 1244–1247. Yang, T., Guo, Y., Ma, M., Li, Y., Tian, H., & Deng, J. (2017). Job stress and presenteeism among Chinese healthcare workers: The mediating effects of affective commitment. International Journal of Environmental Research and Public Health, 14(9), 978.

CHAPTER 2

Measuring Presenteeism

Abstract The concept of presenteeism is multi-layered and complex. Defining presenteeism and understanding this complexity is fundamental to any rigorous study of the concept. Understanding the antecedents and consequences of presenteeism will also assist in developing efficacious interventions. While conceptual development is crucial, how we measure presenteeism is equally important. This chapter focuses on the measurement of presenteeism. It begins with a discussion on why measurement is important in the field of presenteeism. The chapter also describes and reviews a selection of commonly used measures, describing how they are structured and their psychometric properties. Keywords Psychological variables · Self-report measures · Productivity loss · Test–retest reliability · Internal consistency · Construct validity

2.1

Why is Measurement Important?

Researchers in the social sciences are motivated by curiosity. They strive to understand phenomena—why do people behave the way they do? What has triggered or led to a particular event? What are the consequences of

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certain behaviours? A well-developed conceptual and theoretical framework is important in answering such questions. The measurement of phenomena is integral to the development of conceptual frameworks. Researchers are often interested in comparing individuals on certain variables, or the degree to which a variable influences another variable. Determining how to measure a variable then becomes a relevant activity. Sometimes what we may wish to measure is directly observable. For example, we can record the number of days a person is absent from work. However, there are occasions when the phenomenon of interest is not directly observable. Psychological variables, for instance, fall into this category (Flake & Fried, 2020). While it may be easy to record the number of days a person is absent from work, it’s more difficult to measure the motives of people who come to work when they are ill. Instead of the ability to measure motivations directly, researchers obtain a sample of behaviours (typically the responses to items on a scale or instrument) that are assumed to be related to the latent variable (Bollen, 2002). Moreover, these motivations may be complex in nature and workplace-specific. Understanding the complexity of variables and attributes, then, is integral to developing useful measures of those variables and attributes. In turn, measures can then be used to assess these variables and attributes. Hypotheses about relationships among key variables can be tested and so advance our understanding of the concepts of interest. When determining which measures, scales or instruments to use to assess variables, researchers look to the psychometric properties of the measures. The psychometric properties of a measure or instrument refer to both the mathematical and statistical characteristics of data generated from using the measure as well how those data are used and evaluated in decision-making (Nunnally, 1978). Reliability and validity are two concepts commonly used when assessing the utility and usefulness of scales and measures. Reliability refers to consistency of measurement which in turn reflects the amount of error in the measurements (Nunnally, 1978). In other words, it is that characteristic of the scale that makes it insensitive to change (Kelly, 1955). Typically, in the literature, researchers may refer to the internal consistency of scales (for example, assessed using Cronbach’s alpha) and test–retest reliability, an assessment of temporal stability. The validity of a scale or measure refers to the extent to which it means what it says it will measure. Kelly (1955) referred to validity as the capacity of a test to tell us what we already know.

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There has been an ongoing debate in the literature about measurement in psychology, the concept of validity and psychometrics more generally. A detailed discussion of the issues raised in this debate are beyond the scope of the chapter. What is challenged is the classical view of construct validity (see Cronbach & Meehl, 1955) and the ontological status of latent variables. Borsboom et al. (2004, p. 1061), for example, take a realist perspective stating that ‘a test is valid for measuring an attribute if and only if (a) the attribute exists and (b) variations in the attribute causally produce variations in the outcomes of the measurement procedure’. Researchers such as Borsboom advocate the importance of integrating theory, the scale construction process and data analysis in dealing with validity (Borsboom et al., 2004). Michell (2000) takes a stronger position and argues that psychometrics is a ‘pathological science’ for neglecting to investigate whether attributes that are being measured have quantitative structure and proceeding as if this assumption holds. While this debate is important, the consensus view of validity is still influential and adopted by researchers. This view posits the importance of providing evidence to support test score interpretation—the focus is on the validity of scores generated by tests or instruments rather than the test itself (Newton, 2012). The consensus view of validity still posits concepts such as construct validity and criterion validity. Within this framework, validity can be considered in terms of validity of measurement (encompassing concepts such as construct validity) and the association between validity and decision-making (Murphy & Davidshofer, 2005). The latter consideration points to why good measurement is of particular importance. For example, information from scales, tests and measures are used in organisations to make decisions, and the quality of those decisions will be influenced by the quality of the measures used in the decision-making process.

2.2

Two Sides of the Presenteeism Coin

A review of the presenteeism literature shows that researchers have taken two related, but nonetheless distinct, strategies to measuring presenteeism. One approach is grounded in the definition that reflects presenteeism as a behaviour that results from a decision to either attend work while ill or be absent from work (Ruhle et al., 2020). As discussed in Sect. 1.1, you will see researchers referring to measuring the ‘act’ of

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presenteeism (Johns, 2010; Ruhle et al., 2020)—that is, to attend work while ill. The second approach to measurement in the presenteeism literature is concerned with estimating the work productivity loss or the economic impact on an organisation of an individual attending work when ill. Typically, this involves an individual providing a subjective estimate of the per cent work productivity or time loss associated with being at work when ill, and then converting that time estimate into a monetary cost estimate. This strategy, then, provides an assessment of the financial or economic consequence of the act of presenteeism. The act or behaviour of presenteeism and the consequences of that behaviour may be two sides of the same coin, but it is important to avoid the conflation of behaviour and work productivity loss (Johns, 2010; McGregor et al., 2018). This is especially the case when considering measurement; there needs to be clarity about the concept being measured—are you measuring behaviour or the consequence of behaviour?

2.3

Measuring the Act of Presenteeism

What do we know about measuring the act of presenteeism? The literature tells us that, typically, presenteeism is measured using a single item that captures the frequency of being presentee (Lohaus & Habermann, 2019). The item that is used may vary in terms of content or wording, the response format associated with the measure and the recall period or timeframe during which a respondent has been presentee (Ruhle et al., 2020). Recently, Ruhle et al. (2020) provide a detailed and useful description of variations in the item content, response format and timeframe of single-item measures of presenteeism. In terms of the wording of items, Ruhle et al. (2020) classify items into three types. First, the content can be unrestrictive in nature. Unrestrictive items do not make reference to why the respondent is presentee or the consequences of the behaviour. Ruhle et al. (2020) cite the following item from Demerouti et al. (2009) as an example of an unrestrictive item—‘Have you gone to work despite feeling sick?’. The wording or content of items can also be categorised as dysfunctional (Ruhle et al., 2020). Wording that is dysfunctional in nature typically reflects behaviour that departs from an action that would normally occur in that situation. Ruhle et al. (2020) point to the measure used by Aronsson, Gustafsson and Dallner (2000) as exhibiting behaviour

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that is dysfunctional. The item reads ‘Has it happened over the previous 12 months that you have gone to work despite feeling that you really should have taken sick leave due to your state of health?’ (Aronsson et al., 2000, p. 504). Being presentee rather than taking sick leave is the deviation from what would normally happen in this situation. The third type of variation on content or wording identified by Ruhle et al. (2020) reflects the perception of being forced to work when ill. Ruhle et al. (2020) point to the item employed by Lu et al. (2013) to exemplify this variation. The item reads ‘Although you feel sick, you still force yourself to go to work’ (Lu et al., 2013, p. 411). In terms of response formats, Ruhle et al. (2020) identified a few different types that are commonly used in single-item measures of presenteeism—(i) if presenteeism occurs; a yes/no response format; (ii) the frequency of the act is recorded, e.g., 2–5 times; or (iii) the total number of presenteeism days. Interestingly some researchers collapse the scale points into smaller categories for analysis purposes. For example, Aronsson et al. (2000) used a 4-point response scale, where 1 = No, never; 2 = Yes, once; 3 = Yes, 2–5 times; 4 = Yes, more than 5 times (p. 504). For the purposes of using logistic regression to analyse responses, Aronsson et al. (2000) collapsed the 4-point scale into two categories—one category combining the original scale points 1 and 2; and a second category that combines the original scale points 3 and 4. Measures also differ in terms of the recall period a respondent is asked to consider when responding to the measure. Recall periods can vary from as little as one week to up to 12 months (Ruhle et al., 2020). Given the variability in recall periods, what then constitutes an acceptable or reliable recall period? Skagen and Collins (2016) conducted a systematic review of the consequences of presenteeism on health and wellbeing. While they also reported variations in recall period across studies, Skagen and Collins (2016) noted that most studies in their review asked participants to report over a 12-month period. Studies by Lu et al., (2013, 2014) used a 6-month recall period. Collins et al. (2018) adopted a recall period of 3 months, but they point out that what is deemed to be an appropriate recall period is still debatable. In any consideration, there needs to be a balance between choosing a recall period that is long enough to adequately sample the presenteeism behaviour, while avoiding issues of recall bias—if the recall period is too long, then an accurate recollection of behaviour may not be possible.

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2.4

Measuring Productivity Loss

Presenteeism can also be measured from the perspective of work productivity loss or the economic cost associated with an employee attending work when ill. The literature is replete with measures of work productivity loss. For example, Ospina et al. (2015) conducted a systematic review of productivity loss measures, identifying 21 measures in the literature. How do these measures work? Measures of work productivity loss typically ask respondents to provide self-reported health information and to estimate the degree that health impairment has affected productivity (Johns, 2010). Health information can be generic in nature, asking a respondent about his or her general health, or the focus can be on specific health conditions (Johns, 2010). Several measurement approaches are used to assess productivity. In terms of assessing productivity, Johns (2010) notes that some measures (i) adopt a qualitative approach, (ii) ask respondents to provide an estimate of productivity or time lost that is then converted to monetary loss, (iii) adopt an approach akin to a job analysis and (iv) a global assessment of productivity. In this chapter, we will present and review a selection of commonly used measures, paying particular attention to their psychometric properties in order to assist readers with their usage. 2.4.1

Stanford Presenteeism Scale

The origins of the Stanford Presenteeism Scale can be traced back to the work of Lynch and Riedel (2001) where its predecessor was known as The Stanford/American Health Association Presenteeism Scale. Koopman et al. (2002) make reference to a 32-item version of the scale that is reported in Lynch and Riedel (2001). The development of the Stanford Presenteeism Scale focused on measuring cognitive, emotional and behavioural aspects of concentration, and therefore, completing workrelated tasks despite health impairments (Koopman et al., 2002). Two versions of the Stanford Presenteeism Scale are discussed in the literature—a 6-item version developed by Koopman et al. (2002) and a 13-item version proposed by Turpin et al. (2004).

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2.4.1.1 Scale Description The 6-item version of the Stanford Presenteeism Scale (referred to as SPS6) aims to capture the emotional, cognitive and behavioural aspects of presenteeism. A person completing the SPS-6 is instructed to consider his or her work experiences in the last month and respond to six statements that describe their experiences at work using a 5-point Likert scale ranging from strongly agree to strongly disagree. Each item refers to a health problem denoting health impairments considered by the respondents (Koopman et al., 2002). The items of the SPS-6 can be grouped into factors. The first factor is labelled Completing Work (indicating work outcome) and includes items such as ‘Despite having my (health problem) I was able to finish hard tasks in my work’. The second factor is labelled Avoiding Distraction (indicating how well work is progressing)—“My (health problem) distracted me from taking pleasure in my work” is an item that exemplifies this factor (Koopman et al., 2002). Responses from the items of the SPS-6 can be summed (once items are appropriately reversed scored) to obtain a total presenteeism score. High values on the total score indicate high presenteeism—‘a greater ability to concentrate on and accomplish work despite health problem(s)’ (Koopman et al., 2002, p. 17). Turpin et al. (2004) developed a 13-item version of the Stanford Presenteeism Scale (SPS-13). The motivation for developing this version of the scale was severalfold. Turpin et al. (2004) argued for a measure that (i) could be applied across, what they referred to as, knowledgebased as well as production-oriented work types; (ii) would indicate the prevalence of work productivity loss pertain to particular health conditions; (iii) would provide a global assessment of how health impairment affects an individual’s perceived work productivity; and (iv) would assess absenteeism. The SPS-13 consists of a number of components that align with the motivational underpinning of this version of the scale. Respondents are asked to identify if they have any of the health conditions on a predetermined list. They are also asked to identify a primary health condition that has affected them in the last 4 weeks. With the focus on the primary health condition, respondents then complete 10 items using a Likert scale to assess how the health condition impacts work functioning. Typically, a 5-point scale is adopted where responses range from 1 (‘always’) to 5 (‘Never’) (Saijo et al., 2017). Item responses are summed to provide an estimate of productivity impairment pertaining to that health condition.

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Higher scores reflect low productivity. These 10 items make up what is referred to as the Work Impairment Scale. Like the SPS-6, the underlying factor structure of the Work Impairment Scale yields two factors that can be labelled Completing Work and Avoiding Distraction. Examples of items that make up the Completing Work factor include ‘Were you able to focus on achieving goals?’ and ‘Did you feel energetic enough to complete your work?’ Items such as ‘Were the stresses of your job hard to handle?’ and ‘Did you feel hopeless about finishing your work?’ are associated with the Avoiding Distraction factor (Turpin et al., 2004). The SPS-13 also asks respondents to assess how much of their usual work productivity (as a percentage) they were able to achieve over a 4-week period given the impact of a primary health condition. Low scores represent larger productivity loss. This measure is referred to as the Work Output Score. Finally, the SPS-13 includes a measure of absenteeism assessing the number of absent hours or days for the past 4 weeks associated with the primary health condition. 2.4.1.2 Psychometric Properties The literature shows that the SPS-6 has good psychometric properties. In their developmental work, Koopman et al. (2002) reported that the scale had good internal consistency1 (α = 0.80). They also reported evidence of concurrent validity with the SPS-6 correlating with other measures of presenteeism, and evidence of criterion and divergent validity. Koopman et al. (2002) found that the SPS-6 correlated with self-reported ratings of the time respondents were productive at work despite being ill (r = 0.53) and proportion of work completed (r = 0.47). Mean scores on the SPS-6 were lower for employees reporting a disability compared to those who reported no disability. Koopman et al. (2002) also found that while SPS-6 was correlated with job satisfaction (r = 0.15) and job stress (r = −0.22), the magnitude of these correlations supported divergent validity. In their review, Ospina et al. (2015) highlighted the good psychometric properties of the SPS-6. They pointed to strong evidence for internal consistency, content validity, as well as construct and convergent validity. Evidence of

1 Internal consistency is a measure of reliability. Cronbach’s alpha is a measure of internal consistency. Consensus is that a Cronbach’s alpha value of 0.70 or higher demonstrates good internal consistency. Cronbach alphas of 0.80 or greater are considered to be very good, and Cronbach alphas of 0.6 are considered to be satisfactory/acceptable (Nunnally, 1978).

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good internal consistency has also been reported in other studies (Beaton et al., 2010; Rainbow et al., 2019; Sanderson et al., 2007; Tang et al., 2009). The SPS-6 has been adapted to be used in the Spanish Healthcare sector (Baldonedo-Mosteiro et al., 2020). The researchers replicated the factor structure of the SPS-6 by yielding two factors, Completing Work and Avoiding Distraction. Their research also showed that these two factors have good internal consistency (both factors having Cronbach alpha coefficients of greater than 0.8). Baldonedo-Mosterio et al. (2020) note that their findings on the reliability of the SPS-6 align with adaptions of the scale in an Italian context (Cicolini et al., 2016), Dutch context (Hutting et al., 2014) and Portuguese context (Laranjeira, 2013). Evidence for the psychometric properties of the SPS-13 is limited, but promising. Turpin et al. (2004) reported good internal consistency for the Work Impairment Scale (α = 0.82). They also found the Completing Work factor had very good internal consistency (α = 0.97), and the Avoiding Distraction factor to have acceptable reliability (α = 0.60). The Cronbach alpha coefficients varied across knowledge-based and production-based occupations. Turpin et al. (2004) found evidence of concurrent validity with the SPS-13 correlating with the Work Limitations Questionnaire (Lerner et al., 2001), another measure of presenteeism. The Scale also correlated with the SF-36 (Ware & Sherbourne, 1992) demonstrating satisfactory convergent validity. Yamashita and Arakida (2008) reported evidence of the reliability and validity of a Japanese version of the SPS-13. They reported good internal consistency for the Work Impairment Scale (α = 0.87) as well as good test–retest reliability (r = 0.83). Yamashita and Arakida also reproduced the 2-factor structure of the Work Impairment Scale and reported good internal consistency for Completing Work and Avoiding Distraction. They also reported that the Work Impairment Scale correlated with the SF-36 (Ware & Sherbourne, 1992) demonstrating concurrent validity evidence. Lee (2010) adapted the SPS-13 to be used with Korean employees and reported good internal consistency for the scale. 2.4.2

Work Limitations Questionnaire

The Work Limitations Questionnaire (WLQ) is designed to measure the degree to which health impairment affects an individual’s performance in specific aspects of job roles, and how work productivity is impacted by

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decrements in performance (Lerner et al., 2001; Munir, 2008). Lerner et al. (2001) originally developed a 25-item version of the questionnaire. Short forms of the WLQ are also reported in the literature. The WLQ has been used in a variety of settings and with a range of professionals (Munir, 2008). 2.4.2.1 Scale Description The WLQ is a self-report measure that asks respondents to assess their ability to perform on 25 job-related demands or limitations in the last two weeks. The 25 items can be grouped into four dimensions or scales (Time Management, Physical Demands, Mental-Interpersonal Demands and Output demands) that reflect the complexity of work roles and how performing in these roles can be differentially impacted by health conditions (Munir, 2008). The Time Management scale consists of five items that assess the impact of health impairment on managing time and scheduling requirements associated with job tasks. Sample items include ‘Get going early at the beginning of the workday’ and ‘Stick to a routine or schedule’. Six items make up the Physical Demands subscale. This scale assesses how health conditions impact a person’s ability to perform tasks that focus on physical aspects of job tasks. Items such as ‘Bend, twist or reach while working’ and ‘Lift, carry, or move objects at work weighing more than 4.50 kg’ are included in this subscale. The WLQ also includes a subscale that assesses how impairment may affect cognitive aspects of job tasks and how one interacts with others while at work. This scale, made up of nine items, is referred to as Mental-Interpersonal scale. It includes items such as ‘Concentrate on your work’ and ‘Control your temper around people when working’. The fourth scale is Output Demands. It consists of 5 items that focus on the impact that health impairment may have on perceived capacity to complete work tasks and the quality of task outputs. Sample items include ‘Finish work on time’ and ‘Do your work without making mistakes’. Respondents are asked to rate each item using a 5-point Likert scale ranging from ‘None of the time’ to ‘All of the time’. Responses on each item of a scale can be summed and averaged. Scale scores can then be transformed onto a scale ranging from 0–100 where 0 refers to ‘limited none of the time’ and 100 ‘limited all of the time’ (Verhoef et al., 2012).

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Short forms of the WLQ are reported in the literature. Burton et al., (2004, 2005) report using an 8-item version of WLQ (WLQ-8). The four domains of the WLQ (Time Management, Mental-Interpersonal, Physical and Output) are still maintained with the WLQ-8. Each domain contains two items. A 16-item version of the WLQ (WLQ-16) is also discussed in the literature. Bültmann et al. (2007) looked at health status and work limitations in a sample or workers with Musculo-skeletal disorders. They used the WLQ-16 to measure work limitations citing earlier work by Beaton and Kennedy (2005). The four domains of the WLQ-25 are retained in the WLQ-16; the Time Management domain has 2 items; Physical domain has 4 items; Mental-Interpersonal domain has 6 items and Output domain has 4 items. Response format and scoring procedures are similar to the WLQ-25. The WLQ-25 has also been adapted for caregivers to assess the impact of caregiving on work performance (Lerner et al., 2015, 2017). 2.4.2.2 Psychometric Properties Beaton and Kennedy (2005) reported good internal consistency for the WLQ-16 with Cronbach alphas for the domains or scales ranging from 0.74 to 0.96. They also reported evidence of construct validity. For instance, the subscales of the WLQ-16 were correlated with the QuickDASH Outcome measure for upper limb disorders (Beaton et al., 2005) and the Roland Morris Scale for lower back pain (Roland & Fairbank, 2000). Bültmann et al. (2007) also reported acceptable alpha coefficients for the domains or scales with values ranging from 0.76 to 0.86. Further psychometric evidence in support of the WLQ-8 is noted in the literature (Walker et al., 2017). Walker et al. (2017) reported acceptable reliability including good test–retest reliability, evidence of good convergent validity and divergent validity. Notably, they found support for a 1-factor model of the WLQ-8, indicating the unidimensionality of the measure. They concluded that the WLQ-8 can be used as an alternative to the WLQ25 but noting that the WLQ-25 is still the preferred measure given its comprehensiveness. The psychometric properties of the WLQ-25 have been examined extensively for both English and non-English versions of the measure. In their early work with the WLQ-25, Lerner et al. (2001) reported good internal consistency (alpha values ranging from 0.88 to 0.91) and construct validity (as evidenced by associations with the SF-36

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Role-Physical Scale (assessing physical health limitations) and the SF-36 Role/emotional Scale (Assessing emotional health limitations) (Ware & Sherbourne, 1992). Additional evidence of satisfactory measurement properties of the WLQ-25 is noted in the literature (Abma et al., 2012; Beaton et al., 2010; Sanderson et al., 2007). Tang et al. (2011) reviewed several measures of productivity, including the WLQ-25. They concluded that the WLQ-25 has acceptable levels of internal consistency and strong support for construct validity. Tang et al. (2013) examined the factor structure of the WLQ-25. They found support for a four-factor model that reflected the 4 scales of the WLQ-25. Interestingly, Tang et al. (2013) also found that a 5-factor model, where the Mental-Interpersonal Scale was separated into Mental Demands and Interpersonal Demands, also yielded a good fit. Verhoef et al. (2012) developed a Dutch language version of the WLQ-25 for use with people with chronic conditions. Alpha coefficients ranged from 0.83 to 0.92. They also reported test–retest reliability and evidence of construct validity. Tamminga et al. (2014), using a Dutch sample, found that the WLQ is a reliable, valid and responsive measure. However, they expressed some concern about the measurement properties of the Physical Demands scale. Using a Japanese cohort, Kono et al. (2014) found that an exploratory factor analysis of the WLQ-25 yielded two factors or subscales reflecting a Cognitive domain and a Physical domain. The Cognitive domain included items that would be in the time management, Mental-Interpersonal and Output scales. The items of the Physical domain of the WLQ-25 loaded on one factor (named Physical Demand). Kono et al. (2014) noted that this domain reflected work efficiency and concentration demands. The Cognitive and Physical Domains exhibited good internal consistency (α = 0.98 and α = 0.89, respectively), test–retest reliability (intraclass correlation of 0.78 and 0.55, respectively) and construct validity (associations with job condition, job stress, social support, and psychological adjustment). 2.4.3

Endicott Work Productivity Scale

The Endicott Work Productivity Scale was developed to assess the extent to which attitudes, feelings and behaviours can reduce work productivity and efficiency (Endicott & Nee, 1997).

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2.4.3.1 Scale Description The Endicott Work Productivity Scale (EWPS) is a 25-item, self-report measure. Each item is rated using a 5-point scale from 0 (never) to 4 (almost always) where the respondent indicates the extent to which the behaviour, feeling or attitude is exhibited over a one-week time period (Endicott & Nee, 1997). Examples of the items from the EWPS include ‘During the past week, how frequently did you find you had forgotten to call someone? During the past week how frequently did you fail to finish assigned tasks?’ (Endicott & Nee, 1997, p. 14). Endicott and Nee (1997) also asked respondents to record the number of hours they are expected to work, the number of hours worked and a reason for working fewer hours than expected. Responses to each item are summed to generate a total score that ranges from 0 (best score) to 100 (worst score). 2.4.3.2 Psychometric Properties Endicott and Nee (1997) provided initial evidence for the psychometric properties of the EWPS. They reported good internal consistency (α = 0.92) and test–retest reliability (intraclass correlation = 0.92). They also provided evidence of concurrent validity, for example the EWPS correlated with measures of serious illness such as the Hamilton Rating Scale for Depression (Hamilton, 1960, 1967) and the Symptoms Checklist 90 (Derogatis & Cleary, 1977). Several reviews of work productivity measures have pointed to the satisfactory measurement properties of the EWPS (see Beaton et al., 2010; Despiegel et al., 2012; Ospina et al., 2015). Beaton et al. (2010) conducted a review of productivity measures, including the EWPS, in patients with rheumatoid arthritis or osteoarthritis. They reported good internal consistency evidence and construct validity with moderate associations between the EWPS and theoretical, work or disease-oriented constructs (such as self-rated work productivity and perceived disability). Despiegel et al. (2012) reviewed productivity measures used to assess presenteeism in people with mood disorders. They reported that the EWPS was sufficiently sensitive to productivity loss in workers with mood disorders compared to those without mood disorders. Despiegel et al. (2012) also concluded that the EWPS has satisfactory measurement properties. Erickson et al. (2009) examined work productivity in people with anxiety disorders. They used several work productivity measures including the EWPS. While the EWPS yielded good internal consistency and evidence of validity, Erickson et al. (2009) indicated there are some

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limitations in terms of sensitivity to symptom change. McMorris et al. (2010) reported good internal consistency for the EWPS with bipolar disorder subjects (α = 0.94) and a normative group (α = 0.91). More recently, Berardelli et al. (2019), when examining how the relationship between perceived disability and work productivity is mediated by job satisfaction, reported an internal consistency estimate of 0.86. 2.4.4

World Health Organisation Health and Work Performance Questionnaire

The World Health Organisation Health and Work Performance Questionnaire (HPQ: Kessler et al., 2003, 2004) is a popular self-report measure of the productivity loss associated with presenteeism that has been applied to a range of work settings (Loeppke et al., 2003). In addition, the HPQ has been translated into several languages. 2.4.4.1 Scale Description The HPQ collects information from workers on aspects of their health including the prevalence of health conditions, the impact of those conditions on work performance, and their absenteeism and presenteeism behaviour. The HPQ also collects demographic and work-related data such as category of work and work scheduling. Work performance is measured by asking respondents to assess (i) perceived work performance of most workers; (ii) how they would rate their usual performance over a 12- to 24-month period; and (ii) their overall work performance on days worked over the last 4 weeks. Respondents use a scale from 0 (worst performance) to 10 (top performance) when responding to work performance items. A sample item is ‘Using the same 0-to-10 scale, how would you rate your overall job performance on the days you worked during the last 4 weeks (28 days)?’ Absenteeism information is collected over a 4-week period in terms of part and whole days worked. Respondents are also asked to report total number of hours worked in the last 7 days and 4 weeks. Two presenteeism scores can be generated using information from the HPQ. First, one can generate an absolute score of self-rated performance. Second, it is also possible to calculate a relative presenteeism score as the ratio of actual work performance to possible work performance (that is, self-rated performance of fellow employees).

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A short form of the HPQ is also available. This form includes the absenteeism and presenteeism questions from the full version of the HPQ. Further information about the HPQ and the short form of the HPQ along with scoring procedures is available from the following website: https://www.hcp.med.harvard.edu/hpq/info.php. 2.4.4.2 Psychometric Properties Initial investigations by Kessler and colleagues (2003, 2004) provided evidence of test–retest reliability and validation of the HPQ. For instance, Kessler et al. (2003) demonstrated good agreement between the HPQ and archival measures of presenteeism and absenteeism across a number of occupations. Ospina et al. (2015) noted that the HPQ has acceptable construct and concurrent validity citing Lam et al. (2009), Terry and Xi (2010) and Zhang et al. (2010). Scuffham et al. (2014) similarly provided evidence for the validity of HPQ-based presenteeism measures, especially absolute presenteeism, which was more correlated with selfreported mental and physical health measures. Mixed validity findings were reported by AlHeresh et al. (2017) when comparing absolute and relative scoring methods for the HPQ. They found the absolute scoring method to have better construct validity compared to the relative method. Utilising a Persian version of the HPQ, Pournik et al. (2012) reported acceptable internal consistency and structural validity. 2.4.5

Work Productivity and Activity Impairment Questionnaire

The Work Productivity and Activity Impairment (WPAI) Questionnaire is a self-report measure that assesses work productivity loss due to health impairment (Reilly et al., 1993). The WPAI can be used to assess productivity loss due to general health impairment (WPAI-GH) or loss due to a specific health condition (WPAI-SHP) (see www.reillyassociates.net/ Index.html). 2.4.5.1 Scale Description The WPAI-GH consists of 6 items that assess (i) paid work status, (ii) hours missed, during the last 7 days, because of health problems, (iii) hours missed, during the last 7 days, due to other reasons such as holidays, (iv) actual hours worked during the last 7 days, (v) perceived productivity loss while at work due to health conditions, and (vi) the extent to which health impairment has affected ability to undertake usual daily

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activities. The extent to which work productivity and daily activities are affected are assessed using a scale from 0 to 10 where 0 refers to no effect and 10 means completely affected. The WPAI-SHP is an adaption of the WPAI-GH where reference to general health impairment is replaced with a specific health problem through the questionnaire. A number of scores can be generated using information collected from either version of the WPAI, including percentage of work lost due to health or a specific condition (a measure of absenteeism); percentage of work productivity loss due to health or a specific condition (a measure of presenteeism); percentage of overall work impairment due to health or a specific condition (combination of absenteeism and presenteeism); and percentage of regular activity impairment (Reilly et al., 2010; see also www.reillyassoci ates.net/Index.html). The WPAI has been applied in a wide range of health conditions including mental health (Asami et al., 2015); asthma (Andreasson et al., 2003); multiple sclerosis (Glanz et al., 2012) and Crohn’s disease (Reilly et al., 2008). 2.4.5.2 Psychometric Properties An abundance of studies has examined the psychometric properties of the WPAI-GH and WPAI-SHP. Validation studies have been conducted in numerous settings, with a range of health conditions and in different languages. Leggett et al. (2016) examined the test–retest reliability of atwork productivity loss measures (including the WPAI) in patients with arthritis or osteo arthritis. They reported an acceptable intraclass correlation for the WPAI. In addition, Leggett et al. (2016) found that the WPAI correlated moderately with other productivity loss measures (including the HPQ and Work Productivity Scale-Rheumatoid Arthritis) (Osterhaus et al., 2009) providing support for the construct validity of the measure. Reilly et al. (2008) demonstrated good psychometric properties for the WPAI in patients with Crohn’s disease. They found evidence of discriminant validity, demonstrating that impairments were lower in a ‘best health’ group relative to a ‘worst health’ group defined using measures of disease severity. Reilly et al. (2008) also demonstrated that the WPAI was responsive to patients who were in remission. In a sample of Singaporean patients with axial spondylarthritis, Phang et al. (2020) reported evidence of content and construct validity for the WPAI. They also found acceptable test–retest reliability (intraclass correlations) for the four outcome

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measures of the WPAI (for example, absenteeism and presenteeism) with intraclass correlations ranging from 0.54 to 0.83. In their systematic review of presenteeism measures, Ospina et al. (2015) reported acceptable measurement properties (test–retest reliability, construct and concurrent validity and responsiveness) for applications in general health and specific health condition versions of the WPAI. Yarlas et al. (2018) conducted a systematic review of the use of the WPAI in patients with colitis. They found evidence of test–retest reliability; convergent validity as evidenced by correlations with measures of quality of life and disease activity; and the measures sensitivity to detect change. However, Yarlas et al. (2018) noted the lack of evidence from randomized controlled studies to test the utility of the WPAI to reliably detect changes in test scores (i.e., responsiveness) due to treatments or interventions when they occur. Readers are also directed to the Reilly Associates website (http://www.reillyassociates.net/WPAI_R eferences.html). This website provides references for validation studies and specific health applications of the WPAI. The four work productivity loss measures discussed above represent a subset of possible measures available in the literature. Descriptions of other productivity loss measures are presented in review articles (see Brooks et al., 2010; Mattke et al., 2007; Ospina et al., 2015; Ozminkowski et al., 2004; Schultz & Edington, 2007).

2.5 Final Comments on the Measures of Presenteeism The concept of presenteeism has an established foothold in the relevant literatures. While there are numerous studies investigating the reliability and validity of instruments, researchers have raised some challenges that need to be addressed to ensure confidence in the use of presenteeism measures. Consequently, accurate and psychometrically sound measurement of presenteeism remains important. Concerns have been raised about the validation of measures of presenteeism. Researchers have pointed to the need for additional evidence of construct and criterion validity for productivity loss measures (Ospina et al., 2015; Ruhle et al., 2020). Ruhle et al. (2020) noted ‘a lack of convergence between various instruments and the absence of true construct validity evidence’ (p. 351). Associated with this issue are concerns about the quality of validation studies and making claims of

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validity based on poor evidence (Beaton et al., 2010; Ospina et al., 2015; Ruhle et al., 2020). Common method bias also ties in with issues of study quality. Common method bias occurs when using the same methods to collect data potentially exaggerates the relationship between variables (Podsakoff & Organ, 1986; Podsakoff et al., 2003). Johns (2010) expressed concern that asking an employee to self-report health conditions and then estimate associated productivity loss may lead to common method variance issues. Interestingly, Ruhle et al. (2020) have argued the need to compare self-report and objective measures of productivity loss to determine the value of productivity loss due to presenteeism. A more nuanced approach to evaluating validity of productivity loss measures is warranted. For instance, Thompson and Waye (2018) adopted a multitest multi-construct approach to examine the level of agreement among measures of presenteeism. This approach allowed the researchers to assess the relative contribution of variability due to construct and method. Ruhle et al. (2020) have also suggested applying modern test theory techniques such as item response theory to assess the psychometric properties of presenteeism measures. The measures discussed in this chapter rely on employees responding to questions about the impact of health on work productivity. While self-reported work productivity data can be useful and valuable, there are methodological challenges associated with self-report measures. For example, Evans (2004) highlights issues such as the accuracy of recalled productivity data and the impact that social desirability may have on the reliability of responses. Researchers and consumers of research need to be mindful of these issues. In addition, the extent to which productivity loss estimates correlate with objective measures of presenteeism remains a challenge in presenteeism measurement (Evans, 2004; Johns, 2010). Indeed, Johns (2010) asks whether these measures can be correlated given that ‘objective output and appraisals essentially reflect between-employee differences in typical performance while work loss estimates are meant to reflect within-employee differences’ (p. 523). That said, additional validation studies that make use of archival work performance data are warranted (Evans, 2004). The focus of this chapter has been on measuring presenteeism. However, the monetarisation of work productivity loss is also of interest. A reliable estimate of productivity loss is important in any attempt to

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monetarise loss. Moreover, Brooks et al. (2010) noted that converting productivity loss to a dollar cost is not always straightforward. For example, there are issues associated with what is known in the literature as conversion—can the data that are collected using a measure be readily converted into reliable estimates of presenteeism. Measures such as the WPAI readily allows a conversion of data into both absenteeism and presenteeism indices; while other measures such as the WLQ does not allow for direct conversion (Brooks et al., 2010). Equally important is the process of translation—translating work productivity loss into an estimate of monetary loss.2 Brooks et al. (2010) rightly acknowledge that translation is challenging because measuring presenteeism is challenging. This type of challenge highlights the importance of continually striving for good measurement in this domain.

2.6

Chapter Summary

In this chapter we addressed the measurement of presenteeism. To provide some context, we firstly outlined why measurement is important especially in the social sciences. We then discussed the two main types of presenteeism measures in the literature—(i) single-item scales that measure the act of going to work when ill and (ii) work productivity loss scales that measure the reduced productivity associated with going to work when ill. Some considerations when using the single-item scales were discussed such as the wording of the items, the recall period, and the response anchors. Following this a number of the commonly used work productivity loss measures were discussed including a description of the scale and its psychometric properties. The chapter concluded with some final comments on the limitations of the presenteeism measures such as common method variance and self-reported data. In the next chapter, we discuss the theoretical and empirical models of presenteeism reported in the literature.

2 The monetarisation of work productivity loss was not a focus of this chapter. Readers are directed to Brooks et al. (2010) who provide a summary of conversion and translation formulae for selected measures.

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CHAPTER 3

Conceptualising Presenteeism

Abstract In Chapter 1, presenteeism was defined as a behaviour—the act of attending work while ill. However, why do people engage in presenteeism? This chapter focuses on answering this question by considering two approaches. First, we provide a comprehensive review of different models that have been adopted to explain presenteeism as well as a consideration of their strengths and weaknesses. The second approach considers a handful of attempts by scholars to conceptualise presenteeism. In this section we focus on Johns (Journal of Organizational Behavior 31:519– 542, 2010), Halbesleben et al. (Human Resource Management Review 24:177–192, 2014) and Karanika-Murray and Biron (Human Relations 73:242–261, 2020), and how these models could be applied as we move closer towards a theory of presenteeism. This chapter concludes with suggestions for how frameworks for understanding presenteeism could be improved in future research. Keywords Health · Work-environment factors · Stress · Job strain · Presenteeism modelling

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 A. McGregor and P. Caputi, Presenteeism Behaviour, https://doi.org/10.1007/978-3-030-97266-0_3

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3.1

Understanding Presenteeism: Adoption of Existing Models and Frameworks

Much of the earlier research on presenteeism is largely atheoretical; it focused instead on the health and medical predictors of presenteeism and its financial costs (Burton et al., 2004; Goetzel et al., 2003). However, the emphasis has shifted, and studies have adopted and integrated existing theoretical frameworks commonly used within organisational psychology, such as the Demand-Control-Support (DCS) model (Johnson & Hall, 1988; Karasek, 1979; Karasek & Theorell, 1990), the Conservation of Resources (COR) theory (Hobfoll, 1989, 2001), the Effort-Reward-Imbalance (ERI) model (Siegrist, 1996), the model of Person-Environment Fit (P-E) (Edwards, 1996), the Effort-Recovery theory (Meijman & Mulder, 1998), the Transactional Stress model (Lazarus & Folkman, 1984), the Social Cognitive Theory (SCT) (Bandura, 1986) and the Job Demands-Resources (JD-R) model (Bakker & Demerouti, 2007), to better understand the pathways underpinning presenteeism (Baeriswyl et al., 2016; Cooper & Lu, 2016; Coutu et al., 2015; Deery et al., 2014; Ferreira et al., 2019; Jourdain & Vezina, 2014; Laing & Jones, 2016; McGregor et al., 2016; Miraglia & Johns, 2016; Pohling et al., 2016; Robertson et al., 2012; Wheeler Poms, 2012; Yang et al., 2016). While these models are not directly theoretical models of presenteeism, they have been adopted to understand both what initiates the choice to presentee, and the consequences of such a decision. These well-understood models and frameworks used to explain presenteeism are described in the following sections. 3.1.1

Demands-Control-Support Model

The Job Demands-Control (DC) model was first developed by Karasek (1979), and later expanded by Johnson and Hall (1988), to include workplace support (the DCS model). In essence, the DCS model argues that ‘high strain’ jobs, characterised by high demands and low control and support, are likely to lead to job strain and reduced wellbeing due to the effort required to accomplish excessive job demands with little control or support at work. Whereas the model predicts that increased performance and wellbeing are likely for ‘active’ jobs, characterised by a combination of high job demands, job control and support, as high levels of job control and support can mitigate some of the stress associated with the high

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demands, resulting in more positive experiences at work (Häusser et al., 2010; Virtanen et al., 2007). Some researchers have drawn upon the DCS model to understand presenteeism behaviour at work (Jourdain & Vezina, 2014; Saijo et al., 2017; Schmidt et al., 2019). For example, Jourdain and Vezina (2014) used the DCS model to investigate the relationship between presenteeism and job demands (e.g., workload), job control (e.g., decision authority, skill discretion) and workplace support (e.g., supervisor support and co-worker support). Overall, they found that exposure to high job demands, and low resources provoked daily residual strain among workers that led to increased incidences of presenteeism. However, under certain circumstances, for example, when some job resources increased (e.g., supervisor support) and others remained low (e.g., decision authority), the previously positive relationship between job demands and presenteeism attenuated. Interestingly, these findings were only observed for workers who had been exposed to the same job conditions for 10 years or less (Jourdain & Vezina, 2014). In a Japanese study, Saijo and colleagues (2017), utilised the DCS model to understand presenteeismrelated productivity loss (measured using the Stanford Presenteeism Scale, SPS-13) (Turpin et al., 2004). In line with the DCS literature, Saijo et al. (2017) found that high strain jobs (i.e., high job demands and low job control/ low support) are associated with more presenteeism-related productivity loss with lower job control having the strongest impact on presenteeism compared to workplace support. 3.1.2

Conservation of Resources Theory

Hobfoll’s (1989) Conservation of Resources (COR) theory provides a useful framework for understanding workplace stress. COR theory is based on the premise that people will act to gather, conserve, and build resources; it is the fear of actually (or potentially) losing these valued resources that triggers a stress response (Hobfoll, 1989, 2001). In his earlier work, Hobfoll (1989) outlined a variety of resources which may cause stress when threatened, including aspects of one’s life and work such as personal health, status at work, stability of employment and finances and adequate income. When confronted with resource-depleting circumstances (such as high job demands or a health problem), individuals will engage in behaviours that are focused on restoring their resources (Hobfoll, 1989, 2001).

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The concept of conservation of resources has been applied to presenteeism to explain the act of going to work when ill as a behaviour employed by workers to protect and rebuild their resources (Conway et al., 2016; Demerouti et al., 2009; Ferreira et al., 2019; KaranikaMurray & Biron, 2020; Li et al., 2019; Zhang et al., 2020; Zhou et al., 2016). For example, Demerouti and colleagues (2009) argued that job demands are predictive of presenteeism as demanding work characteristics, such as high workloads, drain employees’ resources. Therefore, drawing upon COR theory, when losses occur, workers will focus on reserving and re-building their resources, which in turn increases the likelihood of working while sick to avoid any performance decrements associated with taking time off work. Similarly, Conway et al. (2016) utilised the COR theory to explain the link between workplace bullying and presenteeism evident in their study of Danish workers. In particular, they argued that workers who had experienced workplace bullying were more likely to attend work when ill as a resource-protection strategy to avoid further resource losses that may occur as a result of being absent from work (Conway et al., 2016). 3.1.3

Effort-Reward Imbalance Model

The Effort-Reward Imbalance (ERI) model (Siegrist, 1996) argues that effort at work is exchanged for rewards as part of a contract based on the norm of social reciprocity (i.e., the ‘give and take’ that underpins social interaction). According to Siegrist (1996), efforts refer to demands and obligations placed on individuals at work, such as time pressure, workloads and deadlines; rewards, on the other hand, refer to money, esteem, career opportunities and job security provided to a worker. An imbalance occurs when efforts are perceived to exceed rewards. Work-related stress and subsequent health complications may unfold if an imbalance is sustained overtime due to ongoing strain reactions in the sympathetic nervous system (i.e., increased cortisol and heart rate) (Siegrist, 1996; Siegrist et al., 2004). The ERI model also considers individual differences, particularly overcommitment, in the experience of effort-reward imbalance. Workers who are overly committed are likely to consciously or subconsciously make themselves available for more job demands than others, ultimately increasing their susceptibility to the frustrations elicited from effort-reward imbalance. Research suggests that overcommitment is

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an independent construct, negatively impacting workers’ health and wellbeing. However, the ERI model proposes that the strongest effects on health and wellbeing are expected when ERI and overcommitment are both involved (Siegrist, 1996; Siegrist et al., 2004). Two published studies have incorporated the ERI model to explain presenteeism-related productivity loss (Rosemberg & Li, 2018; Schmidt et al., 2019), with both studies arguing that the stress provoked as a result of an imbalance between efforts and rewards increases the likelihood of impairments at work. The ERI model and presenteeism were more comprehensively investigated in a doctoral thesis (Wheeler Poms, 2012), where the combined effects of ERI and overcommitment were examined in relation to absenteeism and presenteeism. Drawing upon the ERI model, Wheeler Poms (2012) argued that employees who are both overly committed to work and have high ERI are most susceptible to illness and reduced wellbeing. Overcommitted individuals tend to underestimate the effort required to meet job demands and to overestimate their own reservoir of coping resources (Preckel et al., 2007; Siegrist, 2005), which increases their risk of prolonged exposure to a nonreciprocal exchange of efforts and rewards. Individuals who are overly committed are also less likely to take sick leave and, thus, more likely to engage in presenteeism, further prolonging illness as attending work while sick does not allow time for recovery. Overcommitment was, therefore, predicted to exacerbate the health impairing effects of ERI, leading to lower absenteeism and higher presenteeism (Wheeler Poms, 2012). 3.1.4

Person-Environment Fit

The theory of Person-Environment Fit (P-E fit) is based on a comparison between an individuals’ perceived needs and expectations and those actually received from the organisation (Edwards, 1996). In essence, as the ‘misfit’ between what a worker perceives that he or she needs and expects and the organisational characteristics that he or she receives increases, the greater the levels of stress experienced (Edwards, 1996). The theory of P-E fit has been utilised to explain presenteeism at work in a couple of instances (Deng et al., 2019; Pohling et al., 2016). For example, Pohling et al. (2016) investigated the mediating role of employee health on the relationships between work-environment factors (defined as high-risk

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conditions in areas of work life, i.e., workload, control, reward, community, fairness and values) and presenteeism using the P-E fit theory. They argued that the stress triggered as a result of a misfit between workers’ perceptions of work-environment factors (i.e., workload, control, reward, community, fairness, and values) and those held by the organisation would lead to physical and mental health problems, and ultimately higher rates of presenteeism due to the health impairing effects of stress (Eriksen, 2017; Harris et al., 2007). 3.1.5

Effort-Recovery Theory

The Effort-Recovery theory posits that efforts spent at work, such as accomplishing tasks and meeting deadlines, can provoke negative affect, fatigue and strain, leading to a need for recovery (Meijman & Mulder, 1998). When energy levels are depleted, recovery is a necessary process to return the body to equilibrium. According to the effort-recovery theory, recovery occurs when job demands ease as well as the fatigue and strain associated with achieving job demands reduces. However, if excessive job demands are managed over a prolonged timeframe and there is no chance for recovery, the nervous system will remain active (e.g., high cortisol levels, increased heart rate), leading to poorer health status and an increased risk of presenteeism. Attending work while unwell could further compound the effort-recovery process, making it harder for workers to truly recover (Côté et al., 2021; Li et al., 2019). Research suggests under these conditions, it is increasingly likely that negative job attitudes may develop, such as decreased job satisfaction, commitment and work engagement (Côté et al., 2021; Lu et al., 2013) as well as further health problems, exhaustion and longer spells of absence (Bergstrom et al., 2009; Lu et al., 2013; Taloyan et al., 2012). 3.1.6

Transactional Theory of Stress

According to the Transactional Theory of Stress (Lazarus & Folkman, 1984), when an event occurs in the workplace, such as a dispute with a supervisor, workers engage in a cognitive appraisal of the situation. This appraisal involves an evaluation of the workplace event, if the worker perceives it to be threatening to his or her wellbeing then a secondary appraisal process is engaged where the worker weighs up his or her options for tackling the stressor. Alternatively if the worker perceives the

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workplace event as non-threatening then it will be dismissed or ignored. Drawing upon the Transactional theory of stress, strain is likely to occur when a workplace event is perceived to be threatening, and there is a subsequent imbalance between the demanding work situation and the resources available to the worker to cope with it (Lazarus & Folkman, 1984; Lu et al., 2013; Meurs & Perrewé, 2011). The Transactional theory of stress has been adopted to understand the mechanisms underpinning presenteeism (Chun & Song, 2020; Laing & Jones, 2016; Lu et al., 2013). Laing and Jones (2016) argued that the strain associated with trying to overcome a poor workplace culture would increase workers’ chance of experiencing mental health problems, such as anxiety and depression. The researchers suggested that the workers might cope with the work-related strain and mental health impairments by reducing their on-the-job productivity (i.e., presenteeism-related productivity). 3.1.7

Social Cognitive Theory

The central thesis of Bandura’s (1986) Social Cognitive Theory (SCT) is that behaviour is coordinated by an individual through his or her cognitive processes as well as his or her experience of the environment through social situations (Cooper & Lu, 2016). Socio-cognitive mechanisms that are commonly discussed within SCT include a person’s level of self-efficacy, outcome expectations as well as goal setting. Self-efficacy is defined as the extent to which people believe they can achieve a desired outcome or more simply their level of self-belief, whereas outcome expectations refer to a person’s beliefs about the probable consequences of engaging in a particular behaviour (Bandura, 1986). Social cognitive theory argues that people’s behaviour is largely driven by their perception of what they think they can do (i.e., self-efficacy) as well as their perception about the likely outcome of various actions (i.e., outcome expectations) (Cooper & Lu, 2016). Goals are also integral to understanding behaviour under SCT. For example, goals are inherently motivating, helping people to organise and guide their behaviour so that they can reach a desired future outcome (Bandura, 1986; Cooper & Lu, 2016). Social cognitive theory has been used to explain presenteeism behaviour in the workplace. Cooper and Lu (2016) propose the strongest theoretical argument, positing that presenteeism occurs because of workers’ self-efficacy and positive outcome expectancies associated with performance accomplishments at work. Intentions and goal systems are also put

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in place to achieve this desired outcome, which leads to an increased risk of working through illness (i.e., presenteeism) to make sure the desired performance accomplishments are achieved (Cooper & Lu, 2016). Other studies, such as Li and colleagues (2019) and Lu et al. (2013), have incorporated self-efficacy into their study of presenteeism using SCT. For example, Lu and colleagues (2013) argued that self-efficacy would lessen the burden of presenteeism on productivity loss as people with high levels of self-belief and confidence are better equipped to handle work stressors, and therefore are less likely to experience performance-related impairments from working while ill. 3.1.8

Job Demands-Resources Model

The Job Demands-Resources (JD-R) model (Bakker & Demerouti, 2007) provides a robust conceptual framework to examine the ways in which aspects of the work environment affect employee health and motivation (Bakker & Demerouti, 2007; Demerouti & Bakker, 2011; Demerouti et al., 2001). According to the JD-R model, a broad range of antecedents from the work environment can be studied and classified as either job demands (e.g., work overload, time pressure, role conflict) or job resources (e.g., workplace support, job security, job control). Under the JD-R model, two pathways are hypothesised to exist—(i) the health impairment pathway, and (ii) the motivational pathway, with the former linking job demands with poor health or burnout, and the latter linking job resources with work engagement (Bakker & Demerouti, 2007). Although job demands are not necessarily negative, they have the potential to cause performance decrements when associated with chronic exposure to stress. For example, this situation occurs under conditions where there are not enough job resources available to support job demands, and when job demands require excessive effort following inadequate recovery from previous work sequences (Maslach et al., 2001). Drawing upon the health impairment pathway, this extra effort, if sustained over time, has the potential to drain employees’ energy, which may lead to exhaustion (burnout) and poorer health (McGregor et al., 2016; Miraglia & Johns, 2016). Conversely, the motivational pathway predicts that employees are likely to dedicate their efforts towards achieving tasks when job resources are readily available within a workplace, which may lead to increased levels of motivation and engagement (Hu et al., 2011; McGregor et al., 2016; Miraglia & Johns, 2016).

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Several studies have incorporated the JD-R model to understand why employees might engage in presenteeism (Baeriswyl et al., 2016; Deery et al., 2014; Demerouti et al., 2009; Dietz & Scheel, 2017; Ferreira et al., 2019; Jensen et al., 2019; Mach et al., 2018; McGregor et al., 2016; Miraglia & Johns, 2016; Yang et al., 2016). Two studies in particular have utilised both the health impairment and motivational pathways predicted under the JD-R model. First, McGregor and colleagues (2016) applied the JD-R model to understand how job demands (e.g., workplace bullying, time pressure and work–family conflict) and job resources (e.g., supervisor support and leadership) are associated with presenteeismrelated productivity loss via burnout and work engagement. Drawing upon the health impairment pathway, McGregor et al. (2016) argued that the strain associated with managing excessive job demands may drain the employees’ energy, leaving them fatigued and exhausted. In turn, this increases their risk of presenteeism-related productivity loss as a burnt-out worker is likely to experience more impairments in their productivity (i.e., difficulties concentrating and processing information) than an employee who is unaffected by burnout. Utilising the motivational pathway it was argued that a lack of job resources could be the catalyst for increased presenteeism-related productivity loss among employees. McGregor et al. (2016) proposed that limited job resources within the workplace could lead to lower levels of motivation and work engagement among employees, which in turn, increases their risk of presenteeism-related productivity loss. This outcome is expected because an unmotivated and disengaged employee is more likely to experience impairments in their productivity at work than an engaged worker. Lower job resources were also predicted to increase presenteeism-related productivity loss via their health impairing effects. Second, Miraglia and Johns (2016) utilised both pathways under the JD-R model to explain the relationships between work-environment factors (i.e., job demands and job resources) and presenteeism via employee health and motivation. In particular, they argued that presenteeism may occur because of the strain and health problems associated with trying to meet excessive job demands. Miraglia and Johns (2016) also argued that job demands may reduce presenteeism due to their negative impact on motivation (e.g., employees are less likely to come to work when ill if they are lacking motivation). In terms of job resources, Miraglia and Johns (2016) suggested that presenteeism may be reduced if employees have access to resources, such as collegial support, as this may

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alleviate stress levels and health risks. Alternatively, job resources could promote working while ill due to their positive effect on employees’ job satisfaction, work attitudes and motivation. Other studies have taken a narrower approach, focusing on the health impairment pathway under the JD-R framework (Baeriswyl et al., 2016; Deery et al., 2014; Demerouti et al., 2009; Mach et al., 2018; Yang et al., 2016). For example, Deery and colleagues (2014) argued that the stress associated with excessive job demands evokes a health impairment process that increases the likelihood of presenteeism, which in turn, leads to longer spells of absence. However, if the employee has job resources (e.g., organisational justice) then the indirect relationship between job demands and absenteeism (through presenteeism) is predicted to be weaker as employees are better equipped to cope with the strains of working while ill, and consequently, are less likely to require time off work. Baeriswyl and colleagues (2016) also draw upon the health impairment pathway when examining the relationship between job demands, presenteeism and emotional exhaustion. In particular, they argue that the effort required to overcome excessive job demands (e.g., heavy workloads) causes fatigue and strain. Workers may decide to attend work while unwell as a coping mechanism to manage excessive workloads. However, with limited time to rest and recover, presenteeism is likely to lead to emotional exhaustion as attending work while ill is not a sustainable way to manage excessive job demands over time.

3.2 Synopsis of the Models Adopted to Understand Presenteeism The strengths and weaknesses of the different theoretical models that have been adopted to understand presenteeism are presented in Table 3.1. A synopsis of the models, including how they are applied to presenteeism is then discussed. The theoretical models described in Sect. 3.1 largely predict employee behaviour as an outcome of a stress (or sometimes referred to as strain) response triggered by an imbalance. For example, the DCS model (Johnson & Hall, 1988; Karasek, 1979) posits that an imbalance between the demands of the job and the resources available (i.e., control and support) predicts stress, while the ERI model (Siegrist, 1996) conceptualises stress in terms of whether there is an imbalance between the effort

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Table 3.1 The strengths and weaknesses of models adopted to explain presenteeism Theory or model

Strengths

Weaknesses

Transactional theory of stress

• Stress is triggered by an imbalance • Easy to follow • Broad range of work factors can be incorporated into the model • Stress is triggered by an imbalance • Easy to follow • Job demands, control and support map onto quadrants—clear evidence of the quadrants on key health, wellbeing, and work indicators in the literature • Investigates both health impairing and motivating antecedents of presenteeism • A broad range of work factors can be incorporated into the model

• Individual differences not accounted for • No consideration of the motivating antecedents of presenteeism

Demands-control-support model

Job demands-resources model

Effort-recovery model

Conservation of resources model

Effort-reward imbalance model

• Stress is triggered by an imbalance • Easy to follow • A broad range of work factors can be incorporated into the model • Stress is triggered by an imbalance • Secondary losses or further impairments over time are explained well • A broad range of work factors can be incorporated • Stress is triggered by an imbalance • Easy to follow • A broad range of work factors can be incorporated into the model • Individual differences, specifically— overcommitment incorporated into model

• Focuses specifically on job demands, control and support • Individual differences not accounted for • No consideration of the motivating antecedents of presenteeism • Individual differences not accounted for in the original model (newer versions include personal resources but these haven’t been tested in relation to presenteeism) • No consideration of the motivating antecedents of presenteeism • Individual differences not accounted for • No consideration of the motivating antecedents of presenteeism • Individual differences not accounted for

• No consideration of the motivating antecedents of presenteeism

(continued)

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Table 3.1 (continued) Theory or model

Strengths

Weaknesses

Person environment fit model

• Stress is triggered by an imbalance • Easy to follow • A broad range of work factors can be incorporated into the model • Focuses on what motivates presenteeism behaviour (i.e., people’s self-belief, outcome expectancies and goals) rather than using the stress response to explain why presenteeism occurs • Includes individual differences (i.e., self-efficacy)

• No consideration of the motivating antecedents of presenteeism • Individual differences not accounted for

Social cognitive theory

• Common job demands and resources are not included in the model

put into work and the rewards received. The theory of P-E fit (Edwards, 1996) also predicts that stress is likely if there is an incongruence between what is desired and what is actually received at work. Other occupational stress models, such as the Effort-Recovery model (Meijman & Mulder, 1998), focus on the effort required to overcome excessive job demands in relation to the time available to recover from this investment. Stress, for instance, is likely to occur when employees do not have the chance to adequately recover from excessive job demands. Similar to the Effort-Recovery model, the JD-R model (Bakker & Demerouti, 2007) posits that stress is likely when excessive effort is required to overcome job demands and there is little chance for recovery. Building upon this proposition, an interaction hypothesis is also proposed under the JD-R model, where job demands are predicted to be more strongly related to poor health, as a result of increased stress, when insufficient job resources are available to manage high job demands. Some theoretical models applied to presenteeism hypothesise that a motivating force may be driving people’s behaviour at work. The JDR model, for instance, predicts that employees are likely to focus their efforts towards achieving tasks when job resources are readily available within a workplace, which may lead to increased levels of motivation and engagement with their work (Bakker & Demerouti, 2007). The SCT also focuses on what motivates people, arguing that employee’s behaviour is

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largely driven by their perception of what they think they can do (i.e., selfefficacy) as well as their perception about the likely outcome of various actions (i.e., outcome expectations) (Cooper & Lu, 2016). Individual differences are also accounted for in some of the existing theoretical models, such as overcommitment (ERI model) and self-efficacy (SCT). The ERI model, for instance, contends that individuals who are overly committed to work are at a greater risk of the damaging effects of effortreward imbalance on wellbeing and health compared to individuals who have a healthy commitment to work (Siegrist, 1996). In terms of understanding presenteeism, a few different approaches are evident in the research applying the theoretical models discussed in Sect. 3.1. First, most studies explain presenteeism behaviour as an outcome of a stress response. For example, being stressed negatively influences employees’ health through an over activation of the sympathetic nervous system (e.g., higher cortisol levels and heart rate), which in turn, increases their chance of working when unwell (Jourdain & Vezina, 2014; Miraglia & Johns, 2016; Rosemberg & Li, 2018; Schmidt et al., 2019). Second, some studies discussed in Sect. 3.1 explain presenteeism from a motivational perspective, arguing that employees might be driven to work rather than (or in addition to) a reaction to stress-related health concerns. Miraglia and Johns (2016), for instance, argued that an abundance of resources at work, such as high levels of support and control, might boost employees’ motivation and dedication to their work, encouraging them to continue working when ill. Cooper and Lu (2016) also explained presenteeism from the perspective of motivation, arguing that a high level of self-efficacy and positive outcome expectancies associated with performance accomplishments at work may motivate employees to show up for work when unwell to ensure their desired performance is maintained. Finally, some studies presented in Sect. 3.1 explain presenteeism in terms of a coping mechanism (Baeriswyl et al., 2016; Demerouti et al., 2009; Laing & Jones, 2016). For example, Demerouti and colleagues (2009) argued that employees may attend work when ill as a way to reserve and rebuild resources that have been depleted by the strain associated with high job demands. In other words, employees engage in presenteeism to prevent any further losses that might occur as a result of being away from work (e.g., loss of income). In the next section, we describe attempts at developing theoretical explanations of presenteeism.

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3.3

Towards a Theory of Presenteeism

Thus far, the discussion has focussed on the application or adoption of existing models to understand presenteeism behaviour. But are there examples in the literature of attempts to theorise and conceptualise the phenomenon of presenteeism? Gosselin et al. (2013) noted the move towards attempting to explain presenteeism and its determinants. They highlighted three such attempts: (i) Aronsson and Gustafsson’s (2005) model of presenteeism which focuses on understanding the decision or choice to presentee; (ii) Hansen and Andersen (2008) expand on Aronsson and Gustafsson by considering the dual influence of individual and organisational factors on decision-making around presenteeism; and (iii) Johns’ (2010) framework that presents a formal theory of presenteeism outlining both triggers of absence and presence as well as potential consequences. Similar to these earlier attempts to conceptualise presenteeism, Gosselin et al. (2013) also proposed a model of presenteeism where the effect of a health event on the choice between presenteeism and absenteeism is influenced by several individual and organisational factors. For example, if employees are sick, and they do not have sick leave entitlements (i.e., an organisational factor), arguably they are more likely to choose presenteeism over absenteeism as they will not get paid if they take a sick day. While this body of work represents an important first step towards theorising about presenteeism, it does not address the issue of an absence of a theory of why employees presentee (Cooper & Lu, 2016). For instance, Cooper and Lu (2016) critiqued these early attempts at conceptualising presenteeism, arguing that they are largely checklists outlining the factors that should be considered when deciding to go to work or stay home when sick rather than providing a theoretical explanation for why and how the attendance behaviour was chosen. That said, some researchers have come closer to a formal theory of presenteeism. For example, using dialectical theory, Halbesleben and colleagues (2014) examined how dialectical tensions could be understood in the supervisorsubordinate relationship, and more importantly, how these tensions might influence a decision to presentee or stay at home when ill. More recently, Karanika-Murray and Biron (2020) have proposed an adaptive framework for understanding presenteeism that considers the balance between health and performance when theorising why employees may continue working when ill. A more detailed consideration of some of these models and frameworks is presented in the next sections.

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John’s (2010) Framework for a Dynamic Model

While not articulating a theory of presenteeism per se, Johns (2010) has provided a framework for future theoretical development that is underpinned by several assumptions and propositions. First, it is important to recognise the relationship between absenteeism and presenteeism in any theory of presenteeism. Furthermore, Johns (2010) noted existing theories of absenteeism should be considered when trying to understand presenteeism behaviour. Second, health events can impact employee attendance. These health events can be acute, episodic or chronic. The type of health event may also determine whether someone decides to presentee or be absent. To illustrate, Johns (2010, p. 531) argues that an employee with gastroenteritis will be absentee, while an employee recently diagnosed with diabetes is more likely to presentee. Any theoretical development should also acknowledge that an evaluation of health status can be subjective. Third, a theory of presenteeism should include the influence of work content. For instance, how is presenteeism behaviour influenced by job demands and job insecurity? Is there an absenteeism or presenteeism culture in the workplace? Fourth, while understanding the impact of work content is important in a theory of presenteeism, it is equally relevant to account for individual or personal factors, such as attitudes to work, personality and stress. Likewise, a theory of presenteeism should also acknowledge social dynamism in any setting. For example, Johns (2010) points to gender-bias in absenteeism and presenteeism behaviour citing Aronsson and Gustafsson (2005) who found that women were more inclined to be presentee compared to men. Finally, a theory of presenteeism should also consider the consequences of absenteeism and presenteeism, such as its impact on productivity and the attribution of that behaviour. A schematic representation of Johns’ dynamic model is depicted in Fig. 3.1. 3.3.2

A Dialectical Approach to Understanding Presenteeism

The relationship between employer and employee is important to consider when attempting to understand why an employee might choose to be absent or decide to go to work when ill. For instance, if job insecurity is an issue in a workplace, then the employer-employee dyad may be influential in deciding to go to work when ill (Gül & Gül, 2016). Halbesleben and colleagues (2014) point out that workplace relationships have been

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Context factors

Presenteeism Consequences

Health Absenteeism

Individual factors

Fig. 3.1 Johns’ (2010) conceptual model (Adapted from Johns 2010, p. 532)

explored using social exchange theories as a way of understanding how these relationships impact behaviours in the workplace (Rhoades & Eisenberger, 2002). However, they also argue that social exchange theories ‘do not fully account for the dynamics of the supervisor-subordinate relationship’ (Halbesleben et al., 2014, p. 178). In response, Halbesleben et al. (2014) draw on dialectical theory (Baxter, 1990; Baxter & Montgomery, 1996) to understand the employer-employee dyad and the decision to go to work when ill. Dialectical theory posits that relationships such as the employeeemployer relationship are dynamic and changeable (Leon et al., 2015). The constructs that underpin dialectical relationships are paired but opposing and negating (Leon et al., 2015). Leon and colleagues provide ‘autonomy-connection’ as an example of a dialectic construct whereby an individual seeks to be autonomous while still being connected to others (p. 90). Halbesleben et al. (2014) argued that the decision to be absent or presentee can be understood by considering dialectical tensions that may exist in a work setting, especially tensions between employers and employees, and how these tensions are managed. An assumption of dialectical theories is the notion of contradiction. Contradiction involves functionally defined rather than logically opposite constructs existing at the same time in a dynamic exchange (Halbesleben et al., 2014). The dialectic autonomy-connection is an example of a

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contradiction. Halbesleben and colleagues (2014) argue that dialectics, such as autonomy-connection, can be useful in understanding employeeemployer relationships. For example, they point to research that shows connection is related to an employee’s identity (Curry, 2003 cited as an example) and greater job satisfaction (Maslyn & Ulh-Bien, 2001 cited an example). But at the same time, employees also seek autonomy. The decision to attend work or not can be understood in terms of relational dialectics (Halbesleben et al., 2014). For example, if an employee has a comfortable and strong relationship with an employer, then deciding to be absent is a way of demonstrating autonomy. Conversely, the decision to go to work when ill may demonstrate commitment and a possible strengthening of the connection with the employer (Halbesleben et al., 2014). Other relevant contradictions include openness-closedness and predictability-novelty (Halbesleben et al., 2014). The opennessclosedness dialectic focuses on the extent to which information is shared between an employee and employer, while the predictability-novelty dialectic focuses on the tension between seeking stability in job tasks and the desire to seek new experiences (Halbesleben et al., 2014). The decision to be absent or presentee is influenced by the strategies that are used to manage relational contradictions. Halbesleben et al. (2014) outline several such strategies. To illustrate, we consider the strategy of denial. The denial strategy involves denying one pole of the dialectic. For example, an employee may believe that all work should be done collaboratively. However, the employer may expect employees to work independently. In this context the employee is denying that there are times when both independent and collaborative work may be required. Therefore, an employee who denies autonomy is more likely to presentee, while denying connection may lead to a decision to be absent (Halbesleben et al., 2014). 3.3.3

An Adaptive Framework of Presenteeism

A recent theoretical development in presenteeism acknowledges that the behaviour is a choice that can have positive benefits for employees and employers alike (Karanika-Murray & Biron, 2020). This idea is not new; for instance, Miraglia and Johns (2016) noted a positive pathway to presenteeism via factors such as support. However, Karanika-Murray and Biron (2020) reinforce the view that work can be beneficial to health;

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and that work can be meaningful and restorative. Karanika-Murray and Biron (2020) argue that the focus should be on the purpose rather than the outcome of presenteeism behaviour. They note that researchers such as Cooper and Lu (2016) and Halbesleben et al. (2014) have focussed on the decision-making processes to work while ill. Furthermore, KaranikaMurray and Biron (2020) note that deciding to presentee is influenced by factors such as health severity and the availability to be productive. Taken together, this points to the adaptive nature of presenteeism—balancing health and work performance (Karanika-Murray & Michaelides, 2015). Therefore, presenteeism is purposeful and adaptive. Karanika-Murray and Biron (2020) proposed four types of presenteeism based on decisions by the presentee around balancing health and work performance. These categorisations are distinguished by the employee’s health and performance when presentee, and are referred to as functional, dysfunctional, therapeutic and overachieving presenteeism (see Fig. 3.2). Functional presenteeism behaviour is characterised by the employee engaging with work, meeting work demands, but not comprising his or her health (Karanika-Murray & Biron, 2020). In this context, presenteeism is seen as a positive and sustainable experience. The employee may accomplish tasks and goals through being at work. While there may be restrictions on the availability of resources, attending work while

(Good health; poor performance)

(Good health; good performance) Framework of Presenteeism

Fig. 3.2 Karanika-Murray and Biron (2020)’s Presenteeism Framework based on the relationship between health and performance

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ill may prevent further losses in resources, and even achieve gains in resources. Therefore, productivity may be maintained, and recovery is possible (Karanika-Murray & Biron, 2020). Dysfunctional presenteeism behaviour is unsustainable and harmful. In this context, employees’ health and performance deteriorate while they try to accomplish tasks and meet work demands. Karanika-Murray and Biron (2020) cite Aronsson et al. (2011) and Bergstrom et al. (2009) who show that poorly managed presenteeism can lead to future impaired health outcomes, and similarly declines in performance. Therapeutic presenteeism behaviour involves engaging with work that benefits health, but not necessarily improving productivity; there are no benefits to job performance in adopting this behaviour (Karanika-Murray & Biron, 2020). Overarching presenteeism behaviour allows an employee to maintain a high level of performance at work but achieves no benefits to health recovery. Overcommitting to work leaves little time to restore resources and recover. Moreover, there is a depletion of energy which leads to burnout (Karanika-Murray & Biron, 2020). Employees in this presenteeism category are typically over-committed and over-engaged; their behaviour is characterised by workaholism (Karanika-Murray & Biron, 2020). While the adaptive framework is novel in its conceptualisation of presenteeism, Karanika-Murray and Biron (2020) acknowledge that this framework also draws on existing theories. For instance, Karanika-Murray and Biron point to COR theory to understand the differences in resource utilisation that leads to adaptive presenteeism. Dysfunctional presentees may under-utilise resources that are available to them because they may have poorer health and less support from colleagues (Karanika-Murray & Biron, 2020). The adaptive framework of presenteeism also draws on selfdetermination theory (Deci et al., 2017). For example, Karanika-Murray and Biron (2020) highlight the importance of autonomous motivation, characterised by a sense of agency and the capacity to make choices, in understanding presenteeism. Karanika-Murray and Biron (2020) argue that work resources can facilitate this type of motivation if they provide flexibility to adjust performance demands under impaired health, such as working from home and flexible scheduling. Therefore, the negative effects of presenteeism could be reduced in organisations that promote self-regulation, emphasising the potential sustainability of the choice to continue working through an illness (Karanika-Murray & Biron, 2020).

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3.4

Future Considerations

Our recommendations for future research are two-fold. First, despite the concerns raised by Cooper and Lu (2016), we recommend that future studies continue to build upon recent attempts to model presenteeism outlined in Sect. 3.3. In particular, focusing on the contradictions within the employee-employer relationship and how these tensions may affect presenteeism (Halbesleben et al., 2014) as well as the sustainability of presenteeism if managed appropriately in the workplace (i.e., functional presenteeism) (Karanika-Murray & Biron, 2020). Second, future theoretical work should still consider the utility of existing theoretical models that have not been applied to presenteeism, such as the Theory of Planned Behaviour (TPB) (Ajzen, 1985) and the revised JD-R model (Bakker & Demerouti, 2017). Lohaus and Habermann (2019) argue that the TPB could be a useful framework to explain the actual decision-making process between absenteeism and presenteeism. We also see potential in the TPB to capture some of the social aspects of presenteeism that have been largely unaccounted for in previous models that have been adopted to explain presenteeism. For example, the important role that social norms play within an organisation in the determination of presenteeism could be hypothesised and tested using the TPB. Bakker and Demerouti’s (2017) revision of the JD-R model hypothesizes both health impairing and motivational predictors of performance and incorporates common work-environment factors (e.g., job demands and resources) as well as personal resources (e.g., self-efficacy and optimism). An interesting avenue for future theoretical work would be to apply this revised version of the JD-R model to presenteeism. Further recommendations on applying this model to presenteeism are discussed in Sect. 5.1.3.

3.5

Chapter Summary

In this chapter we provided a thorough description of the existing theoretical frameworks that have been applied to presenteeism. For each model, the mechanisms underpinning their design were described, followed by how they are used to explain presenteeism behaviour in the workplace. The strengths and weaknesses of these adopted models, such as the inclusion of individual differences, were also considered in Table 3.1. In this chapter, we also presented examples of conceptualisations of

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presenteeism that move beyond the application of existing models and frameworks to theorising about presenteeism behaviour. In particular, we focused on work by Johns (2010), Halbesleben et al. (2014) and Karanika-Murray and Biron (2020). Finally, we suggested that future research continue to model presenteeism, focusing in particular on the ways in which contradictions within the employee-employer relationship affect presenteeism behaviour (Halbesleben et al., 2014) as well as the sustainability of presenteeism if appropriately managed (KaranikaMurray & Biron, 2020). Existing theoretical models such as the TPB and the revised version of the JD-R model were also suggested as interesting avenues for future theoretical work on presenteeism. In the next chapter, existing presenteeism interventions are discussed along with suggestions for future interventions.

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CHAPTER 4

Presenteeism Interventions

Abstract This chapter provides an overview of presenteeism interventions currently available in the literature, such as health promotion, exercise, counselling, stress management and job redesign. Several recommendations for future interventions to manage presenteeism behaviour in the workplace are then considered. These recommendations include tailoring interventions based on different categories of presenteeism; the role of positive work environments; the importance of providing mental health awareness, education and training across all levels of an organisation; and the utility of occupational medicine and digital technologies. Keywords Physical health · Mental health · Job redesign · Occupational medicine · Digital technologies

4.1

Existing Presenteeism Interventions

Very few presenteeism interventions are discussed in the literature. Traditionally, presenteeism interventions have been targeted at improving the root causes of presenteeism, that being—poor physical and mental health and stressful work environments (Cancelliere et al., 2011; Ruhle et al., 2020). Physical health interventions have primarily focused on improving presenteeism through exercise, diet and health promotion, © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 A. McGregor and P. Caputi, Presenteeism Behaviour, https://doi.org/10.1007/978-3-030-97266-0_4

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while mental health interventions have focused on activities, such as relaxation, mindfulness and cognitive behavioural therapies, to improve employee wellbeing, reducing the likelihood of presenteeism. Alternatively, organisational interventions have focused on improving presenteeism through effective job design, such as workload management and flexible work arrangements (Ruhle et al., 2020). A systematic review of the effectiveness of workplace health promotion interventions on presenteeism provides some evidence of a positive effect (Cancelliere et al., 2011). The review identified 10 scientifically admissible intervention studies that significantly improved presenteeism among workers. The intervention studies were quite varied with some focusing on exercise and health promotion, while others focused on mental health, and job redesign.1 For example, an exercise-based intervention that involved a personalised exercise plan and a counselling session with a physiotherapist to improve self-directed physical activity outside of work and weekly 60-minute group worksite sessions to improve physical activity while at work, reported a significant reduction in presenteeism over a nine-month period (Nurminen et al., 2002). A lifestyle intervention (Alive!) that provided employees with education and training on goal setting, physical activity and healthy eating through a number of online modules over a four-month period was also found to significantly reduce presenteeism (Block et al., 2008). A health promotion intervention delivered both online and in-person where workers were provided unlimited access to a personalised web portal with interactive behaviour change and health-focused programs; tailored bimonthly emails containing wellness and health information and four onsite (face to face) seminars on the most prevalent health risks also reported a positive effect on presenteeism (Mills et al., 2007). A depression-focused treatment program, delivered by licensed mental health clinicians was found to reduce presenteeism among workers from a diverse range of industries. The intervention was provided in-person and involved both psychotherapy and medication consultation; for those unwilling to participate in-person, eight phone-based cognitive behaviour therapy sessions were offered (Wang et al., 2007). A mental health intervention, that was specifically targeted at improving supervisors’ ability to 1 For a detailed critical review of the intervention studies included in the systematic review including their methodological validity, findings and limitations see Additional Files 3, 4, 5 and 6 (Cancelliere et al., 2011).

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manage job stress among their staff through active listening training and psychoeducation (e.g., importance of early awareness of mental health problems and return-to-work support) was associated with a decline in presenteeism over a three-month period (Takao et al., 2006). Interventions targeted at creating a positive work environment through job redesign were also found to be effective at reducing presenteeism among workers (Cancelliere et al., 2011). For example, an intervention on rest break configuration in a meat processing plant found that the provision of additional short breaks throughout employees shifts significantly reduced presenteeism (Dababneh et al., 2001). Other workplace changes, such as the provision of blue-enriched white light was found to reduce presenteeism among employees while improving vitality, energy, concentration and alertness (Viola et al., 2008). Key features commonly reported among the interventions that significantly reduced presenteeism were identified in a systematic review (Cancelliere et al., 2011). For example, 70% of the successful interventions incorporated screening tools, such as Health Risk Assessments (HRAs) or other questionnaires into their design. HRAs are useful as they can be used to identify personal health habits and health-related risks, to measure key health and productivity outcomes and to facilitate program tailoring. Interestingly, only 25% of the unsuccessful interventions used a screening tool. Another key feature of successful presenteeism interventions was the use of tailored programs that specifically addressed the participants needs (70%). Alternatively, only 50% of the unsuccessful interventions employed tailored programs. Finally, monetary incentives were only used in one of the 10 successful interventions and in none of the unsuccessful interventions; however, the researchers argued that future interventions should consider incentivizing respondents to promote participation and to reduce dropout rates (Cancelliere et al., 2011). Two intervention studies on presenteeism have been published more recently (Ammendolia et al., 2016; Coffeng, 2014). The first study reports on a workplace health promotion and wellness program that was developed using intervention mapping to promote healthy workplace behaviours and to reduce presenteeism among a large international financial services corporation. A qualitative review of the intervention mapping procedure was provided, which could be used to replicate the intervention among other organisations and employee groups. Further research to test the efficacy of the proposed intervention to significantly

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reduce presenteeism is warranted (Ammendolia et al., 2016). The second study evaluated the effects of a social and physical environment intervention on presenteeism, absenteeism, performance and work engagement among a sample of office workers (Coffeng, 2014). The social intervention involved group motivational interviewing where leaders delivered three 90-minute sessions with their team over six weeks to stimulate physical activity, relaxation and goal setting. The physical environment intervention involved the creation of new ‘zones’ in the office, such as the inclusion of comfortable seating, exercise balls, table tennis, plants and a coffee area, to promote positivity and employee morale. The results of the study indicated significant improvements to some aspects of perceived work performance and work engagement; however, no significant reduction in presenteeism was reported for either intervention (Coffeng, 2014). In their review of workplace interventions on presenteeism, Garrow (2016) reported on the importance of line managers and supervisors in the fight against presenteeism. While senior leadership needs to be supportive of the health and wellbeing of staff to ensure an overall health strategy is established and sustained, line managers and supervisors are responsible for the day-to day operation of the health and wellbeing of staff. For example, line managers and supervisors are often the first point of contact if an employee has a problem and/or requires support; however, they often do not have adequate training and resources to be able to handle the physical, emotional and organisational concerns that employees may be experiencing (Garrow, 2016). Furthermore, if employees are working when sick, line managers and supervisors are usually responsible for the allocation of work tasks and the distribution of resources, which is an important part of the return-to-work process (Karanika-Murray & Biron, 2020; Whysall et al., 2018). Finally, line managers and supervisors also act as role models, encouraging or discouraging presenteeism depending on their own attendance behaviour when sick (Dietz et al., 2020; Garrow, 2016; Ruhle et al., 2020). Similarly, Ramsey (2006) describes the tendency of management to display an ‘iron man’ mentality where overworking is seen as a badge of honour which purpetuates presenteeism behaviour within a workplace. Garrow (2016) argues that presenteeism interventions have to focus on education and training for line managers and supervisors, because if their language and behaviour encourages presenteeism, either consciously or unconsciously, then not even the most well-developed and researched intervention will be effective.

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Recommendations for Future Presenteeism Interventions

As outlined in Sect. 4.1, some preliminary evidence for the efficacy of presenteeism interventions has been reported in the literature. However, further development and evaluation of presenteeism interventions is needed to manage the rising costs associated with poorly managed presenteeism in the workplace. In this section we present suggestions for future presenteeism interventions that could be helpful for workplace practitioners. Firstly, as outlined in Karanika-Murray and Biron (2020), we recommend that presenteeism interventions should be tailored for different employees depending on their categorisation of presenteeism. For example, interventions targeted at job resources, such as improving social support or job flexibility, could be used to help functional presentees (i.e., employees with good health and high job performance) perform even better as they navigate through an illness, while high-risk dysfunctional presentees (i.e., employees with poor health and poor job performance) might respond better to more clinically focused interventions, such as psychological counselling, individual coaching sessions or stress management programs. Thinking about therapeutic presentees (i.e., employees with good health and poor job performance) and overachieving presentees (i.e., employees with poor health and high job performance), the former may benefit from interventions that help employees work more efficiently and productively while unwell, such as working from home or advanced training in Microsoft Excel, while the latter are likely to benefit from interventions targeted at employee health, such as exercise programs, workplace health promotions, free influenza vaccinations or mental health education. Secondly, prior research suggests that presenteeism is more likely to occur in poor work environments where work-related stressors, such as workloads, time pressure and job insecurity are high (Miraglia & Johns, 2016; Whysall et al., 2018). Therefore, interventions that help workers cope with the stresses of work are warranted to effectively manage presenteeism behaviour in the workplace. Interventions that could be used to promote positive work environments and to develop protective factors (e.g., social support, job control and quality leadership) include—peer support and mentor programs, introducing a ‘chill out’ room within the office where employees can go to relax and unwind after a stressful

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event, work from home options, flexible start and finish times (as long as required hours are worked), rest break changes or training for leaders on goal setting, motivational skills, and empathy. Thirdly, interventions aimed at improving employees physical and mental health are a logical choice for organisations trying to manage presenteeism as employees are less likely to be at work in an impaired state if they are physically and mentally healthy. Both physical and mental health conditions have been linked with presenteeism in the literature (Burton et al., 2004; Iverson et al., 2010; Schultz & Edington, 2007). However, the poor mental health of workers appears to have the most salient effects in the workplace (Harvey et al., 2014). For example, poor mental health is the leading cause of sickness absence and long-term work incapacity in most developed countries (Cattrell et al., 2011; Murray et al., 2012), and there are clear links between poorer mental health (e.g., stress, anxiety, depression, fatigue and emotional exhaustion) and higher rates of presenteeism (Arjona-Fuentes et al., 2019; Conway et al., 2014; Demerouti et al., 2009; Dudenhöffer et al., 2017; Harvey et al., 2011; Howard & Howard, 2020; Johnston et al., 2019; Yang et al., 2017). Workers’ compensation claims for psychological injury are also rising at a much faster rate than claims for physical injury (Productivity Commission, 2020). Considering the negative impact of poor mental health in the workplace, we suggest future research focus on the development and evaluation of mental health interventions at all levels within an organisation as a novel way to manage presenteeism. For example, mental health awareness campaigns could be implemented at the organisational level to reduce the stigma associated with mental health and to increase mental health literacy and help-seeking behaviours. At the employee level, proactive mental health education could be used to build employees’ resilience to help them better manage their own mental health. This education strategy could be achieved through interactive workshops where employees are taught about coping strategies (e.g., nutrition, sleep, mindfulness and gratitude), positive mindsets (e.g., reframing and perspective, proactive versus reactive and positive self-talk) and support networks (e.g., professional support—psychologist, general practitioner; social support— clubs, community groups; and peer support—friends, family). Lastly, at a managerial level, we recommend that managers and supervisors undertake specialised mental health training (e.g., mental health first aid) so that they are equipped with the skills to (i) identify the signs and symptoms of

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declining mental health; (ii) hold conversations with workers about their mental health; and (iii) provide best practice support options (Mental Health Movement, 2021). If managers and supervisors can effectively support employees with a mental health struggle early on, the likelihood of the concerns escalating to a more serious diagnosed psychological disorder will be reduced. Recently, the effects of physiological indicators such as biomarkers (C-reactive protein CRP and blood glucose) and hormones (cortisol and TSH thyroid hormone) on presenteeism-related productivity have been investigated (Ferreira et al., 2021). Interestingly, the researchers found that the negative relationship between cortisol (i.e., stress hormone) and presenteeism-related productivity was stronger for workers who had higher CRP and blood glycemia levels, while high levels of TSH combined with high levels of blood glucose were also found to negatively impact presenteeism-related productivity. The findings suggest that high levels of glycemia and TSH may be particularly problematic, impacting an employee’s ability to work productively while sick (Ferreira et al., 2021). Although Ferreira and colleagues’ study is a pilot, the findings are quite novel, incorporating important occupational medicine technologies to further understand presenteeism behaviour in the workplace. As recommended by Ferreira and colleagues, custom-made presenteeism interventions could be developed based on employees’ biometric data such as individualised exercise programs, nutritional plans and therapy sessions. Finally, we recommend that presenteeism interventions utilise digital technology to increase their functionality and useability. For example, smartphone applications imbedded with a Quick Response (QR) code could be used to measure and track an employee’s journey through an intervention by directing him or her to a survey and storing the information. This process would streamline data collection as the employee would not have to log onto a computer to complete the survey, increasing participation and reducing dropout rates. Smartphone applications could also be designed with push notifications, reminders and alerts as a way to positively reinforce and motivate employees to change their behaviours. Other technologies such as artificial intelligence (AI) could be used to create presenteeism interventions that are able to predict future behaviours based on retained information learned from previous data collection or events. This could be used to tailor interventions to the users’ needs and interests in real time.

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4.3

Chapter Summary

In this chapter we provided an overview of the existing presenteeism interventions available in the literature. Key features apparent among the successful presenteeism interventions were noted including the use of screening tools, tailored offerings and monetary incentives. Another commentary on presenteeism interventions was discussed such as the importance of supervisors and line managers in the delivery of presenteeism interventions. The chapter concluded with a number of recommendations for future researchers to consider when designing and evaluating presenteeism interventions, such as the (i) benefit of offering different types of interventions to employees depending on their categorisation of presenteeism; (ii) importance of positive work environments; (iii) use of consistent mental health awareness, education and training across all levels of an organisation; and (iv) importance of occupational medicine and digital technologies (e.g., QR codes, smartphone applications and AI). In the next chapter, suggestions for future research studies on presenteeism are discussed including expected outcomes and potential limitations.

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Howard, J. T., & Howard, K. J. (2020). The effect of perceived stress on absenteeism and presenteeism in public school teachers. Journal of Workplace Behavioral Health, 35(2), 100–116. Iverson, D., Lewis, K. L., Caputi, P., & Knospe, S. (2010). The cumulative impact and associated costs of multiple health conditions on employee productivity. Journal of Occupational and Environmental Medicine, 52(12), 1206–1211. Johnston, D., Harvey, S., Glozier, N., Calvo, R., Christensen, H., & Deady, M. (2019). The relationship between depression symptoms, absenteeism and presenteeism. Journal of Affective Disorders, 256, 536–540. Karanika-Murray, M., & Biron, C. (2020). The health-performance framework of presenteeism: Towards understanding an adaptive behaviour. Human Relations, 73(2), 242–261. Mental Health Movement. (2021). Mental health workplace blueprint. https:// www.mentalhealthmovement.com.au/our-services/our-mental-health-workpl ace-blueprint Mills, P. R., Kessler, R. C., Cooper, J., & Sullivan, S. (2007). Impact of a health promotion program on employee health risks and work productivity. American Journal of Health Promotion, 22(1), 45–53. Miraglia, M., & Johns, G. (2016). Going to work ill: A meta-analysis of the correlates of presenteeism and a dual-path model. Journal of Occupational Health Psychology, 21(3), 261–283. Murray, C. J., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., & Abdalla, S. (2012). Disabilityadjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990– 2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2197–2223. Nurminen, E., Malmivaara, A., Ilmarinen, J., Ylöstalo, P., Mutanen, P., Ahonen, G., & Aro, T. (2002). Effectiveness of a worksite exercise program with respect to perceived work ability and sick leaves among women with physical work. Scandinavian Journal of Work and Environmental Health, 28(2), 85–93. Productivity Commission. (2020). Mental Health, Report no. 95. https://www. pc.gov.au/inquiries/completed/mental-health/report/mental-health.pdf Ramsey, R. D. (2006). “Presenteeism”: A new problem in the workplace. Supervision, 67 (8), 14–17. Ruhle, S. A., Breitsohl, H., Aboagye, E., Baba, V., Biron, C., Correia, C., Dietz, C., Ferreira, A. I., Gerich, J., Johns, G., Karanika-Murray, M., Lohaus, D., Løkke, A., Lopes, S. L., Martinez, L. F., Miraglia, M., Muschalla, B., Poethke, U., Sarwat, N., et al. (2020). “To work or not to work, that is the question”— Recent trends and avenues for research on presenteeism. European Journal of Work and Organizational Psychology, 20(3), 344–363. Schultz, A. B., & Edington, D. W. (2007). Employee health and presenteeism: A systematic review. Journal of Occupational Rehabilitation, 17 (3), 547–579.

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Takao, S., Tsutsumi, A., Nishiuchi, K., Mineyama, S., & Kawakami, N. (2006). Effects of the job stress education for supervisors on psychological distress and job performance among their immediate subordinates: A supervisor-based randomized controlled trial. Journal of Occupational Health, 48(6), 494–503. Viola, A. U., James, L. M., Schlangen, L. J., & Dijk, D.-J. (2008). Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality. Scandinavian Journal of Work, Environment & Health, 34(4), 297–306. Wang, P. S., Simon, G. E., Avorn, J., Azocar, F., Ludman, E. J., McCulloch, J., Petukhova, M. Z., & Kessler, R. C. (2007). Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial. JAMA, 298(12), 1401– 1411. Whysall, Z., Bowden, J., & Hewitt, M. (2018). Sickness presenteeism: Measurement and management challenges. Ergonomics, 61(3), 341–354. Yang, T., Guo, Y., Ma, M., Li, Y., Tian, H., & Deng, J. (2017). Job stress and presenteeism among Chinese healthcare workers: The mediating effects of affective commitment. International Journal of Environmental Research and Public Health, 14(9), 978.

CHAPTER 5

Suggestions for Future Research Studies on Presenteeism

Abstract In this chapter we discuss suggestions for future research on presenteeism. In particular, we will share some ideas about potential avenues for future work that warrant further investigation. These avenues include the indirect relationship between poor health and burnout via presenteeism, the effects of different types of presenteeism on key work and health outcomes, the utility of the revised JD-R model to explain presenteeism and the link between presenteeism and safety behaviours (i.e., poor decision-making). Expected outcomes and potential barriers for each of the suggestions will also be considered. The chapter concludes by pointing out some other suggested areas of research such as the role of social and contextual factors in the determination of presenteeism. Keywords Health · Burnout · Benefits of presenteeism · Job crafting · Self-undermining behaviour · Unsafe decision-making

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5.1 Suggestions for Future Research on Presenteeism Presenteeism research has gained popularity over the past couple of decades. In the field of occupational health psychology constructs such as absenteeism, job performance and wellbeing have been studied much more thoroughly relative to presenteeism. It follows that there are still many gaps in the presenteeism literature worthy of investigation. 5.1.1

Poor Health, Presenteeism and Burnout

The importance of health has been demonstrated in many studies on presenteeism. For example, a range of health conditions, such as arthritis, allergies, headaches, stress, anxiety and depression, are commonly linked with presenteeism as well as overall indicators of self-rated health (Burton et al., 2004; Gosselin et al., 2013; Monzani et al., 2018; Munir et al., 2008; Schultz & Edington, 2007; Schultz et al., 2009; Serrano et al., 2013). Poor health has also been linked with burnout (Ahola & Hakanen, 2014; Baeriswyl et al., 2016; Demerouti et al., 2009; Schonfeld et al., 2019) and the association between presenteeism and burnout is well understood in the literature (Baeriswyl et al., 2016; Demerouti et al., 2009; McGregor et al., 2016; Pei et al., 2020). Building upon this research, future studies could explore the effect that poor health has on presenteeism, and how the behaviour of going to work when ill might lead to burnout (in particular emotional exhaustion) over time. Continued research into the scenarios that might provoke burnout is important given its negative impacts in the workplace, such as early retirement intentions and staff turnover and reduced work engagement, wellbeing, stamina and work productivity (Upadyaya et al., 2016). A theoretical model, such as the Conservation of Resources theory (Hobfoll, 1989), could provide a useful framework to explain the indirect relationship between poor health and burnout via presenteeism. For example, as outlined in Sect. 3.1.2, COR theory is based on the premise that people will act to gather, conserve and maintain their resources in order to avoid stress (Hobfoll, 1989, 2001). Therefore, when faced with a health problem, employees might choose to attend work while ill to avoid resource depletion associated with taking days off work, such as reduced pay and possible job loss (Demerouti et al., 2009; Ferreira et al., 2019). According to Hobfoll (2001), initial losses, such as those resulting

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from the presence of an illness, may trigger a loss spiral, which is described as the accelerated negative effect of being in a state of resource depletion following inadequate recovery. Under these circumstances, it seems likely that a secondary loss, such as burnout, might develop as the employee becomes increasingly drained trying to avoid the resource loss associated with his or her illness by continuing to work. 5.1.1.1 Expected Outcomes and Potential Barriers We expect to find a positive indirect effect between poor health and burnout via presenteeism in that poorer health will lead to more incidences of presenteeism, which in turn, will foster feelings of exhaustion and burnout. This relationship is expected as working while unwell is not a sustainable coping strategy to manage the resource loss associated with poor health over time. Potential barriers that may impact any research to examine these relationships include accessibility to a longitudinal sample and difficulties obtaining objective presenteeism data. Longitudinal data collected across multiple time points will allow for important baseline effects to be accounted for; however, accessing longitudinal data can be challenging given the extended time and costs associated with this type of data collection. The anonymity of survey responses is also harder to protect using longitudinal data as some form of information is needed to match participants overtime such as an email address. Unlike absenteeism where HR records can be accessed to objectively measure days absent from work, presenteeism is less visible and, therefore, harder to measure. For example, very few studies have been able to use objective measures when studying presenteeism, and they have been limited to workplaces with clearly defined and repetitive tasks, such as call centres and manufacturing plants (Albensi, 2003; Burton et al., 1999). Considering the difficulties of obtaining objective presenteeism data, self-reported measures are commonly used. Therefore, other factors for consideration that impact self-report measures include social desirability and memory recall (Podsakoff & Organ, 1986) (see Chapter 2, Sect. 2.5 for further comments about the use of self-reported data). To address the issue of self-report bias, other studies, such as Iverson et al. (2010) have adjusted their findings on presenteeism based on prior research that has compared objective and self-reported presenteeism data (Burton et al., 1999).

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5.1.2

The Effects of Different Types of Presenteeism on Key Work and Health Outcomes

Presenteeism has been shown to predict burnout, poorer health outcomes and increased spells of short and long-term absences (Bergstrom et al., 2009; Demerouti et al., 2009; Taloyan et al., 2012). In light of the negativity surrounding presenteeism, the benefits that could be attained from working through an illness, such as increased self-esteem and comradery, and the purpose, fulfillment and meaning that work can provide, have often been overlooked. Ruhle et al. (2020) argue that presenteeism can be a positive choice for employees and employers alike when appropriate support is provided, and adjustments are made to work tasks to ensure working through illness is restorative and productive. Recently, a framework has been proposed that conceptualises presenteeism into four different categories according to an employee’s level of health and performance (Karanika-Murray & Biron, 2020). This novel understanding of presenteeism offers a more balanced perspective where both the detrimental and beneficial aspects of attending work while unwell are considered. Please refer back to Sect. 3.3.3 for a detailed account of this framework. Drawing upon Karanika-Murray and Biron’s (2020) framework of presenteeism as a function of health and performance, a worthwhile avenue for future research would be to empirically test whether there are differences across the four types of presenteeism in relation to important work and health variables, such as work engagement, organisational commitment, wellbeing, burnout and absenteeism. Prior research has reported differences in the way work and health variables relate to absenteeism and presenteeism (Bockerman & Laukkanen, 2010; Johns, 2011; Whysall et al., 2018). Therefore, further research that investigates potential differences that may exist within presenteeism could be very impactful, providing insight into the health and work variables that could be encouraged to support functional presenteeism in the workplace (Karanika-Murray & Biron, 2020). 5.1.2.1 Expected Outcomes and Potential Barriers We expect to find that workers who meet the criteria for functional presenteeism (i.e., good health and performance) will have significantly higher levels of wellbeing, organisational commitment and work engagement and significantly lower levels of burnout and absenteeism than

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workers who meet the criteria for dysfunctional presenteeism (i.e., poor health and performance). Arguably, these associations are possible because workers who have better self-perceived health and performance while working through an illness are likely to feel more positively about work (leading to better outcomes) than workers whose health and performance is deteriorating while working through an illness. Potential barriers that may impact the research suggestion include the measurement and categorisation of presenteeism into quadrants based on health and performance dimensions as outlined by Karanika-Murray and Biron (2020). This categorisation has not been done before empirically. Therefore, a challenge will be to source suitable measures of health and perceived performance while ill. We suggest that health could be measured using a single-item from the SF-36 such as—‘In general, how would you say your health is?’ (scored from 1–poor to 5–excellent) (Ware & Sherbourne, 1992). The World Health Organisation Health and Work Performance Questionnaire could be used to measure the participants’ performance when unwell at work (Kessler et al., 2003). Cut-off points will also need to be determined for the health and performance measures to delineate the boundaries of functional and dysfunctional presenteeism. These cut-off scores will be used to identify ‘good’ and ‘poor’ health, and ‘good’ and ‘poor’ performance. It is imperative that any cut-off scores allow for valid categories of functional and dysfunctional presenteeism. 5.1.3

Applying the Revised JD-R Model

The Job Demands-Resources (JD-R) model (Bakker & Demerouti, 2007) has been used to explain the indirect relationship between job demands and resources and presenteeism via health impairing (e.g., poor health and burnout) and motivational pathways (e.g., work engagement and job satisfaction) (McGregor et al., 2016; Miraglia & Johns, 2016; Vinod Nair et al., 2020) (see Sect. 3.1.8 for a detailed outline of the JD-R model). More recently, Bakker and Demerouti (2017) have revised their JD-R model, incorporating personal resources, such as optimism and selfefficacy. They have also added two feedback loops—the first links the motivational pathway back to the job and personal resources through job crafting (i.e., one’s ability to proactively modify work tasks), while the second links the health impairment pathway back to the job demands through self-undermining behaviour.

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Drawing upon the revised JD-R model (Bakker & Demerouti, 2017), a useful line of inquiry would be to test the effect of personal resources (i.e., optimism and self-efficacy) on presenteeism, and whether personal resources are also indirectly related to presenteeism via the motivational and health impairing pathways like job resources. Building upon this work, it would also be interesting to specifically test the gain and loss spirals predicted in the revised JD-R model, and how the cycle between job crafting and job resources fuelled by motivation and between selfundermining behaviours and job demands fuelled by health impairment impacts presenteeism behaviour in the workplace. 5.1.3.1 Expected Outcomes and Potential Barriers According to the revised JD-R model, employees who are motivated by their work are more likely to job craft, which leads to more perceived job resources and ultimately higher levels of motivation (Bakker & Demerouti, 2017). A suitable line of inquiry would be to examine whether this gain spiral impacts presenteeism; it would be expected that workers with high levels of motivation and good job crafting skills may successfully negotiate presenteeism better than workers with lower motivation and poorer job crafting abilities, leading to better outcomes (e.g., higher perceived performance). In terms of the loss spiral, workers who are strained by their work are more likely to engage in self-undermining behaviours, such as communicating poorly and fostering conflict at work, which may lead to more perceived job demands and ultimately more strain over time (Bakker & Demerouti, 2017). Therefore, it would be expected that the increased strain associated with the cycle between undermining behaviours and further job demands would worsen the employees’ health, leading to even higher rates of presenteeism over time. Similar to Sect. 5.1.1.1, it is anticipated that difficulties accessing longitudinal data and the use of self-reported measures may be problematic. 5.1.4

Work-Environment Factors, Presenteeism and Unsafe Decision-Making

In industries such as mining, construction, and manufacturing, where health and safety approaches are paramount due to high risk of injury, incapacitation or death, presenteeism is a critical behaviour that needs managing as showing up for work impaired could have devasting effects. Furthermore, as populations, such as that in Australia, continue to age,

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this issue will worsen given that prevalence rates of many illnesses increase with age contributing to further presenteeism (Aronsson & Gustafsson, 2005; Bierla et al., 2013; Johns, 2011). Clearly, presenteeism is an important issue especially within high-risk industries, such as mining, construction and manufacturing, that is expected to persist well into the future. There are clear links between work-environment factors, such as high workloads, time pressure, job insecurity and poor supervisor support and increased levels of presenteeism (Cho et al., 2016; Claes, 2011; Demerouti et al., 2009; Dietz & Scheel, 2017; Janssens et al., 2016; Miraglia & Johns, 2016). Within the nursing profession, going into work when unwell has been associated with overall perceptions of patient safety and the frequency of unsafe reported events (Rainbow, 2019). However, the link between presenteeism, and specifically, unsafe decision-making is less understood. There is evidence linking presenteeism with poorer mental health and wellbeing including but not limited to depression, fatigue, anxiety and burnout (Aronsson et al., 2000; Bansback et al., 2012; Demerouti et al., 2009; Johnston et al., 2019; Rainbow et al., 2020). Considering the negative impact of presenteeism on an employee’s mental state, attending work while ill may also affect one’s ability to concentrate and make safe decisions at work. Therefore, taking the above research into consideration, we suggest that future studies investigate whether presenteeism mediates the relationship between a poor work environment and unsafe decision-making, especially within high-risk industries, such as mining, construction and manufacturing. 5.1.4.1 Expected Outcomes and Potential Barriers We would expect to find a positive indirect effect between workenvironment factors (i.e., job insecurity, time pressure, high workloads and poor supervisor support) and unsafe decision-making through increased presenteeism. This association is expected given the stress associated with managing a poor work environment could lead to more incidences of presenteeism. In turn, the employees’ decision-making ability may be impaired as continuing to work while ill could foster more stress and fatigue, affecting their ability to concentrate and make safe decisions at work. Again, the difficulties and challenges associated with accessing longitudinal data and the use of self-reported measures are relevant for the proposed research. A further challenge may involve sourcing a suitable decision-making measure for the research. While some

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scales were found that assess decision-making in relation to addiction and mental illness (e.g., IOWA Gambling Task) (Bechara, 2007), a suitable scale to measure unsafe decision-making in the workplace could not be found. Therefore, future research may need to consider tailored scale development of unsafe decision-making to engage in the suggested research. 5.1.5

Other Research Suggestions

Building upon some of the contemporary research discussed in Sect. 1.3.1, we recommend that future studies continue to explore the role of social and contextual factors on presenteeism. For example, Ruhle and Süß (2020) proposed three attendance culture archetypes (namely health-focused, presentistic and individual decision) that are based on underlying assumptions about the perceived legitimacy of presenteeism versus absenteeism within an organisation. An interesting avenue for future research would be to empirically test the different attendance culture archetypes over time. In particular, future research could examine the health and work consequences associated with the different archetypes to determine which attendance cultures should be encouraged (i.e., positive consequences) versus those that are likely to be problematic (i.e., negative consequences) (Ruhle & Süß, 2020). Another suggestion for future research would be to consider other social factors that have recently been explored, such as housework engagement, and how the amount of time and effort invested in family responsibilities may affect employees’ willingness to attend work when ill (Correia Leal & Ferreira, 2021). Finally, building upon previous research where the labour market in which employees are embedded influenced the rate of presenteeism (Reuter et al., 2021), it is recommended that future research consider other contextual factors that could impact presenteeism, such as interest rates, gross domestic product, political regimes and national government policies.

5.2

Chapter Summary

Presenteeism research has become increasingly popular over the past couple of decades. However, as mentioned in Sect. 5.1, compared to many other areas in the field of occupational health psychology, such as absenteeism, job performance and wellbeing, there are still many

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gaps in the presenteeism literature worthy of study. In this chapter we presented several suggestions for future research on presenteeism. These recommendations included (i) an indirect relationship between poor health and burnout via presenteeism; (ii) an empirical investigation into the differences between functional and dysfunctional presenteeism, and whether they vary in terms of work engagement, wellbeing, commitment, burnout and absenteeism; (iii) the role of personal resources (e.g., optimism and self-efficacy), and the impact of job crafting (gain cycle) and self-undermining behaviours (loss cycle) on presenteeism; and (iv) an indirect relationship between work-environment factors (e.g., time pressure, job demands, job insecurity and poor supervisor support) and unsafe decision-making via presenteeism. Expected outcomes and potential barriers for each of the suggestions were also considered. Potential barriers noted across the proposed research suggestions included difficulties securing a longitudinal sample and objective presenteeism data as well as challenges obtaining suitable scales to measure functional and dysfunctional presenteeism and decision-making ability in a work-related context. The chapter concluded with a final comment highlighting some other social and contextual factors worthy of further research on presenteeism.

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Index

A Absenteeism, 1, 3, 8, 9, 11, 12, 14, 31, 32, 38–41, 43, 55, 60, 64–66, 70, 80, 90–92, 96, 97 Accomplishment, 1, 10, 13, 57, 58, 63 Active listening, 79 Artificial intelligence, 83, 84

leader presenteeism, 7, 14 presenteeism climate, 7–9, 14 transformational leadership, 7, 8, 14 Common method bias, 42 Coping mechanism, 60, 63 Coronary heart disease, 11 Costs, v, 1–3, 9, 14, 28, 30, 43, 52, 81, 91

C Chronic health conditions, 3 Classical view of construct validity, 27 Cognitive behavioural therapies, 78 Consensus view of validity, 27 Conservation of resources theory (COR Theory), 52–54, 61, 69, 90 Contemporary research, 7, 14, 96 attendance cultures, 7, 9, 14 challenge demands, 10 hindrance demands, 10, 14 housework engagement, 96 interest rates, 96 labour market, 7, 9, 14

D Decision making, 26, 27, 64, 68, 70, 95–97 Definition, 2 behavioural, 2 productivity loss, 2 Demands-Control-Support model (DCS Model), 52, 53, 60, 61 Denial, 67 Dialectical theory, 64, 66 dialectical tensions, 66 supervisor-subordinate relationship, 66 contradictions, 66, 67 Diet, 77

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 A. McGregor and P. Caputi, Presenteeism Behaviour, https://doi.org/10.1007/978-3-030-97266-0

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INDEX

Digital technology, 83 Dynamic model, 65 Dysfunctional presenteeism, 69, 81, 93, 97

Individual coaching sessions, 81 Individual differences, 54, 61–63, 70 Infectious disease, 11 Influenza vaccinations, 81

E Early retirement intentions, 90 Education and training, 78, 80, 84 Effort-Recovery Theory, 52, 56 Effort-Reward Imbalance (ERI Model), 52, 54–55, 60, 61, 63 Endicott Work Productivity Scale, 36, 37 Empathy, 82 Exercise, 77, 78, 80, 81, 83 Exhaustion, 3, 11, 12, 56, 58, 60, 82, 90, 91

J Job attitudes, 5, 6, 14, 56 affective commitment, 5, 6 job satisfaction, 5–7, 10, 14, 32, 38, 56, 67, 93 work engagement, 5, 6, 56 Job crafting, 93, 94, 97 Job demands, 4, 5, 7, 10, 14, 52–56, 58–63, 65, 70, 93, 94, 97 job insecurity, 4, 5, 65, 97 time pressure, 4, 5, 10, 54, 58, 59, 97 understaffing, 4, 5 workload, 4, 10, 53, 54, 56, 60 Job Demands-Resources Model (JD-R Model), 52, 58, 59, 61, 62, 70, 71, 93, 94 Job flexibility, 81 Job performance, 10, 12, 38, 69, 81, 90, 96 Job resources, 53, 58–60, 62, 81, 94 co-worker support, 4, 53 job control, 5–7, 14, 52, 53, 58, 81 leadership, 59, 81 organisational support, 4 supervisor support, 4, 53

F Feedback loops, 93 Flexible start and finish times, 82 Functional presenteeism, 70, 92 G Gain spiral, 94 Gender, 65 Goal setting, 57, 78, 80, 82 Gradual return to work, 13 H Health, 3–5, 10, 11–14, 29–31, 34–36, 38, 40–42, 52–70, 77–83, 90–97 Health promotion, 77–79 Healthy eating, 78 High-risk industries, 95

L Latent variable, 26, 27 Leader training, 82 Line managers and supervisors, 80 Longitudinal, 7, 8, 14, 91, 94, 95, 97 Loss spiral, 91, 94

I Imbalance, 8, 54, 55, 57, 60–63

M Maintaining quality relationships, 13

INDEX

Medical performance, 12 Medication consultation, 78 Mental health, 3, 11, 14, 40, 56, 57, 77, 78, 79, 81–84, 95 anxiety, 3, 57, 82, 95 burnout, 3, 14, 95 depression, 3, 14, 57, 82, 95 fatigue, 3, 82, 95 stress, 3, 82 Mental health education, 81, 82 Mental health awareness campaigns, 82 Mental health training, 82 Mindfulness, 78, 82 Motivation(al), 31, 58, 59, 63, 80, 82, 93, 94 Monetary incentives, 79, 84 O Objective productivity, 12 Occupational medicine, 83, 84 biometric data, 83 Ontological status of latent variables, 27 Optimism, 4–6, 70, 93, 94, 97 Organisational citizenship behaviour, 13, 14 Organisational commitment, 10, 92 Outcome expectancies, 57, 62, 63 Overall perceptions of physical health, 11 Overachieving presenteeism, 68 P Pathological science, 27 Peer support and mentor programs, 81 Performance, 5, 8, 12, 13, 33, 34, 38, 42, 52, 54, 57, 58, 63, 64, 68–70, 80, 92–94 Performance-based self-esteem, 13

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Person-Environment Fit (P-E fit), 52, 55, 56, 62 Personal resources, 4, 5, 14, 61, 70, 93, 94, 97 optimism, 4–6, 70, 93, 94, 97 conscientiousness, 5, 6 Physical activity, 78, 80 Physical health, 3, 36, 39, 77 general ill health, 3, 14 headaches, 90 head colds, 3 arthritis, 3, 90 allergies, 3, 90 Poor health, 58, 62, 81, 90–93, 97 Prevalence, 2, 31, 38, 95 Productivity, v, 2, 3, 9–12, 14, 28, 30–33, 36–43, 53, 55, 57–59, 65, 69, 79, 83 Psychoeducation, 79 Psychological counselling, 81 Psychological variable, 26 Psychometric properties, v, 14, 26, 30, 32, 33, 35, 37, 39, 40, 42, 43 Psychotherapy, 78 R Realist perspective, 27 Relaxation, 78, 80 Reliability, 26, 32, 33, 35, 42 internal consistency, 26, 32, 33, 35–39 Test-retest reliability, 33, 35–37, 39–41 Responsiveness, 41 Rest break, 6, 79, 82 Revised JD-R model, 70, 89, 93, 94 Rewards and promotions, 13 S Safety, 94, 95

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INDEX

Screening tools (Health risk assessments), 79, 84 Self-efficacy, 57, 58, 63, 70, 94, 97 Self-esteem, 13, 14, 92 Self-rated health, 11, 90 Self-rated job performance, 12 Self-report measures, 42, 91 social desirability, 42, 91 memory recall, 91 Self-undermining behavior, 93, 94, 97 Sensitivity to detect change, 41 Sensitivity to symptom change, 38 Single item measures, 28, 29 item content, 28 response format, 28, 29, 35 recall period, 28, 29, 43 Social cognitive theory (SCT), 52, 57, 58, 62, 63 Social norms, 8, 9, 13, 70 Social support, 13, 36, 81, 82 Staff turnover, 13, 90 Stamina, 90 Stanford Presenteeism Scale, 30, 31, 53 Strain, 9, 52–54, 56, 57, 59, 60, 63, 94 Stress, 3, 4, 10, 14, 32, 36, 42, 52–58, 60–62, 63, 65, 79, 81–83, 90, 95 Stress management programs, 81

T Theory of planned behaviour, 70, 71 Therapeutic presenteeism, 69 Transactional theory of stress, 56–57, 61

U Unsafe decision making, 94–97 V Validity, 26, 27, 33, 37, 39, 41, 42 concurrent validity, 32, 33, 37, 39, 41 content validity, 32 construct validity, 27, 35–37, 39, 40 convergent validity, 32, 33, 35, 41 criterion validity, 27 discriminant validity, 40 divergent validity, 32, 35 W Wellbeing, 5, 29, 52, 55, 56, 61, 63, 78, 80, 90, 92, 95–97 Work Health Organisation Health and Work Performance Questionnaire, 38, 93 Work(ing) from home, 69, 81 Work Limitations Questionnaire, 33–34 time management, 34–36 physical demands, 35 mental-interpersonal demands, 35, 36 output demands, 35, 36 Work Productivity and Activity Impairment Questionnaire, 39–41, 43 Workplace rehabilitation programs, 13 Work productivity, 12, 28, 30–33, 36–43, 90 Work redesign, 78, 79