The determinants of presenteeism: a comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce

Effect of authentic leadership on nurses' stress, burnout, presenteeism during COVID-19

PURPOSE

The COVID-19 pandemic has burdened the health-care system and exposed nurses to immense stress. This study therefore aims to investigate nurses' mental well-being who are working with COVID-19-positive patients. Burnout leads to decreased productivity and manifests as emotional exhaustion, depersonalisation (cynicism) and low personal accomplishment (professional efficacy). Authentic leadership is built on a humanistic value system, which is the core value of nurses and other health-care professionals. This study therefore used authentic leadership as the independent variable.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional quantitative research method was adopted by distributing validated online questionnaires to 1,334 nurses in a private pathology laboratory and 241 questionnaires were analysed with 93.4% female respondents. Multiple linear regression model testing was conducted.

FINDINGS

Multiple regression analyses showed statistically significant negative correlations between authentic leadership and emotional exhaustion, cynicism, job stress and job-stress-related presenteeism, and a positive correlation between authentic leadership and professional efficacy.

PRACTICAL IMPLICATIONS

This study provides empirical data to encourage organisations to focus on developing authentic leaders to decrease nurses' burnout, job stress and presenteeism. The health-care sector should strive to create an environment where nurses are valued and their talent is recognised to increase employee engagement and commitment.

ORIGINALITY/VALUE

There were two contributions in this study: first, to determine whether there is a relationship between authentic leadership job stress and job-stress-related presenteeism. Second, to determine whether there is a relationship between authentic leadership and the three sub-constructs of burnout.

Effects of Presenteeism on Burnout among Rehabilitation Medical Workers in Korea: Multiple Mediating Effects of Organization and Supervisor Supports

PURPOSES

This study aimed to examine the discriminatory impacts of two major impairment factors-job presenteeism and attention presenteeism (JP and AP)-in presenteeism on burnout and to verify the multiple mediating effects of organizational and supervisory support in their causal relationship to provide theoretical and practical implications for alleviating burnout among rehabilitation medical workers (RMWs).

METHODS

Participants were convenience sampled from 23 hospitals and rehabilitation medical institutions in Korea, and 494 datasets were analyzed using the R packages R-studio, Jamovi, and JASP.

RESULTS

The significant effects of JP and AP on burnout were investigated; AP (0.609) had a much higher effect than JP (0.170) on burnout among RMWs. Moreover, the multiple mediating effects of organizational support and supervisory support were verified in the JP-AP relationship and burnout among RMWs. Additionally, the absolute effect on burnout was more from AP than JP, and organizational support had a far more significant effect than supervisory support in the process of affecting burnout.

CONCLUSIONS

The present study contributes to the literature on burnout by examining the relationships between presenteeism and burnout and by extending the current understanding of burnout and presenteeism to RMWs. And it is practically important to understand that the effect of AP was greater than that of JP between the two key sub-factors of presenteeism affecting burnout among RMWs, and Korean RMWs are more affected by support from the organization system than by personal support from their boss. Related theoretical and practical implications are further elaborated.

The mediating role of job satisfaction and presenteeism on the relationship between job stress and turnover intention among primary health care workers

BACKGROUND

Turnover problems among primary health care workers are a significant contributor to the shortage of health human resources. This study aims to determine the relationship between job stress and turnover intention among primary health care workers, as well as to examine the mediating effects of job satisfaction and presenteeism on this relationship.

METHODS

Stratified random sampling and quota sampling were used to select 703 primary health care workers in Jilin Province, China in January 2020. Validated scales were used to measure turnover intention, job stress, job satisfaction, and presenteeism among primary health care workers. The study utilized a partial least squares structural equation modeling (PLS-SEM) approach to test the research hypotheses.

RESULTS

The turnover intention score of primary health care workers in Jilin Province was 2.15 ± 1.03, and 19.5% of respondents reported a higher turnover intention. Significant sex and occupation differences were found, with a higher rate of turnover intention for male and doctor groups among primary health care workers. This study also revealed a positive correlation between job stress and turnover intention (β = 0.235, P < 0.001), a significant negative correlation between job satisfaction and turnover intention (β= -0.347, P < 0.001), and a significant positive correlation between presenteeism and turnover intention (β = 0.153, P < 0.001). Moreover, the study revealed a significant indirect effect of job stress on turnover intention which was mediated by job satisfaction (β = 0.183, P < 0.001) and presenteeism (β = 0.078, P < 0.001).

CONCLUSION

We confirmed the positive association between job stress and presenteeism with turnover intention, as well as the negative association between job satisfaction and turnover intention. Moreover, our study confirmed the mediating role of job satisfaction and presenteeism in the relationship between job stress and turnover intention. This study provides scientific evidence to address the turnover problem among primary health care workers.

The role of effort-reward imbalance and depressive symptoms in the relationship between long working hours and presenteeism among Chinese village doctors: a moderated mediation model

BACKGROUND

Long working hours and effort-reward imbalance (ERI) among medical workers may contribute to poor mental health and reduced productivity. However, the potential mechanisms among them are not well understood. This study aimed to explore the role of depressive symptoms and ERI in the relationship between long working hours and presenteeism among village doctors.

METHODS

We conducted a cross-sectional study in Jiangsu Province, eastern China. 705 village doctors were assessed for working hours, ERI (the Effort-Reward Imbalance Questionnaire, ERI questionnaire), presenteeism (6-item Stanford Presenteeism Scale, SPS-6 Scale), and depressive symptoms (12-item General Health Questionnaire, GHQ-12). A moderated mediation model was used to test the role of depressive symptoms (M), and ERI (W) in the relationship between long working hours (X) and presenteeism (Y).

RESULTS

45.11% of the village doctors worked more than 55 h per week, and 55.89% were exposed to ERI. The prevalence of depressive symptoms among Chinese village doctors was 40.85%. Long working hours (≥ 55 h per week) were significantly associated with presenteeism behaviors (β = 2.17, P < 0.001). Mediation analysis demonstrated that depressive symptoms (GHQ score > 3) could partly mediate the relationship between long working hours and presenteeism (indirect effect β = 0.64, P < 0.001). Moderated mediation further indicated that the interaction of long working hours and ERI was significantly and positively associated with depressive symptoms, which in turn predicted elevated presenteeism behaviors.

CONCLUSIONS

Depressive symptoms had a mediating role in the association of long working hours with presenteeism behaviors among Chinese village doctors and ERI augment their negative effects.

An Empirical Study Analyzing the Moderating Effect of Supervisor Support and Mediating Effect of Presenteeism among Eustress, Distress, and Innovative Behavior

Purpose: This article aims to illustrate that stress is not always a negative experience as it can have both positive and negative outcomes. The term “eustress” describes positive stress, while the term “distress” describes negative stress. To date, research on eustress is in the infancy stage. There are approximately 306 items that can be found in the Web of Science core collection for “eustress”, while there are 184,714 items found for “distress”. Few studies have examined the relationship between presenteeism, stress, and innovative behavior. Thus, the mechanism underlying this pathway still needs to be fully understood. Materials and Methods: A survey was conducted among 350 medical healthcare professionals from Pakistan. With the help of SPSS and AMOS, the data were analyzed and the combined effects of the variables were also investigated. Results: According to the current study, a mediation effect has been observed between innovative behavior and stress (eustress and distress). However, supervisor support moderates the relationship between stress and presenteeism and, likewise, between presenteeism and innovative behavior. Conclusion: Our analysis of variables establishes empirically robust relationships between the innovative behavior of medical healthcare professionals and the two different dimensions of stress. In addition, it describes a hypothetical alternative situation that explains how employees’ innovative work behavior is affected by eustress and distress in the presence of supervisor support. This study could have implications for improving medical healthcare professionals’ ability to incorporate innovative behavior into their practice in an effective manner in the future.

Measuring Presenteeism From Work Stress: The Job Stress-Related Presenteeism Scale

OBJECTIVE

Presenteeism can result from a variety of causes, one of which is job stress. This study examined the factor structure and validity of the Job Stress-Related Presenteeism Scale (JSRPS).

METHODS

Using three organizational samples, the study aimed to determine the factor structure of the JSRPS, its relationship to a sickness presenteeism scale, and the association between the JSRPS and associated concepts.

RESULTS

Exploratory and confirmatory factor analyses supported a reliable 6-item, 2-factor model for the JSRPS. JSRPS scores were associated with higher levels of psychological distress, workplace harassment, and turnover intentions and lower levels of job satisfaction, and work engagement. The JSRPS had stronger associations with psychological distress and workplace harassment than did the Stanford Presenteeism Scale.

CONCLUSIONS

Results suggest that the JSRPS provides a valid measure of presenteeism resulting from job stress.

Appreciation at work and the effect on employees’ presenteeism

BACKGROUND: Presenteeism, which means attending work while feeling unhealthy or ill, is a serious risk behavior that reduces the employees’ productivity and performance. Employees who are treated appreciatively by their work environment show less presenteeism. Investigating the mechanisms behind the relationship between appreciation and presenteeism can help to understand how presenteeism can be reduced even more in the workplace. OBJECTIVE: This study aimed to investigate the impact of two forms of appreciation (supervisor appreciation and general appreciation from the work environment), on presenteeism and includes the moderating effects of resources and stress. This will help to answer the questions a) which form of appreciation is more beneficial for employees and b) whether appreciation counteracts presenteeism by building up resources. METHOD: 1077 Austrian workers were invited to fill-in an online survey about work-related issues. The data was analyzed with structural equation modelling (SEM). RESULTS: The results showed that both forms of appreciation increase the resources of the employees. Through this increase of resources employees experience less stress, which consequently lowers presenteeism. Additionally, general appreciation is more beneficial than supervisor appreciation. CONCLUSION: The findings indicate that appreciative behavior builds resources at the workplace which are essential for showing less presenteeism at work.

Associations between Coping Profile and Work Performance in a Cohort of Japanese Employees

This study aimed to investigate the effects of coping profiles on work performance. Data were collected during a 2-year prospective cohort study of 1359 employees in Japan. Participants completed a self-administered questionnaire in 2018 (T1; baseline) and again in 2020 (T2; followup; followup rate: 69.8%) to enable the assessment of work performance, perceived stress, and stress coping profiles at T1 and T2. Multivariate logistic regression models and causal mediation analysis were performed to identify the effects of coping profiles on work performance. Covariates included age, sex, company, job type, employment status, working hours, holidays, and lifestyle behaviors (e.g., smoking, sleep duration). A dysfunctional coping profile (β = −1.17 [95% CI, −2.28 to −0.06], p = 0.039) was negatively associated with work performance. Coping profiles of planning (β = 0.86 [95% CI, 0.07−1.66]) and self-blame (β = −1.33 [95% CI, −1.96 to −0.70], p < 0.001) were significantly associated with work performance. Dysfunctional coping, specifically, self-blame (β = −1.22 [95% CI, −1.83 to −0.61]), mediated the association between stress and work performance. Thus, some coping profiles may lead to an increase or decrease in work performance. The possible impact of coping strategies on workers’ productivity requires further exploration. Furthermore, information on effective coping profiles should be incorporated into occupational health examinations.

Work-Related Factors Affecting the Occurrence of Presenteeism － Recent Research Trends and Future Directions

Productivity loss due to presenteeism accounts for a large proportion of economic losses caused by workers' health problems. To reduce presenteeism, it is necessary to identify its causes, but, in contrast to the large amount of research on the effects of diseases and lifestyles, there is not enough research on the effects of work-related factors on presenteeism. In this study, those factors include the work environment and the work-related psychological status of workers. The purpose of this review was to identify research trends in presenteeism, defined as work-related productivity loss, and to examine future directions for presenteeism research. We conducted a search with only the keyword "presenteeism" using MEDLINE/PubMed for the last 5 years and extracted 30 relevant articles, most of which were cross-sectional studies. The articles were categorized into the following themes: 1) studies on the associations of various stress models and factors with presenteeism; 2) studies on the mediators and the pathways of association between stress factors and presenteeism; 3) studies on the relationships between organizational factors and presenteeism; and 4) studies on the link between workers' positive and negative psychological status and presenteeism. Our findings showed that, over the last 5 years, the relationship between psychological stress and presenteeism has been extended to include a variety of stress models and stressors. In addition, by putting many models and factors into a single statistical model and adjusting for their interrelationships, important factors have been examined by ensuring that a significant relationship with presenteeism remains. As there is still a lack of longitudinal studies necessary to discuss causality, more research of higher quality is needed.

Understanding the Decision-Making Process Between Presenteeism and Absenteeism

Due to their impact on various stakeholder groups, research on the global phenomena of sickness presenteeism (working despite illness) and sickness absenteeism (absence due to illness) is constantly growing. Most studies focus on identifying factors associated with the attendance behaviors. In contrast, there have been few theoretical approaches to explain the individual decision-making process for or against working while ill. Moreover, their empirical verification is still pending. In the present study, we refer to expectancy theory to theoretically explain how the decision is made. To empirically test the model predictions we applied experimental vignette methodology in an online survey with working adults. The hypotheses were confirmed in that the calculated and predicted decisions significantly matched the intentionally chosen decisions. The results contribute to a better theoretical understanding of the decision-making process and provide starting points for interventions to manage attendance behavior in organizations.

Does Co-worker Presenteeism Increase Innovative Behavior? Evidence From IT Professionals Under the 996 Work Regime in China

Drawing on the event system and regulatory focus theory, this study constructed an impact mechanism model to investigate the relationship between the event strength of co-worker presenteeism and innovative behavior among IT professionals under the 996 work regime. In addition to test the direct effect, we examined the indirect effect of promotion focus and the moderating effect of event time in this relationship. Data were collected through an online survey administered to 374 IT professionals in China. The results showed a positive relationship between the criticality of co-worker presenteeism events and innovative behavior. An indirect effect of promotion focus was also found in this relationship. The timing of co-worker presenteeism events moderated the relationship between the criticality of co-worker presenteeism events and promotion focus. Specifically, the effect was more significant when co-worker presenteeism events occurred during project delays.

Health-Related Symptoms and Working Conditions on Vulnerability to Presenteeism Among Nurses in South Korea

Presenteeism among nurses is reported to be higher than that of other professional workers, and affects one's health and the safety of their patients. Therefore, study on correlation between complex working condition and presenteeism is needed among nurses. This study aimed to predict characteristics of high-risk groups for presenteeism among nurses. The analysis used data which generated 478 nurses who participated in the fifth Korean Working Conditions Survey (2017). This study built a complex samples logistic regression model and decision tree analysis. Presenteeism was significantly higher among those who experienced musculoskeletal pain, high emotional demands, discrimination, and psychological adverse social behavior at the workplace. Combined presence of psychological adverse social behavior and musculoskeletal pain was predicted presenteeism, and should be treated as groups with a high risk of presenteeism. Nurses should be aware of high-risk group for presenteeism and treat them as a priority group to manage.

Nurses' Job Insecurity and Emotional Exhaustion: The Mediating Effect of Presenteeism and the Moderating Effect of Supervisor Support

Presenteeism refers to attending work when one is ill, which not only leads to a decline in the physical and mental health of employees but also negatively impacts organizational productivity and increases an organization's extra costs. Therefore, to explore the antecedents and outcomes of nurses' presenteeism behavior and the acting mechanism among the variables, a sample of 330 nurses from China were investigated with the Sickness Presenteeism Questionnaire, Job Insecurity Scale, Perceived Supervisor Support Scale, and Emotional Exhaustion Scale. The results indicated that (1) job insecurity had a significantly predictive effect on nurses' presenteeism behavior; (2) nurses' presenteeism partially mediated the relationship between job insecurity and emotional exhaustion; and (3) supervisor support moderated the relationship between nurses' presenteeism behavior and emotional exhaustion; i.e., the higher the level of supervisor support, the weaker the positive relationship between nurses' presenteeism behavior and emotional exhaustion. The findings provide theoretical guidance and an empirical basis for prevention and intervention strategies concerning nurses' presenteeism behavior.

Presenteeism among health care workers: literature review

Presenteeism is an occupational and psychosocial phenomenon with negative impact on the work environment. In addition to causing losses in productivity losses, it also has implications for the state of health of workers. Therefore, presenteeism is likely to become a serious public health problem. The aim of the present study was to discuss the implications, means for evaluation and impact of presenteeism on the health and work of health care workers. We performed a literature search in database PubMed using keywords presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization, and working sick. We conclude that adequate assessment, raising the health managers' awareness about the risks and harms associated with this phenomenon, and developing management tools will contribute to reduce the impact of presenteeism. This seems to be the proper path to make this problem more visible and hinder its growth.

Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Cynical Hostility

Cynical hostility in the workplace has been studied. However, there is still no complete study examining how cynical hostility affects work performance. We examined how work environment impacts presenteeism through the mediation of cynical hostility and how chronic work discrimination moderates the relationship between work environment and cynical hostility among ageing workforces. The psychosocial vulnerability model supplies theoretical support for our model. We analyzed data from a sample of 2926 aging workforces from the Health and Retirement Study. Structural equation modeling (SEM) was used to examine the relationships with a moderated mediation model. In the final SEM model, our results showed that work environment was directly negatively associated with presenteeism. Moreover, cynical hostility was significantly inversely correlated with work environment and positively correlated with presenteeism. We found that the significant indirect effect between work environment and presenteeism can be significantly mediated by cynical hostility. In addition, cynical hostility is more likely to be affected by work environment among ageing workforces with lower levels of chronic work discrimination than those with higher levels. Enterprise, government, and employees themselves should be aware of the impact of presenteeism on ageing workforces with high levels of cynical hostility.

Factors Related to Presenteeism among South Korean Workers Exposed to Workplace Psychological Adverse Social Behavior

Presenteeism negatively affects both individuals and society. This study identified factors of presenteeism among workers in South Korea, especially in relation to exposure to adverse social behaviors. Here, an adverse social behavior refers to any forms of workplace violence or intimidation. This study used the data from 23,164 full-time salaried employees, who participated in the fifth Korean Working Conditions Survey. This study attempted to predict presenteeism based on the exposure to adverse social behaviors and working conditions using logistic regression. Presenteeism was reported in 15.9% of the sample. Presenteeism was significantly higher among workers with the following characteristics: females, aged 40 years or older; middle school graduates; over 40 working hours a week; shift workers; no job-related safety information received; exposure to adverse social behavior and discrimination; and those with a high demand for quantitative work, low job autonomy, high emotional demands, and high job stress. The workers exposed to adverse social behavior showed a higher prevalence of presenteeism (41.2%), and low job autonomy was the most significant predictor of presenteeism. The findings of this study suggest that allowing enough autonomy in job-related roles may help alleviate presenteeism among those who have experienced adverse social behavior at work.

Presenteeism among Chinese workers in Japan and its relationship with mental health and health-promoting lifestyles

This study aimed to investigate factors related to presenteeism among Chinese workers residing in Japan by assessing their mental state and health-promoting lifestyles. An anonymous, self-reported questionnaire was administered to 450 Chinese workers living in Hiroshima Prefecture, of whom, 313 completed it in its entirety. Results showed that 40.6% reported suffering from depression (Center for Epidemiologic Studies Depression Scale, CES-D). Sociodemographic characteristics such as being female, having a lower educational background, being widowed/divorced, having fewer years of residence, fluency in basic-level Japanese, being employed part-time, being an engineer, and workplace environment (having no health education in the workplace) increased the likelihood of depression. Path analysis indicated that marital status (being married) was negatively associated with presenteeism on the Work Limitations Questionnaire-Chinese version via work-related stress. There was a positive correlation between work-related stress and presenteeism through mental health (CES-D). Health-promoting lifestyles (Health-Promoting Lifestyle Profile II) showed a negative correlation with presenteeism, via work-related stress and mental health. Furthermore, health-promoting lifestyles showed a direct negative association with presenteeism. Thus, health education that emphasizes mental health was a significant factor for improving presenteeism. Furthermore, the provision of health education shortly after Chinese workers had arrived in Japan is important.

Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Sense of Control

With the rapid increase of aging workforces, companies worldwide are concerned with improving the health and working status of older workers. Sense of control is an important psychological variable in sociology but has attracted less attention in studies of occupational health and management. This study examined the association of sense of control with presenteeism among aging workers in the United States. Data from the Health and Retirement Survey were analyzed, specifically, 2308 observations in 2012. Structural equation modeling was used to assess work environment, sense of control (measured in relation to personal mastery and perceived constraints), and associations with presenteeism. The moderating effect of subjective social status on the association between sense of control and presenteeism was examined with a moderated mediation model. In the final structural equation modeling model, work environment was directly inversely associated with presenteeism, and work environment was significantly inversely associated with perceived constraints. There was a direct positive association between work environment and personal mastery, a direct positive association between perceived constraints and presenteeism, and a significant inverse association between personal mastery and presenteeism. The significant indirect effects between work environment and presenteeism were significantly mediated by sense of control. Subjective social status inversely moderated the relation between presenteeism and perceived mastery, a dimension of sense of control. To increase the performance of aging workers in the United States, managers should create a work environment that facilitates access to job resources, as this might improve personal sense of control, particularly among those with high subjective social status.

Association of discrimination and presenteeism with cardiovascular disease: the Fourth Korean Working Conditions Survey

Background

Discrimination is a representative social determinant of health. Presenteeism is defined as presenting to work despite of illness and is an indicator of group health. We investigated the association of discrimination and presenteeism with cardiovascular disease using Korean data.

Methods

This study used the fourth Korea Working Conditions Survey (2014) data of 27,662 wage workers (employees). Presenteeism and discrimination related to age, sex, education, birth region, and employment type were ascertained. Self-reported cardiovascular disease was also assessed using the survey questionnaire. General and occupational characteristics found to be significant in univariate analyses were entered into a multivariate logistic regression analysis of the association of discrimination and presenteeism with cardiovascular disease. We also calculated the odds ratios of multiple discriminations and/or presenteeism for cardiovascular disease.

Results

In the univariate analyses, sex, age, education, monthly income, employment type, occupation, hours worked per week, workplace scale, and shift work were significantly associated with cardiovascular disease. A multivariate logistic regression analysis adjusted for general and occupational characteristics showed that discrimination and presenteeism were significantly associated with cardiovascular disease. Finally, the association with cardiovascular disease was strongest when both multiple discriminations and presenteeism were present.

Conclusions

Discrimination and presenteeism are associated with cardiovascular disease, and this association was stronger in the presence of multiple types of discrimination and presenteeism.

Perceived social support and presenteeism among healthcare workers in China: the mediating role of organizational commitment

Objectives

We assessed the role of social support in presenteeism by examining organizational commitment among Chinese healthcare workers.

Methods

One thousand four hundred thirty-four healthcare workers from 6 hospitals in 4 Chinese cities completed a questionnaire measuring presenteeism, social support, and organizational commitment. With organizational commitment as the mediator, regression analyses and structural equation modeling were used to test the model.

Results

Organizational commitment was directly inversely associated with presenteeism (β = − 0.42, p < 0.001). Coworker support was moderately but significantly inversely associated with presenteeism (β = − 0.15, p < 0.001), but the path from supervisor support to presenteeism was not significant (β = 0.05, p > 0.05). The correlation between supervisor support and coworker support was significant (β = 0.71, p <0.001). Supervisor support and coworker support were significantly positively associated with organizational commitment (β = 0.41, p < 0.001, and β = 0.14, p < 0.001, respectively).

Conclusions

Supervisor support was more important in promoting organizational commitment, while coworker support was more effective in reducing presenteeism. The mediating effect of organizational commitment was significant.

Public service motivation as a mediator of the relationship between job stress and presenteeism: a cross-sectional study from Chinese public hospitals

BACKGROUND

Job stress is a strong indicator of presenteeism, but few studies have examined its diverse effects and mediators on presenteeism. This study explored the relationships between job stress, public service motivation (PSM) and presenteeism and how job stress and PSM influence presenteeism in a large national sample of Chinese healthcare workers.

METHODS

A cross-sectional survey including 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central and western China was used in the analysis. Descriptive statistical analysis, correlation analysis and structural equation modeling were used to test the research hypothesis.

RESULTS

Hindrance stress was inversely associated with PSM (β = - 0.27; P < 0.001) but significantly positively associated with presenteeism (β = 0.35; P < 0.001). PSM was directly inversely associated with presenteeism (β = - 0.35; P < 0.001). PSM partially mediated the relation of hindrance stress with presenteeism.

CONCLUSIONS

The findings suggest that efforts to prevent presenteeism among healthcare workers in China should emphasize PSM improvement and reduction of hindrance stress.

Supervisor Support, Coworker Support and Presenteeism among Healthcare Workers in China: The Mediating Role of Distributive Justice

Healthcare workers in China are exposed to extremely high job stress and inequitable work conditions, and the Healthy China 2030 blueprint has made them an important focus of policymakers. To examine the importance of distributive justice in Chinese medical reform, we analyzed data from 1542 healthcare workers employed in 64 primary, secondary and tertiary hospitals in 28 Chinese cities in Western, Central and Eastern China in 2018. Supervisor support, coworker support, distributive justice, and presenteeism were assessed with the supervisor support scale, coworker support scale, distributive justice scale and perceived ability to work scale, respectively. Structural equation modeling was used to examine relationships among variables. The mediating effect of distributive justice on associations between supervisor support, coworker support, and presenteeism was examined with the Sobel test. The results revealed that significant indirect effects between supervisor support and presenteeism and between coworker support and presenteeism were significantly mediated by distributive justice. Better supervisor and coworker support might improve distributive justice among healthcare workers in Chinese hospitals, thereby increasing their performance.

Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study

OBJECTIVES

This study investigated the relationship between presenteeism and health-related quality of life (HRQoL) among Japanese adults with chronic lower back pain (CLBP).

DESIGN

This was a retrospective, cross-sectional study.

SETTING

Data were collected via a self-administered online survey of the Japanese adult general population.

PARTICIPANTS

The present study used 2014 Japan National Health and Wellness Survey (NHWS) data (n=30 000). Specifically, data were included from NHWS respondents who self-reported being employed in the past week and having experienced LBP in the past month, with these symptoms lasting for at least 3 months (n=239). 84 (35.1%) participants in this study were female.

PRIMARY AND SECONDARY OUTCOME MEASURES

Presenteeism and HRQoL were measured using the Work Productivity and Activity Impairment Questionnaire-General Health (categorical (none: 0%, low: 10%-20%, high: ≥30%) and continuous) and Medical Outcomes Study 36-Item Short Form Health Survey, respectively. Covariates included patient demographics, health characteristics, pain characteristics and depression severity (Patient Health Questionnaire).

RESULTS

Presenteeism was reported by 77.4% of respondents. High (vs no) presenteeism related to more severe pain in the prior week (4.9±2.2 vs 3.6±2.1, p=0.001) and currently (5.1±2.1 vs 3.9±3.9, p=0.007), more pain sites (1.9±1.6 vs 1.1±1.4, p=0.004) and greater depression severity (7.5±6.5 vs 3.6±3.6, p<0.001). Adjusting for covariates, high (vs no) presenteeism related to lower mental and physical HRQoL. For low versus no presenteeism, significant HRQoL differences were observed in general health (43.0, 95% CI 40.3 to 45.6 vs 46.9, 95% CI 43.9 to 49.8, p=0.015).

CONCLUSIONS

Most respondents experienced presenteeism. Those with high or low presenteeism had poorer HRQoL than respondents with no presenteeism. Monitoring presenteeism rates may help identify workers with an unmet need for better CLBP-related pain management.

Effectiveness of the blended-care lifestyle intervention 'PerfectFit': a cluster randomised trial in employees at risk for cardiovascular diseases

BACKGROUND

Web-based lifestyle interventions at the workplace have the potential to promote health and work productivity. However, the sustainability of effects is often small, which could be enhanced by adding face-to-face contacts, so-called 'blended care'. Therefore, this study evaluates the effects of a blended workplace health promotion intervention on health and work outcomes among employees with increased cardiovascular risk.

METHODS

In this multicentre cluster-randomised controlled trial (PerfectFit), 491 workers in 18 work units from military, police, and a hospital with increased cardiovascular risk were randomised into two intervention groups. The limited intervention (n = 213; 9 clusters) consisted of a web-based Health Risk Assessment with advice. In the extensive intervention (n = 271; 8 clusters), coaching sessions by occupational health physicians using motivational interviewing were added. One cluster dropped out after randomisation but before any inclusion of subjects. Primary outcome was self-rated health. Secondary outcomes were body weight, body mass index (BMI), work productivity, and health behaviours. Follow-up measurements were collected at 6 and 12 months. Effect sizes were determined in mixed effects models.

RESULTS

At 12 months, the extensive intervention was not statistically different from the limited intervention for self-rated health (4.3%; 95%CI -5.3-12.8), BMI (- 0.81; 95%CI -1.87-0.26) and body weight (- 2.16; 95%CI -5.49-1.17). The within-group analysis showed that in the extensive intervention group body weight (- 3.1 kg; 95% CI -2.0 to - 4.3) was statistically significantly reduced, whereas body weight remained stable in the limited intervention group (+ 0.2 kg; 95% CI -1.4 to 1.8). In both randomised groups productivity loss and physical activity increased and excessive alcohol use decreased significantly at 12 months.

CONCLUSIONS

There were no effects on self-rated health, body weight, and BMI. However, within the group with web-based tailored Health Risk Assessment including personalized advice body weight reduced significantly. Adding motivational coaching is promising to reduce body weight.

TRIAL REGISTRATION

Retrospectively registered at the Netherlands Trial Registry with number NTR4894 , at Nov 14 2014.

Challenge or hindrance: Does job stress affect presenteeism among Chinese healthcare workers?

Background:

We examined the effects of challenge stress and hindrance stress on general health and presenteeism among Chinese healthcare workers.

Methods:

Structural equation modeling was used to evaluate data from a national hospital survey in China (n = 1392). Job stress, general health, and presenteeism were measured by the Perceived Ability to Work Scale, the 8-item Short-Form Health Survey, and the Challenge- and Hindrance-Related Self-reported Stress Scale.

Results:

Challenge stress and hindrance stress were significantly positively correlated (β = 0.62, SE = 0.021; p < 0.001). Challenge stress was directly negatively associated with presenteeism (β = -0.05, SE = 0.037; p < 0.001), while hindrance stress was positively associated with presenteeism (β = 0.25, SE = 0.040; p < 0.001). These associations with presenteeism were partially mediated by health.

Conclusions:

Hospital managers should provide healthcare workers with an appropriate level of challenge, but employee health is the most important consideration. Further efforts targeting job stress and health of junior healthcare workers are required.

The reciprocal relationship between sickness presenteeism and psychological distress in response to job stressors: evidence from a three-wave cohort study

OBJECTIVES

Sickness presenteeism (SP) is postulated as workers' response to their general state of health; hence, SP is expected to affect workers' future health. In the present study, we examined the reciprocal relationship between SP and health in response to job stressors, with specific reference to psychological distress (PD) as workers' state of health.

METHODS

We conducted mediation analysis, using data from a three-wave cohort occupational survey conducted at 1-year intervals in Japan; it involved 1,853 employees (1,661 men and 192 women) of a manufacturing firm. We measured SP and PD, using the World Health Organization Health and Work Performance Questionnaire and Kessler 6 score, respectively. For job stressors, we considered job demands and control, effort and reward, and procedural and interactional justice.

RESULTS

PD mediated 11.5%-36.2% of the impact of job control, reward, and procedural and interactional justice on SP, whereas SP mediated their impact on PD, albeit to a much lesser extent in the range of 3.4%-11.3%. Unlike in the cases of these job stressors related to job resources, neither SP nor PD mediated the impact of job demands or effort.

CONCLUSIONS

Our results confirmed the reciprocal relationship between SP and PD in response to selected types of job stressors, emphasizing the need for more in-depth analysis of the dynamics of these associations.

Job Stress and Presenteeism among Chinese Healthcare Workers: The Mediating Effects of Affective Commitment

BACKGROUND

Presenteeism affects the performance of healthcare workers. This study examined associations between job stress, affective commitment, and presenteeism among healthcare workers.

METHODS

To investigate the relationship between job stress, affective commitment, and presenteeism, structural equation modeling was used to analyze a sample of 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central, and western China. The mediating effect of affective commitment on the association between job stress and presenteeism was examined with the Sobel test.

RESULTS

Job stress was high and the level of presenteeism was moderate among healthcare workers. Challenge stress and hindrance stress were strongly correlated (β = 0.62; p < 0.05). Affective commitment was significantly and directly inversely correlated with presenteeism (β = -0.27; p < 0.001). Challenge stress was significantly positively correlated with affective commitment (β = 0.15; p < 0.001) but not with presenteeism. Hindrance stress was significantly inversely correlated with affective commitment (β = -0.40; p < 0.001) but was significantly positively correlated with presenteeism (β = 0.26; p < 0.001).

CONCLUSIONS

This study provides important empirical data on presenteeism among healthcare workers. Presenteeism can be addressed by increasing affective commitment and challenge stress and by limiting hindrance stress among healthcare workers in China.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism

Background

Presenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism.

Methods

We partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders.

Results

The top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability.

Conclusions

In general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3843-x) contains supplementary material, which is available to authorized users.