The association between health risk change and presenteeism change

Association Between Suboptimal Health Status and Health-Related Productivity Loss in Primary Healthcare Workers in China: a Cross-Sectional Survey

Objective

This study aimed to clarify the association between suboptimal health status and health-related productivity loss among primary healthcare workers in China.

Material and Methods

A field questionnaire survey was conducted with a multistage sampling among primary healthcare workers. The data on sub-health and health-related productivity loss were collected using the Sub-health Measurement Scale Version 1.0 and Work Productivity and Activity Impairment Questionnaire: General Health, respectively. Ordinary least squares regression was used to evaluate the association of the suboptimal health and health-related productivity loss. Subgroup analyses were performed by occupation (physician and nurse).

Results

Front-line primary healthcare workers (N = 1709) from 31 provinces in China responded to the survey. Of all participants, 73.43% experienced suboptimal health. The status of being in physical suboptimal health (Coef. = 0.050, p < 0.001, 95% CI = [0.031,0.070]) and mental suboptimal health (Coef. = 0.040, p < 0.001, 95% CI = [0.020,0.059]) status exerted significant effect on the extent of health-related productivity loss among primary healthcare workers in China. Nurses in social adaptation suboptimal health status (Coef. = 0.030, p = 0.027, 95% CI = [0.003,0.057]) had significant effect on health-related productivity loss.

Conclusion

The prevalence of suboptimal health is high among the respondents. Providing support for primary healthcare workers from bio-psycho-social aspects is an effective measure to promote their occupational health and improve their productivity.

Exploring presenteeism trends: a comprehensive bibliometric and content analysis

Objective

This research will conduct a bibliometric and content analysis of presenteeism from 2000 to 2023. It aims to investigate publication trends, authorship patterns, and significant publications by using presenteeism conceptualizations, measurements, determinants, consequences, and interventions analysis. The study provides valuable insights for researchers, practitioners, and policymakers about understanding and addressing workplace presenteeism issues.

Methods

The research involved conducting a bibliometric study to analyze presenteeism publication trends, authorship patterns, and significant publications. It also explored the evolution of presenteeism research over time, identifying contributing countries, institutions, and writers. The interdisciplinary nature of presenteeism research was emphasized, covering occupational health, psychology, management, and public health. The researchers have used VOS Viewer and R Studio (biblioshiny) for this study.

Results

The study identified several elements influencing presenteeism, such as health issues, work-related factors, organizational culture, and individual characteristics. It further examined the impact of organizational policies, leadership support, employee assistance programs, and health promotion activities in reducing absenteeism and enhancing employee well-being. These findings highlight the importance of addressing these factors to mitigate presenteeism issues and promote a healthier work environment.

Conclusion

This research identified deficiencies in presenteeism research and provided recommendations for future investigations in this field. It emphasized the need for standardized measures and methodologies, longitudinal studies to understand causality, and industry- and population-specific interventions. These insights can guide future research directions and interventions to address presenteeism issues in a rapidly changing work and research landscape.

Translation and Psychometric Testing of the Hägerbäumer Presenteeism Scale in English

PURPOSE

Interest in presenteeism has increased in research. Presenteeism is a behaviour of going to work despite illness. It has been predominantly measured using single items, which introduce limitations to validity. To overcome these limitations, Hägerbäumer developed a German multi-item presenteeism scale.

METHODS

The aim of the study was to provide an English translation and psychometric testing of the scale. This was conducted in two phases with native English-speaking employed adults. Phase 1 includes translation and cognitive debriefing, phase 2 testing construct validity and internal consistency reliability.

RESULTS

Cognitive debriefing with 10 employees revealed no problems with understanding or answering the translated items. In total, 487 employed adults participated in the study, of which data from 287 were included in the analysis. For structural validity, the goodness-of-fit indicators all reached their thresholds (TLI = 0.98, CFI = 0.99, RMSEA = 0.07, SRMR = 0.02). The scale does not show differences between sexes and age groups but between sectors (F6,70.95 = 5.53, p < 0.001). The internal consistency reliability was satisfactory with α = 0.89 (CI 95%, 0.87-0.91).

CONCLUSION

The translated multidimensional scale for measuring presenteeism at the behavioural level demonstrated good psychometric properties in an initial validation. Further psychometric testing is required before using this scale in cross-national comparison in research and international companies.

Investigating Associations Between Physical Activity and Presenteeism - A Scoping Review

OBJECTIVE

The aim of this study is to scope the literature on what is currently known between physical activity and presenteeism.

DATA SOURCE

A search strategy was conducting in six scientific databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies written in English about the relation between physical activity and presenteeism were considered for inclusion.

DATA EXTRACTION

Data on definitions and measurement of presenteeism and physical activity were extracted.

DATA SYNTHESIS

The data is categorized according to the understanding of presenteeism of the studies to give a better idea of how this phenomenon is studied in relation to physical activity.

RESULTS

After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria. The majority of the articles were published since 2010 and originated predominantly in the United States. Most studies (70%) define presenteeism as lost productivity due to health problems, according to the American line of research, whereas 19% of the studies define it as "working while ill" which refers to the European line of research. The studies that reflected the American school of thought tends to report more results that supported their hypothesis (i.e., that more physical activity is associated with less presenteeism).

CONCLUSION

This review has highlighted the homogeneity in how presenteeism is conceptualized and measured in studies included in our sample. Research on physical activity and presenteeism should be expanded across various disciplines in social sciences to respond to the needs that many researchers have expressed to promote healthier organizations.

In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact

Background

Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown.

Methods

This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD.

Findings

There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed.

Interpretation

We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.

Association between lifestyle habits and presenteeism

BACKGROUND

Presenteeism is affected by work-related and individual factors. Among individual factors, the effect of combining various lifestyle habits on presenteeism is unknown.

AIMS

This study aimed to determine the relationship between changes in multiple good lifestyle habits with a change in presenteeism and to examine the effect of psychological factors on this relationship.

METHODS

We performed a 1-year retrospective cohort study on employees of large Japanese companies. Data were collected from health check-ups and a self-administered questionnaire. Changes in presenteeism were measured using the Quality and Quantity method. Changes in lifestyle habits were measured using a modified form of Breslow's seven health practices. Psychological factors were measured using the Kessler 6-Item Psychological Distress Scale. Linear regression was used for statistical analysis.

RESULTS

The number of practised lifestyle habit changes was negatively correlated with a change in presenteeism. This result was consistent when adjusted for age, sex and company (B, -0.010; P < 0.05), but became non-significant when additionally adjusted for psychological distress (B, -0.006). When analysed separately, only an improvement in the body mass index (B, -0.054; P < 0.05) and a worsened sleep habit (B, 0.040; P < 0.01) influenced a change in presenteeism.

CONCLUSIONS

This study suggests that improving various practised lifestyle habits in combination, rather than improving a single lifestyle habit, is beneficial in reducing presenteeism. Our finding that psychological distress altered the relationship of practised lifestyle habit changes with presenteeism indicates the importance of organizational-level intervention in presenteeism.

When does presenteeism harm productivity the most? Employee motives as a key moderator of the presenteeism–productivity relationship

Purpose

While presenteeism is empirically linked to lower productivity, the role of a person's motives for engaging in presenteeism has been overlooked. Using a Conservation of Resources Theory framework, we examine the moderating effects of presenteeism motives (approach and avoidance motives) on the presenteeism–productivity relationship.

Design/methodology/approach

A sample of 327 dental hygienists with chronic health conditions was surveyed. Moderated multiple regression was used to test study hypotheses.

Findings

Results indicate that presenteeism does indeed appear to detriment productivity. However, we demonstrate that motives are an important moderator, such that high approach motives appear to mitigate the negative effects of presenteeism on productivity.

Practical implications

Based on our findings, we suggest managers strive to improve the approach motives of their employees through processes such as job enrichment.

Originality/value

This study demonstrates that presenteeism is not always detrimental to productivity, as approach motives appear to mitigate the negative effects of presenteeism on productivity. These results could drive future research on presenteeism, as well as inform best practices related to managing workers with chronic health issues.

The Prospective Association Between Physical Activity, Insomnia Symptoms and Productivity in an Australian Population-based Cohort

OBJECTIVES

To investigate the joint, prospective associations of physical inactivity and insomnia symptoms and productivity using the 2013 and 2014 Household Income and Labor Dynamics in Australia Survey panel data.

METHODS

The association between i) presenteeism (yes/no, n=5864) and ii) absenteeism (sick leave days, n = 4324) and the mutually exclusive groups "active without insomnia", "active with insomnia", "inactive without insomnia" and "inactive with insomnia" was assessed.

RESULTS

Participants "active with insomnia" or "inactive with insomnia" had greater odds of presenteeism than those "active without insomnia" (OR = 1.41, 95%CI: 1.07-1.85 and OR=1.44, 95%CI: 1.14-1.83 respectively). Participants "inactive with insomnia" had a greater incidence of absenteeism than participants "active without insomnia" (IRR=1.28, 95%CI: 1.07-1.54).

CONCLUSIONS

Findings suggest improving physical activity levels and insomnia symptoms concurrently may improve productivity by reducing presenteeism and sick leave.

The Economic Burden of Lost Productivity due to Presenteeism Caused by Health Conditions Among Workers in Japan

To identify the primary health conditions that cause presenteeism, and to estimate the economic cost of lost productivity due to presenteeism in Japan.

Work Productivity Losses and Associated Risk Factors Among University Employees in the CAMMPUS Wellness Program

OBJECTIVE

The aim of this study was to comprehensively measure work productivity losses of employees enrolled in a pharmacist-led wellness program and assess associated risk factors.

METHODS

The study sample was employees at least 18 years old with a Framingham Risk Score (FRS) at least 10% or 1+ medication-modifiable cardiovascular risk factor (196 participants at baseline and 166 at 12-month endpoint). Total work hour losses (WHL) were measured using the Valuation of Lost Productivity questionnaire. The factors anticipated to be associated with WHL included work habits, FRS, body mass index (BMI), physical activity, and health-related quality of life (HRQoL).

RESULTS

Sedentary work habits, higher BMI, and lower HRQoL were significantly associated with more WHL for males. Among females, only a lower HRQoL was significantly associated with more WHL.

CONCLUSIONS

Our findings help identify employees at greater risk for WHL and provide insights on how workplace wellness programs can be modified.

Testing the Construct Validity and Responsiveness of the Single-Item Presenteeism Question

OBJECTIVE

We tested the construct validity and responsiveness of a single-item instrument for measuring absolute presenteeism-the single-item presenteeism question (SPQ).

METHODS

Two self-report questionnaire surveys were conducted among employees of 24 small- or medium-sized companies (N = 1021) concerning the recognized predictors of presenteeism-absenteeism, subjective health risks, work engagement, and workplace social capital. Responsiveness was measured by determining whether changes in the presence of predictors between the surveys were accompanied by commensurate changes in SPQ presenteeism.

RESULTS

SPQ presenteeism exhibited significant associations with the predictors, denoting adequate construct validity. Regarding responsiveness, unfavorable changes in most predictors were associated with increased SPQ presenteeism, as expected.

CONCLUSIONS

We confirmed the construct validity and responsiveness of the SPQ-an instrument that can be employed to promote workplace health and productivity management.

The Compensatory Protective Effects of Social Support at Work in Presenteeism During the Coronavirus Disease Pandemic

The present study investigated the lasting effects of sickness presenteeism on well-being and innovative job performance in the demanding Chinese work context compounded with the precarities of the post-pandemic business environment. Adopting the conservation of resources (COR) theory perspective, especially its proposition of compensation of resources, we incorporated social resources at work (supervisory support and collegial support) as joint moderators in the presenteeism–outcomes relationship. We employed a panel design in which all variables were measured twice with 6 months in between. Data were obtained from 323 Chinese employees working in diverse industries in Taiwan. We found that after controlling for the baseline level of well-being, presenteeism did not have a lasting effect on employees' exhaustion. However, presenteeism did have a negative lasting effect on employees' innovative behavior 6 months later. Moreover, we found a significant three-way interaction of presenteeism, supervisory support, and collegial support on employees' innovative job performance, after controlling for the baseline level of performance. Specifically, when working under illness, employees displayed the best innovative performance with high levels of both supervisory and collegial support, the worst performance with both support being low, and the intermediate when any one of the support being high. This can be taken as the preliminary evidence to support the COR proposition of resource caravans, showing that supervisory support and collegial support compensated for each other as critical resources in alleviating the impact of working under sickness on employees' innovative performance. Theoretical implications of the findings are discussed, taking into account the macro-cultural context of the East Asian Confucian societies. We also reflected on the managerial implications of the lasting damages of sickness presenteeism and benefits of mobilizing social resources on employees' well-being and performance.

Eight-Year Health Risks Trend Analysis of a Comprehensive Workplace Health Promotion Program

Research has shown that workplace health promotion (WHP) efforts can positively affect employees' health risk accumulation. However, earlier literature has provided insights of health risk changes in the short-term. This prospective longitudinal quasi-experimental study investigated trends in health risks of a comprehensive, eight-year WHP program (n = 523-651). Health risk data were collected from health risk assessments in 2010-2011, 2013-2014, and 2016-2017, applying both a questionnaire and biometric screenings. Health risk changes were investigated for three different time-periods, 2010-2013, 2014-2017, and 2010-2017, using descriptive analyses, t-tests, and the Wilcoxon Signed Rank and McNemar's test, where appropriate. Overall health risk transitions were assessed according to low-, moderate-, and high-risk categories. Trend analyses observed 50-60% prevalence for low-, 30-35% for moderate-, and 9-11% high-risk levels across the eight years. In the overall health risk transitions of the three time-periods, 66-73% of participants stayed at the same risk level, 13-15% of participants improved, and 12-21% had deteriorated risk level across the three intervention periods. Our findings appear to indicate that the multiyear WHP program was effective in maintaining low and moderate risk levels, but fell short of reducing the total number of health risks at the population level.

Presenteeism among workers: health-related factors, work-related factors and health literacy

BACKGROUND

Presenteeism is an important factor in workers' health. However, few studies have examined how variables such as socio-economic status, health status, workplace status and health literacy correlate with and affect presenteeism.

AIMS

To assess the correlates of presenteeism with a focus on health-related factors, work-related factors and health literacy.

METHODS

We conducted a cross-sectional study of 2914 Japanese workers from one company. We used a self-administered questionnaire to assess socio-demographic characteristics, health status, work environment, presenteeism and health literacy.

RESULTS

Forty-one per cent of participants were under 40 years of age and 70% were male. We found that 59% of the participants were at high risk of presenteeism. Presenteeism was associated with sex, age, household income, marital status, health-related factors (i.e. self-rated health status, dietary choices, exercise habits), work-related factors (i.e. workplace support, job demands, job control) and health literacy. Logistic regression analyses indicated that presenteeism was associated with self-rated health status, overtime hours, workplace support, job demands, job control and health literacy after adjusting for sex, age and income.

CONCLUSIONS

Health-related factors, work-related factors and health literacy are all associated with presenteeism. Improving the workplace environment, especially factors such as overtime working hours, workplace support, job demands and job control, and increasing health literacy may reduce presenteeism among general office workers.

Lifestyle Medicine and Worker Productivity

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Association between employment status and sickness presenteeism among Korean employees: a cross-sectional study

Background

Sickness presenteeism (SP) indicates “going to work while being ill.” The importance of SP has only recently been investigated, and the association between SP and employment status has been inconsistent across studies. Therefore, we conducted this study to explore the association between SP and employment status by using presenteeism propensity (PP), which can reflect the individual decision-making process.

Methods

The study population included employees participating in the 5th Korean Working Condition Survey. We analyzed data of only employees with at least one health event, which was calculated as the sum of SP and sickness absenteeism days. Employment status was grouped into 3 categories: stable employment, unstable employment (contract period ≥ 1 year), and unstable employment (contract period < 1 year). Survey-weighted logistic regression analysis was conducted to assess the association between employment status and PP (dichotomized as “≤ 0.5” and “> 0.5”).

Results

Unstable employees (contract period ≥ 1 year) had higher odds of PP than stable employees (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.03–1.47), whereas unstable employees (contract period < 1 year) had lower odds of PP than stable employees (OR: 0.82, 95% CI: 0.71–0.96).

Conclusions

Employment status was associated with SP. Given the negative health impact of SP, social efforts, such as paid sick leave, are required to reduce SP and enhance the health status of unstable workers.

Impact of Physician Referral to Health Coaching on Patient Engagement and Health Risks: An Observational Study of UPMC's Prescription for Wellness

PURPOSE

Evaluate impact of physician referral to health coaching on patient engagement and health risk reduction.

DESIGN

Four-year retrospective, observational cohort study with propensity-matched pair comparisons.

SETTING

Integrated delivery and finance system in Pittsburgh, Pennsylvania.

SAMPLE

10 457 adult insured members referred to health coaching by their physician; 37 864 other members identified for health coaching through insurer-initiated outreach.

INTERVENTION

Practice-based, technology-supported workflow and process for physician prescribing of health coaching during regular office visit, with follow-up on patient's progress and implementation supports.

MEASURES

Patient engagement based on completion of pre-enrollment assessment, formal enrollment in health coaching, completion of required sessions, health risk levels, and number of health risks pre- and post-health coaching referral.

ANALYSIS

Difference-in-difference analysis to assess change in health risk levels and number of health risks pre- and post-health coaching and probability weighting to control for potential confounding between groups.

RESULTS

Members referred by a physician were significantly more likely to enroll in a health coaching program (21.0% vs 6.0%, P < .001) and complete the program requirements (8.5% vs 2.7%, P < .001) than when referred by insurer-initiated outreach; significant within group improvement in health risk levels from baseline (P < .001) was observed for both the groups.

CONCLUSIONS

Patients are significantly more likely to engage in health coaching when a referral is made by a physician; engagement in health coaching significantly improves health risk levels.

Associations Between Activities Outside Work and Presenteeism Among Korean Wage Workers: An Analysis Using a Nationwide Survey

Objectives

Presenteeism is currently recognized as a significant global health issue that can potentially cause productivity losses. Hence, many studies have analyzed the relationships between workplace factors and presenteeism. However, few studies have considered non-occupational factors. This study examined the associations between presenteeism and activities outside work, including volunteering, self-development, leisure/sports, and gardening and house repair activities, in Korean wage workers.

Methods

This study analyzed the fourth Korean Working Conditions Survey, in which a total of 19 294 wage workers participated. To identify relationships between presenteeism and activities outside work, multivariate logistic regression analysis was used after adjusting for general and occupational characteristics.

Results

Self-development and leisure/sports activities significantly increased the odds ratio (OR) of presenteeism (OR, 1.166; 95% confidence interval [CI], 1.061 to 1.282 and OR, 1.276; 95% CI, 1.181 to 1.379, respectively).

Conclusions

Certain activities outside work, such as self-development or leisure/sports, were related to presenteeism among Korean wage workers. Although many previous studies have emphasized the positive effects of those activities on health, this study documented negative effects of these activities outside work on health.

Presenteeism in a Dutch hand eczema population-a cross-sectional survey

BACKGROUND

Presenteeism (attending work despite complaints and ill health, which should prompt rest and absence) has been overlooked in the field of hand eczema.

OBJECTIVES

To examine the 1-year prevalence of presenteeism related to hand eczema in a population of hand eczema patients who visited a tertiary referral centre. Secondary objectives: to identify intrinsic/extrinsic reasons for presenteeism and to evaluate associated factors.

METHODS

This was a cross-sectional questionnaire study. Presenteeism was defined as "going to work despite feeling you should have taken sick leave because of hand eczema". Respondents answered questions about socio-demographic factors, clinical features, occupational characteristics, and hand eczema related to occupational exposure.

RESULTS

Forty-one per cent (141/346) of patients who had both worked and had hand eczema during the past 12 months reported presenteeism. The most often reported reasons were: "Because I do not want to give in to my impairment/weakness" (46%) and "Because I enjoy my work" (40%). Presenteeism was associated with: mean hand eczema severity; absenteeism because of hand eczema; improvement of hand eczema when away from work; and high-risk occupations.

CONCLUSIONS

In this study, presenteeism was common and predominantly observed in patients with more severe hand eczema and occupational exposure. The most frequently reported reasons for presenteeism were of an intrinsic nature.

Cost and Return on Investment of a Work-Family Intervention in the Extended Care Industry: Evidence From the Work, Family, and Health Network

OBJECTIVE

To estimate the cost and return on investment (ROI) of an intervention targeting work-family conflict (WFC) in the extended care industry.

METHODS

Costs to deliver the intervention during a group-randomized controlled trial were estimated, and data on organizational costs-presenteeism, health care costs, voluntary termination, and sick time-were collected from interviews and administrative data. Generalized linear models were used to estimate the intervention's impact on organizational costs. Combined, these results produced ROI estimates. A cluster-robust confidence interval (CI) was estimated around the ROI estimate.

RESULTS

The per-participant cost of the intervention was $767. The ROI was -1.54 (95% CI: -4.31 to 2.18). The intervention was associated with a $668 reduction in health care costs (P < 0.05).

CONCLUSIONS

This paper builds upon and expands prior ROI estimation methods to a new setting.

Role and Value of the Corporate Medical Director

: The role of the corporate medical director (CMD) has evolved over the last 300 years since Ramazzini first identified diseases of Italian workers in the early 1700s. Since then, there has been a gradual blurring of the boundaries between private and workplace health concerns. Today's CMD must have intimate knowledge of their corporation's industry and the businesses that they support, particularly the occupational and environmental programs that comply with all local, state, and/or national standards and regulations. Leading companies not only measure compliance with such standards but also may hold programs to their own internal corporate global standards even if these go beyond local government requirements. This document will explore in greater depth the strength and importance that the CMD brings to the business operations to support a healthy, engaged, and high performing workforce. Part 1 describes the role and value of the CMD, while Part 2 provides collective wisdom for the new CMD from current and past highly experienced CMDs.

Associations between perceived leadership and presenteeism in an industrial population

Background

Presenteeism has received increasing attention in occupational health research but the evidence for its association with perceived leadership is scant.

Aims

To assess the association of perceived leadership and presenteeism among industrial workers.

Methods

Survey responses from employees on perceived leadership were linked to the personnel register of a food industry company. The Presenteeism Scale method was used to determine the presenteeism percentage. Perceived leadership was measured as a composite variable of six individual items on motivating and participating leadership. Generalized linear models were used to determine the association of perceived leadership with presenteeism.

Results

There were 847 participants. The majority of office workers of both genders reported better perceived leadership than factory workers. We found that perceived poor leadership was associated with a higher likelihood of presenteeism (rate ratio (RR) 1.64, 95% confidence intervals (CIs) 1.51-1.78). However, there was variation amongst and within occupational groups and genders, with a higher risk of presenteeism amongst male factory workers (RR 2.28, 95% CI 2.02-2.52) than female office workers.

Conclusions

Leadership was found to be significantly associated with presenteeism, with a greater risk of presenteeism in those reporting poor perceived leadership. The association between levels of perceived leadership and presenteeism was stronger in men than women. Organizations should focus on motivating leadership practices to reduce the risk of presenteeism, especially among men.

Validity and Reliability of the 8-Item Work Limitations Questionnaire

Purpose To evaluate factorial validity, scale reliability, test-retest reliability, convergent validity, and discriminant validity of the 8-item Work Limitations Questionnaire (WLQ) among employees from a public university system. Methods A secondary analysis using de-identified data from employees who completed an annual Health Assessment between the years 2009-2015 tested research aims. Confirmatory factor analysis (CFA) (n = 10,165) tested the latent structure of the 8-item WLQ. Scale reliability was determined using a CFA-based approach while test-retest reliability was determined using the intraclass correlation coefficient. Convergent/discriminant validity was tested by evaluating relations between the 8-item WLQ with health/performance variables for convergent validity (health-related work performance, number of chronic conditions, and general health) and demographic variables for discriminant validity (gender and institution type). Results A 1-factor model with three correlated residuals demonstrated excellent model fit (CFI = 0.99, TLI = 0.99, RMSEA = 0.03, and SRMR = 0.01). The scale reliability was acceptable (0.69, 95% CI 0.68-0.70) and the test-retest reliability was very good (ICC = 0.78). Low-to-moderate associations were observed between the 8-item WLQ and the health/performance variables while weak associations were observed between the demographic variables. Conclusions The 8-item WLQ demonstrated sufficient reliability and validity among employees from a public university system. Results suggest the 8-item WLQ is a usable alternative for studies when the more comprehensive 25-item WLQ is not available.

The longitudinal relation between self-reported physical activity and presenteeism

This study evaluates the longitudinal relation between self-reported physical activity and health related work limitations (also known as presenteeism) among employees from a public university system. A retrospective longitudinal study design was used to examine research aims. Data were from self-reported health assessments collected from employees at a large University System in Texas during the 2013-2015 plan years (n=6515).Work limitations were measured using the self-report 8-item work limitations questionnaire. Latent growth curve models were used to test whether: 1) baseline physical activity was associated with baseline work limitations; 2) changes in physical activity were related to changes in work limitations; and 3) baseline physical activity predicted changes in work limitations. Models were adjusted for demographic and health-related variables. The final adjusted growth curve model demonstrated excellent fit. Results revealed baseline physical activity was inversely associated with baseline work limitations (β=-0.12, p<0.001). In addition, changes in physical activity were related to changes in work limitations (β=-0.33, p=0.02). However, no relation was found between baseline physical activity and changes in work limitations (β=-0.06, p=0.42). Results provide evidence that increasing physical activity among employees leads to decreases in health-related work limitations. Therefore, promoting physical activity among employee populations can help prevent and reduce presenteeism.

A global, cross cultural study examining the relationship between employee health risk status and work performance metrics

Background

Health risk assessments (HRA) are used by many organisations as a basis for developing relevant and targeted employee health and well-being interventions. However, many HRA’s have a western-centric focus and therefore it is unclear whether the results can be directly extrapolated to those from non-western countries. More information regarding the differences in the associations between country status and health risks is needed along with a more global perspective of employee health risk factors and well-being overall. Therefore we aimed to i) quantify and compare associations for a number of health risk factors based on country status, and then ii) explore which characteristics can aid better prediction of well-being levels and in turn workplace productivity globally.

Methods

Online employee HRA data collected from 254 multi-national companies, for the years 2013 through 2016 was analysed (n = 117,274). Multiple linear regression models were fitted, adjusting for age and gender, to quantify associations between country status and health risk factors. Separate regression models were used to assess the prediction of well-being measures related to productivity.

Results

On average, the developing countries were comprised of younger individuals with lower obesity rates and markedly higher job satisfaction compared to their developed country counterparts. However, they also reported higher levels of anxiety and depression, a greater number of health risks and lower job effectiveness. Assessment of key factors related to productivity found that region of residency was the biggest predictor of presenteeism and poor pain management was the biggest predictor of absenteeism.

Conclusions

Clear differences in health risks exist between employees from developed and developing countries and these should be considered when addressing well-being and productivity in the global workforce.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-017-0172-1) contains supplementary material, which is available to authorized users.

Impact on Employee Productivity From Presenteeism and Absenteeism: Evidence From a Multinational Firm in Sri Lanka

OBJECTIVE

This study examines the effects of 13 psychological and physical health conditions on work productivity.

METHODS

One hundred fifty-two staff at the headquarters of a Sri Lankan multinational firm completed a questionnaire asking whether they experienced 13 health conditions common in workplaces, and about their related absenteeism and presenteeism.

RESULTS

Most respondents (85.5%) reported absenteeism, presenteeism, or both. Among those reporting a health condition, 57.6% reported losing days due to absenteeism, and 69.5% reported losing additional days to presenteeism. Among those caring for a sick adult or child, 57.3% reported losing days due to absenteeism, and 36.5% reported losing additional days due to presenteeism. Overall productivity loss was 10.43 days each year, 3.95% of employee capacity, equating to about Sri Lanka Rupees 8 million (US$54,421) for all headquarters employees.

CONCLUSIONS

The health conditions' effects on productivity significantly increased employee costs.

Impact of a Health Promotion Program on Employee Health Risks and Work Productivity

Purpose.

Evaluate the impact of a multicomponent workplace health promotion program on employee health risks and work productivity.

Design.

Quasi-experimental 12-month before-after intervention-control study.

Setting.

A multinational corporation headquartered in the United Kingdom.

Subjects.

Of 618 employees offered the program, 266 (43%) completed questionnaires before and after the program. A total of 1242 of 2500 (49.7%) of a control population also completed questionnaires 12 months apart.

Intervention.

A multicomponent health promotion program incorporating a health risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues.

Measures.

Outcomes were (1) cumulative count of health risk factors and the World Health Organization health and work performance questionnaire measures of (2) workplace absenteeism and (3) work performance.

Results.

After adjusting for baseline differences, improvements in all three outcomes were significantly greater in the intervention group compared with the control group. Mean excess reductions of 0.45 health risk factors and 0.36 monthly absenteeism days and a mean increase of 0.79 on the work performance scale were observed in the intervention group compared with the control group. The intervention yielded a positive return on investment, even using conservative assumptions about effect size estimation.

Conclusion.

The results suggest that a well-implemented multicomponent workplace health promotion program can produce sizeable changes in health risks and productivity.

Sheffield Hallam Staff Wellness service: Four-year follow-up of the impact on health indicators

Aims:

Alongside the increasing prevalence of chronic health conditions such as cardiovascular disease and diabetes has been an increase in interventions to reverse these ill-health trends. The aim of this study was to examine the longitudinal impact of the Sheffield Hallam University Staff Wellness Service on health indicators over a five-year period.

Methods:

The Sheffield Hallam Staff Wellness Service was advertised to university employees. Of 2651 employees who have attended the service, 427 respondents (male = 162, female = 265) aged 49.86 ± 12.26 years attended for five years (4 years follow-up). Each year, participants were assessed on a range of health measures (i.e. cardio-respiratory fitness, body mass index, blood pressure, total cholesterol, high-density lipoproteins, lung function and percentage body fat). Participants also received lifestyle advice (based on motivational interviewing) as part of the intervention to either improve, or in some cases maintain, their current health behaviours (e.g. increased physical activity and diet change).

Results:

The wellness service improved staff health for those with an ‘at risk’ health profile from baseline. These improvements were maintained in subsequent follow-up assessments. Improvement from baseline to 1-year follow-up was observed for all health indicators as was the maintenance of this improvement in years 2, 3 and 4.

Conclusions:

The service demonstrates that a university-based wellness service using a combination of motivational interviewing and health screening to elicit behaviour change (and subsequent improvements in health-related outcomes) was successful in improving the health of employees with an ‘at risk’ profile.

Presenteeism as a global phenomenon: unraveling the psychosocial mechanisms from the perspective of social cognitive theory

Purpose

Presenteeism occurs when people are physically present in the workplace but are functionally absent (Cooper, 1996). With evidence from the developed West, researchers have argued that being excessively present may be even costlier than absenteeism to employers (Burton, Chen, Conti, Schultz, & Edington, 2006; Hemp, 2004). However, research on presenteeism in the East is almost non-existent. With the strong Confucius cultural imperative for hard work, the prevailing pressure for working long hours, compounded with the lack of labor welfare protection at the national level and lack of resources at the organizational level in SMEs, the problem of presenteeism in the developing Asian societies may be exacerbated (c.f., Bockerman & Laukkanen, 2010), making it a worthy subject for cross-cultural research and subsequent intervention. Thus one purpose of this article is to situate this problem in a global context, using the Chinese tradition as a cultural exemplar.

Design/methodology/approach

Furthermore, most of the existing studies on presenteeism have overlooked the underlying psychological process of such an act: why do people decide to work while sick? Thus, our second goal in this article is to outline a conceptual framework that attempts to explain central, dynamic processes and mechanisms through which people ascribe meanings to the situation, make decisions to come to work when ill, and attempt to achieve performance outcomes.

Findings

In formulating this scheme, we drew primarily from Bandura’s (1986) social cognitive theory (SCT) and tried to adapt, elaborate, and extend those aspects of the general theory that seemed most relevant to the basic personal experiences of presenteeism.

Originality/value

We have outlined a social cognitive conceptual framework, to facilitate theory integration in the field of presenteeism research. To systematically examine key mechanisms delineated in the overarching theoretical framework that accounts for the intricate relationships among self-regulation, presenteeism, and performance, we were able to bridge social cognitive psychological processes with organizational research on the global phenomenon of presenteeism. The thrust of using theoretical development to lead empirical investigation in this emerging field may also enable better managerial interventions to promote occupational health and employee development.

The association of self-reported employee physical activity with metabolic syndrome, health care costs, absenteeism, and presenteeism

OBJECTIVE

To examine employees' self-reported physical activity and metabolic syndrome (MetS) risks and their association with health-related workplace outcomes.

METHODS

Employees participated in a health risk appraisal in 2010. Generalized Linear Modeling was used to test the association between MetS risk factors, physical activity, and the outcome measures while controlling for confounders.

RESULTS

MetS was found in 30.2% of employees. Health care costs for employees with MetS who reported sufficient exercise (150 or more minutes/week) totaled $2770 compared with $3855 for nonsufficient exercisers. The percentage of employees with MetS who had absenteeism and presenteeism was also significantly lower for employees achieving sufficient physical activity. All risk factors for MetS were mitigated for regular exercisers.

CONCLUSIONS

Employers should consider programs and services to support regular aerobic exercise to address the growing prevalence and costs of MetS in the workforce.

Well-being, health, and productivity improvement after an employee well-being intervention in large retail distribution centers

OBJECTIVE

To evaluate changes in well-being, biometric, and productivity indicators after a well-being intervention.

METHODS

Biometric and self-reported outcomes were assessed among 677 retail distribution center employees before and after a 6-month well-being intervention.

RESULTS

Despite lower well-being at baseline compared to an independent random sample of workers, program participants' well-being, productivity, body mass index, systolic blood pressure, and total cholesterol improved significantly after the intervention, whereas the decline in diastolic blood pressure was not significant. Moreover, participants' specific transition across well-being segments over the intervention period demonstrated more improvement than decline.

CONCLUSIONS

There is evidence that programs designed to improve well-being within a workforce can be used to significantly and positively impact employee health and productivity, which should result in reduced health care costs, improved employee productivity, and increased overall profitability.

Association of Controlled and Uncontrolled Hypertension With Workplace Productivity

The authors estimated the lost productive time (LPT) due to absenteeism and presenteeism among employees at the Group Health Cooperative with controlled and uncontrolled hypertension compared with normotensive patients. The patients responded to a survey inquiring about health behaviors with links to their medical record to identify diagnoses, blood pressure measurement, and prescription drug dispenses. Individuals with controlled hypertension were more likely to report any LPT relative to individuals with uncontrolled hypertension (40.6% vs 32.6%, P<.05). There were no significant differences in the average hours of LPT due to presenteeism among individuals regardless of their hypertension status but individuals with hypertension were more likely to report hours of LPT due to absenteeism compared with normotensive individuals (1.04 vs 0.59 hours; P=.001). Individuals with uncontrolled hypertension were more likely to report LPT due to absenteeism compared with individuals with controlled hypertension (1.35 vs 0.72 hours; P=.001). There were no significant differences between individuals with hypertension whose blood pressure was controlled and normotensive individuals with respect to the likelihood of reporting any LPT or in the amounts of absenteeism and presenteeism.

Comparing the contributions of well-being and disease status to employee productivity

OBJECTIVE

To compare employee overall well-being to chronic disease status, which has a long-established relationship to productivity, as relative contributors to on-the-job productivity.

METHODS

Data from two annual surveys of three companies were used in longitudinal analyses of well-being as a predictor of productivity level and productivity change among 2629 employees with diabetes or without any chronic conditions.

RESULTS

Well-being was the most significant predictor of productivity cross-sectionally in a model that included disease status and demographic characteristics. Longitudinally, changes in well-being contributed to changes in productivity above and beyond what could be explained by the presence of chronic disease or other fixed characteristics.

CONCLUSIONS

These findings support the use of well-being as the broader framework for understanding, explaining, and improving employee productivity in both the healthy and those with disease.

UPMC MyHealth: managing the health and costs of U.S. healthcare workers

BACKGROUND

Workplace wellness programs hold promise for managing the health and costs of the U.S. workforce. These programs have not been rigorously tested in healthcare worksites.

PURPOSE

To evaluate the impact of MyHealth on the health and costs of UPMC healthcare workers.

DESIGN

Five-year observational study conducted in 2013 with subgroup analyses and propensity-matched pair comparisons to more accurately interpret program effects.

SETTING/PARTICIPANTS

UPMC, an integrated health care delivery and financing system headquartered in Pittsburgh, Pennsylvania. Participants included 13,627 UPMC employees who were continuously enrolled in UPMC-sponsored health insurance during the study period and demonstrated participation in MyHealth by completing a Health Risk Assessment in both 2007 and 2011, as well as 4,448 other healthcare workers employed outside of UPMC who did not participate in the program.

INTERVENTION

A comprehensive wellness, prevention, and chronic disease management program that ties achievement of health and wellness requirements to receipt of an annual credit on participants' health insurance deductible.

MAIN OUTCOME MEASURES

Health-risk levels, medical, pharmacy, and total healthcare costs, and Healthcare Effectiveness Data and Information Set performance rates for prevention and chronic disease management.

RESULTS

Significant improvements in health-risk status and increases in use of preventive and chronic disease management services were observed in the intervention group. Although total healthcare costs increased significantly, reductions in costs were significant for those who moved from higher- to the lowest-risk levels. The contrast differences in costs between reduced- and maintained-risk groups was also significant. Matched pair comparisons provided further evidence of program effects on observed reductions in costs and improvements in prevention, but not improvements in chronic disease management.

CONCLUSIONS

Incorporating incentivized health management strategies in employer-sponsored health insurance benefit designs can serve as a useful, though not sufficient, tool for managing the health and costs of the U.S. healthcare workforce.

Health as an Economic Strategy

This article explores and reviews the available evidence pertaining to lifestyle, disease, and economic losses in the workplace. The literature shows clearly that higher levels of health risks and behaviors lead to the development of disease and moving to a high-cost status. The data suggest that those individuals with lower health risks and those individuals who achieve a reduction in health risks and unhealthy behaviors result in lower probability of disease and high health care costs. The business case for wellness and prevention is also discussed, as is the concept of investing in health as opposed to a strict focus on health care cost reduction. Furthermore, additional determinants of health such as the social–emotional states and positive characteristics of the individual and of the environment and culture are described. Since health is much more than simply the absence of disease, the members of the College of Lifestyle Medicine are encouraged to expand their interests and research inquiry and efforts in evaluating, supporting, and treating these areas. Physicians play a special role in helping individuals improve their healthy behaviors and knowledge of these lifestyle factors will add significantly to their capacity to serve patients. It is very clear that there are growing research, prevention, and treatment opportunities for members of the College of Lifestyle Medicine. It was demonstrated that there is sufficient evidence that justifies the College of Lifestyle Medicine, as observed by the content and quality of the information shared at the conference in Arlington, Virginia in October 2013.