Presenteeism: A review and research directions

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Human Resource Management Review journal homepage: www.elsevier.com/locate/hrmr

Presenteeism: A review and research directions ⁎

Daniela Lohausa, , Wolfgang Habermannb a b

University of Applied Sciences Darmstadt, Haardtring 100, Darmstadt 64295, Germany H & L Karriereberatung, Auerbacher Weg 5, Lautertal 64686, Germany

AR TI CLE I NF O

AB S T R A CT

Keywords: Presenteeism Absenteeism Individual health Individual performance Organizational success

Presenteeism, often defined as going to work ill, is a global phenomenon. In contrast to absenteeism, presenteeism has only recently gained attention as a major factor that affects organizational performance. This article shows that, to date, neither a uniform definition nor consistent measurement methods have been employed in the research on presenteeism. Although there have been several attempts at theory development, a comprehensive model that can explain why people choose presenteeism or absenteeism has yet to be established. Empirical studies have identified correlates of presenteeism, however, a clear distinction between causes and effects has yet to be made. Suggestions for future research cover the relevance, definition, and measurement of the phenomenon and offer a theory development framework that integrates Johns' (2010) prescriptions and refers to the decision-making process.

1. Introduction Absenteeism, generally viewed as the phenomenon of not showing up for scheduled work, has been widely researched in past decades because of its impact on organizations' productivity (Bierla, Huver, & Richard, 2013). Health conditions are seen as the main reason for absenteeism, and they account for 4% of productivity losses (Goetzel et al., 2004). By contrast, the concept of presenteeism (defined, e.g., as attending work in spite of health problems), which has often been understood as the counterpart of absenteeism in the past, has not gained enough attention in the assessment of human efficiency in organizations (Gosselin, Lemyre, & Corneil, 2013). This could be attributed to the fact that, in contrast to absenteeism, presenteeism is not formally registered and is thus more difficult to determine (Hansen & Andersen, 2008). Since the statement was made that presenteeism seems to be a much costlier problem than absenteeism, and it was suggested that its management should offer organizations a crucial source of competitive advantage (Hemp, 2004), the phenomenon has gained exponentially in attention, among both academic scholars and practitioners in organizational health as well as human resources. Although it probably does not “belong to the most costly and dangerous phenomena in world economy” as Pirkovitsch (2007), p. 32, translated by the authors), many scholars have still assumed that the cost of presenteeism exceeds the cost of absenteeism (e.g., Evans-Lacko & Knapp, 2016; Hemp, 2004; Wang, Schmitz, Smailes, Sareen, & Patten, 2010). Because presenteeism is a worldwide phenomenon, it is worth studying. Its prevalence has been documented in the US (e.g., Burton, Conti, Chen, Schultz, & Edington, 1999), Canada (Caverley, Cunningham, & MacGregor, 2007), the UK (e.g., Lu, Cooper, & Lin, 2013; McKevitt, Morgan, Dundas, & Holland, 1997), the Netherlands (Vroome, 2006), Denmark (e.g., Hansen & Andersen, 2008), Sweden (e.g., Aronsson, Gustafsson, & Dallner, 2000; Johansen, Aronsson, & Marklund, 2014), Norway (e.g., Johansen et al., 2014; Rosvold & Bjertness, 2001), Finland (e.g., Böckerman & Laukkanen, 2010a), Germany (e.g., Pohling, Buruck, Jungbauer, & Leiter, 2016; Schnee & Vogt, 2013), Italy (Gustafsson Sendén, Lovseth, Schenck-Gustafsson, & Fridner, 2013), Spain (Agudelo-Suárez et al., ⁎

Corresponding author at: Department of Social Sciences, University of Applied Sciences Darmstadt, Haardtring 100, Darmstadt D-64295, Germany. E-mail address: [email protected] (D. Lohaus).

https://doi.org/10.1016/j.hrmr.2018.02.010 Received 8 October 2017; Received in revised form 19 February 2018; Accepted 25 February 2018 1053-4822/ © 2018 Elsevier Inc. All rights reserved.

Please cite this article as: Lohaus, D., Human Resource Management Review (2018), https://doi.org/10.1016/j.hrmr.2018.02.010

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2010), Taiwan (e.g., Lu, Cooper, & Lin, 2013), South Korea (Kim et al., 2016), Sri Lanka (Fernando, Caputi, & Ashbury, 2017), and Saudi Arabia (Al Nuhait et al., 2017) with presenteeism rates that vary from 30% to more than 90% as reported by study participants. Absenteeism and presenteeism are seen by most researchers as related phenomena (e.g., Baker-McClearn, Greasley, Dale, & Griffith, 2010; Bergström, Bodin, Hagberg, Aronsson, & Josephson, 2009; Bierla et al., 2013; Böckerman & Laukkanen, 2010b; Burton, Chen, Li, Schultz, & Abrahamsson, 2014; Christensen, Overgaard, Hansen, Sogaard, & Holtermann, 2013; Coffeng et al., 2014; Deery, Walsh, & Zatzick, 2014; Gustafsson & Marklund, 2011; Hansen & Andersen, 2009; Harden et al., 2015; Johns, 2010, 2011; Krane et al., 2014; Krpalek, Meredith, & Ziviani, 2014; Merchant et al., 2014). This is due to the fact that health conditions, which are regarded as the main cause of productivity losses, are related to both absenteeism and presenteeism (Johns, 2010). In addition, absenteeism and presenteeism are the consequence of a single decision that rules out the other alternative (i.e., to either attend work or not in the case of a health event; Halbesleben, Whitman, & Crawford, 2014). In both cases, the individual's subjective perception of illness is a crucial factor that influences the choice. The mutual influence of absenteeism and presenteeism becomes obvious when organizational measures such as high attendance requirements or attendance premiums are considered. Such requirements can serve to reduce absenteeism but will probably simultaneously produce an increase in presenteeism (e.g., BakerMcClearn et al., 2010; Hansson, Bostrom, & Harms-Ringdahl, 2006; Taylor, Baldry, Bain, & Ellis, 2003). Regrettably, a generally accepted definition of presenteeism has yet to be offered. However, a common feature of most contributions on the topic is that the phenomenon is negative and should be avoided. This perspective falls short of acknowledging positive aspects that can also be associated with presenteeism (Garrow, 2016; Godoy, 2016; Johansen et al., 2014; Johns, 2010; Markussen, Mykletun, & Røed, 2012; Steinke & Badura, 2011). A further main criticism of presenteeism research is that it has largely been atheoretical (Johns, 2010). In the last few years, there have been several attempts to develop a specific theory of presenteeism (e.g., Cooper & Lu, 2016; Halbesleben et al., 2014; Pohling et al., 2016; Robertson, Leach, Doerner, & Smeed, 2012). However, most of these approaches have not been comprehensive with regard to the antecedents and consequences of presenteeism and some were conceptualized a posteriori on the basis of a researcher's own research findings. Even more important, although researchers tend to recognize the subjectivity of health on a continuum of complete health on the one end and manifest medical conditions that have to be treated professionally on the other end, they have usually failed to explicitly describe the decision-making process that determines whether absenteeism or presenteeism is chosen. In this article, we present a literature review and directions for future research on the phenomenon: After outlining the major definitions of presenteeism and the measurement approaches associated with them, we present and analyze current theories of presenteeism. We then provide a broad overview of research findings on the correlates, antecedents, and consequences of presenteeism. Research directions cover the relevance of the phenomenon, its definition and measurement, and a more comprehensive theory development. 2. Definition and understanding of presenteeism With regard to presenteeism, two (also geographically different) main lines of understanding were developed in parallel (Johns, 2010). One line of research that is prevalent among U.S. American medical scholars and health consultants defines presenteeism as the loss in work productivity due to a person's health problems (e.g., Burton, Pransky, Conti, Chen, & Edington, 2004; Collins et al., 2005; Goetzel et al., 2009; Hemp, 2004; Zhang, Sun, Woodcock, & Anis, 2015). Health conditions can include health-damaging behavior, risks, and acute and minor health problems (e.g., the common cold) and chronic, more serious illnesses (e.g., diabetes, arthritis, or irritable bowel syndrome). The focus of this line of research is on the impact of health conditions on productivity. Efforts tend to concentrate on the measurement of losses in productivity and the search for medical interventions that can demonstrably reduce such losses. Johns (2010) criticizes this approach because presenteeism is defined solely by its consequences. In contrast to the first approach, in European lines of research with the bulk of the research coming out of the Scandinavian countries and the UK, research on presenteeism primarily focuses on why employees show up for work when their health status gives them a legitimate reason to stay home (e.g., Aronsson & Gustafsson, 2005; Bergström et al., 2009; Elstad & Vabo, 2008; Gustafsson Sendén, Schenck-Gustafsson, & Fridner, 2016; Hansen & Andersen, 2009; Johansson & Lundberg, 2004). Here, the major cause of presenteeism behavior is purported to be subjective job insecurity as a result of organizational downsizing, but there is also interest in identifying further causes and motives (e.g., Caverley et al., 2007; Johansen et al., 2014; McKevitt et al., 1997). Another focus is on the consequences of presenteeism for an individual's health (e.g., Bergström et al., 2009; Hansen & Andersen, 2009; Lu, Lin, & Cooper, 2013; Skagen & Collins, 2016; Taloyan et al., 2012). As an advantage of this definition, Johns (2010) explains that it refrains from ascribing motives or consequences to the act of presenteeism and thus does not confuse causes and effects. Irrespective of the line of research, a common feature of most papers on the topic is that the phenomenon of presenteeism is seen as negative and as something that should be avoided. This is to be achieved through medical or other health-related measures that improve employees' health status and thus increase their productivity or by changing aversive working conditions so that employees are no longer forced to attend work while ill, and their health can subsequently be protected. Johns (2010) points out that this perspective falls short in that it does not acknowledge the benefits of presenteeism and the fact that, at least from the point of view of employers, reductions in the productivity of their workforce are still to be preferred over zero productivity due to sickness absence. Steinke and Badura (2011) mention that even from an employee's perspective, there might be cases in which it is more beneficial to attend work than to stay home when sick. Working might be positive for sick employees' self-esteem, might distract them from their health problems, and might be useful for maintaining their employability. One purpose of Johns' (2010) review was to integrate the two lines of research, which has happened at least to some extent since then. His definition of presenteeism as attending work despite feeling ill is important because it stresses the idea that presenteeism 2

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depends on individuals' decisions. Thus, it is necessary to identify why employees make certain decisions or rather to determine when presenteeism is preferred to absenteeism. 3. Measurement of presenteeism In the U.S. line of research, the instruments for measuring presenteeism focus on chronic diseases and the performance impairments or productivity losses that accompany them. The drive to concentrate on productivity losses that can be remedied by treating the diseases with medication has promoted the swift proliferation of measurement instruments (Johns, 2010). Because not many or only theoretical alternative approaches are possible (e.g., objective medical and performance data or supervisor ratings), the majority of these instruments rely on self-reports of work performance and health status (Steinke & Badura, 2011). In their review of instruments that measure presenteeism as productivity loss while at work, Ospina, Dennett, Waye, Jacobs, and Thompson (2015) identified 21 instruments. However, most researchers have adopted the narrower view that presenteeism reflects productivity loss due only to health impairments, but this view restricts the number of measurement instruments to a smaller number. For example, many U.S. studies have applied the short version of the “Stanford Presenteeism Scale” (SPS 6; Koopman et al., 2002), consisting of six items covering performance impairments due to health problems during the past month. Others have applied the World Health Organization's “Health and Work Performance Questionnaire” (HPQ, Kessler et al., 2004), which collects three kinds of information: prevalence and treatment of common diseases, their consequences for work performance, and absenteeism and presenteeism (the latter as perceived productivity loss due to health impairments) during the past 4 weeks. Also in use is the “Health and Work Questionnaire” (HWQ; Shikiar, Halpern, Rentz, & Khan, 2004), which asks respondents for the productivity, quality, and quantity of their work, their irritability and concentration, as well as their job and life satisfaction in the preceding week. Other studies have employed the “Work Limitations Questionnaire” (WLQ; Lerner et al., 2001), which uses a job-analysis-like approach and involves four dimensions (time, physical, mental-interpersonal, and output demands) with a reporting period of 2 weeks. These and other comparable instruments have not been without criticism. Johns (2010) argues that when presenteeism is reduced to self-reported losses in productivity in connection with health conditions, this might lead to overestimated levels of productivity loss, and the reliability of the data might suffer from common method bias and over-reporting. Also, for most instruments measuring presenteeism, criterion validity has yet to be established (Ospina et al., 2015). However, self-report measures of absenteeism are considered to be as valid (Ferrie et al., 2005) as subjective measures of health status (Wu et al., 2013). Another problem seems to be that the measurement instruments described above generate widely varying estimates of productivity loss (Zhang, Bansback, & Anis, 2011). Brooks, Hagen, Sathyanarayanan, Schultz, and Edington (2010) see further critical points in the usual conversion of presenteeism measures into lost productivity and the translation of presenteeism into financial equivalents (see also Mattke, Balakrishnan, Bergamo, & Sydne, 2007). It might be due to measurement heterogeneity and measurement shortcomings that the estimated costs of presenteeism vary widely (e.g., Baase, 2006; Bödeker & Hüsing, 2008; Stewart, Ricci, Chee, & Morganstein, 2003; Vanni, Neupane, & Nygard, 2017). Another major criticism is that the productivity of health-impaired employees is compared with their productivity when they are healthy. Scholars argue that it would be more suitable to compare productivity when ill with zero productivity due to absence (Fissler & Krause, 2010). In addition, Vingård, Alexanderson, and Norlund (2004) point out that many employees are fully productive in spite of their health problems. However, presenteeism is not always measured as comprehensively as described for the abovementioned instruments. Especially European researchers often make use of a single-item measure such as “How many times during the last 12 months have you gone to work although your state of health implied that you should have taken sick leave?” (e.g., Elstad & Vabo, 2008; Hansen & Andersen, 2009; Johansson & Lundberg, 2004). Respondents are asked to provide answers using frequency scales such as many times, a few times, once, and never (Johansson & Lundberg, 2004) or not relevant, have not been sick over the previous 12 months; no, never; yes, once; yes, 2 to 5 times; and yes, more than 5 times (Aronsson & Gustafsson, 2005). Johns (2010) also sees problems in these approaches that refer to and rely on the frequency of the act of presenteeism. Because employees are usually asked to report how often they have shown presenteeism in the past (the time frame used most often is 12 months; Miraglia & Johns, 2016), their answers might be biased by over-reporting and false recollection. Miraglia and Johns (2016) meta-analyzed the retest reliability of four studies that reported it and found a correlation of r = 0.79 (N = 3223, 95% CI [0.88, 0.91]). Six studies using two- or three-item scales to measure presenteeism had an internal consistency of α = 0.88 (N = 2249, CI [0.92, 0.95]). Further, Johns (2010) sees a problem in the response format predominantly used. Response formats using the options never, once, 2 to 5 times, and over 5 times in a 1-year period are suboptimal because this is a crude scaling for such a low base rate behavior. In addition, presenting respondents with a particular range of incidents conveys information about what is regarded as normal and might therefore influence their answers. Gerich (2016) also points out that frequency measures of presenteeism are “predominately determined by the number of health events and, to a lesser extent, by an individual's propensity to opt for presenteeism or absenteeism” (p. 190) and thus rather reflect the vulnerability of an individual than the choice between presenteeism and absenteeism. 4. Theories of presenteeism Johns (2010) criticized the mostly atheoretical approaches employed in investigations of presenteeism and called for model building. If drawing on theory at all, past research often referred to models from other fields of psychology (e.g., the job demandsresources model; Bakker & Demerouti, 2007) to explain presenteeism (e.g., Baker-McClearn et al., 2010; Deery et al., 2014; McGregor, Magee, Caputi, & Iverson, 2016; Thun & Løvseth, 2016). 3

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A number of studies have been conducted to determine which factors are relevant to the emergence of presenteeism. However, many of them did not refer explicitly to a theoretical framework. Others established it afterwards on the basis of their findings. Before and since the publication of Johns (2010), several approaches to theory development have been applied. They can roughly be classified into two groups. One group is characterized by a focus on the type of variables involved in explaining the occurrence and the consequences of presenteeism. These approaches can be labeled “content theories.” The other much smaller group concentrates on the decision-making process that leads to presenteeism or absenteeism and can be labeled “process theories.” We will describe both groups after outlining Johns' (2010) theoretical considerations. 4.1. Johns' (2010) prescriptions for a theory of presenteeism In his article, Johns (2010) reviews the existing literature on presenteeism and specifies key variables as well as prescriptions for a theory of presenteeism. One key variable—or rather a precondition—involves the situation in which a person who is fully productive is struck by a health event, which triggers the decision-making process between attending work and staying home. The type and severity of the health event to some extent determines whether absenteeism or presenteeism will follow. Thus, chronic hypertension is likely to motivate presence, whereas a heavy flu with a high fever will tend to prompt absence. When the illness is less serious or obvious, other factors gain importance. Key variables that should be incorporated are contextual and personal factors. According to Johns, contextual factors are related to the characteristics of the job and the organization, whereas personal factors pertain to attitudes, convictions, personality, or other characteristics of the individual. Another group of relevant factors postulated by Johns are the cumulative individual consequences of presenteeism and absenteeism such as productivity, health, and attributions of the self and of others. Further, Johns frames prescriptions for a theory of presenteeism. These are briefly described as follows: 1. It should recognize the subjectivity of health: Health and illness are two opposite poles of a continuum, and in less severe health events, the decision depends on the subjective evaluation of where on the continuum employees see themselves. 2. It should take into account the relationship between presenteeism and absenteeism: There is evidence of a positive correlation but also of an inverse relation. 3. The job insecurity thesis should be refined: Results on the effects of downsizing and impermanent employment tend to be contradictory. Johns claims that job insecurity should be measured directly rather than inferring its extent from organizational practices. 4. A theory should comprise the personality, work attitudes, and experience of the individual: Taking into account the motivational component of presenteeism, Johns requests the consideration of stable characteristics of the individual such as conscientiousness, locus of control, self-esteem, and hardiness as well as work-related attitudes such as citizenship and job satisfaction but also the subjectively experienced levels of stress and organizational justice. 5. It should pay attention to social dynamics: These include social expectations (e.g., with regard to gender and the interaction of an employee with team members, supervisors, and clients). Certain constellations might promote presenteeism cultures, whereas others might foster absenteeism depending on the job type and the organization. 4.2. Content theories specifying antecedents and consequences of presenteeism Most of the models are content models. They distinguish between two groups of influence factors: person-related aspects and context-related aspects, where the latter usually pertain to the job and the organization. In rare cases, the environment of the organization is also considered to affect the aforementioned factors. Person- and context-related factors either directly affect presenteeism or lead to conditions that precede presenteeism (mediators). Some models are restricted to the consideration of presenteeism, whereas others also encompass absenteeism. Some also deal with the consequences of presenteeism (and absenteeism). However, most content theories do not cover all of the abovementioned aspects. This is probably due to the fact that the authors had not intended to develop a theory of presenteeism. Instead, they mapped the relationships between the variables they had examined in their research, or they used their research results to derive assumptions about the variables involved and the power of these variables to induce presenteeism. Only a few models include person-related factors, context-related factors, and mediators (Bronner & Kraus, 2015; Coutu et al., 2015; McGregor, Iverson, Caputi, Magee, & Ashbury, 2014; Miraglia & Johns, 2016). The models by Cooper and Lu (2016) and Bronner and Kraus (2015) also incorporate environmental factors that influence person- and context-related factors. The models by Baker-McClearn et al. (2010), Gosselin et al. (2013), and Yildiz, Yildiz, Zehir, and Aykaç (2015) comprise only two of the three groups of variables to explain presenteeism (i.e., person- and context-related factors), whereas others embrace either person- or contextrelated factors and mediators (Laing & Jones, 2016; Yang et al., 2016). Of course, in developing a full theory of presenteeism, the most interesting approaches take into account antecedents as well as consequences. We identified nine models that meet this criterion (Aronsson & Gustafsson, 2005; Baeriswyl, Krause, Elfering, & Berset, 2016; Cooper & Lu, 2016; Johns, 2010; Lu, Cooper, & Lin, 2013; Luksyte, Avery, & Yeo, 2015; Pohling et al., 2016; Robertson et al., 2012; Zhou, Martinez, Ferreira, & Rodrigues, 2016). Only three of them include person- and context-related factors as antecedents (Aronsson & Gustafsson, 2005; Cooper & Lu, 2016; Johns, 2010). They are thus the most comprehensive and will therefore be described subsequently. Aronsson and Gustafsson (2005) conceptualized their presenteeism/absenteeism theory on the basis of a study of more than 3000 4

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employees in Scandinavia in which earlier findings were replicated. In the empirical part of their research, the authors covered antecedents of presenteeism and absenteeism. They found that illness and reduced work ability were the best direct predictors of both phenomena. For a given health status, they identified factors that increased or decreased the likelihood of presenteeism. Presenteeism-enhancing variables were lack of replacement and insufficient resources, conflicting job demands, boundarylessness, and private financial problems. Control over one's work led to less presenteeism. Although their empirical data did not cover effects of presenteeism, they postulated consequences for the individual's health and called for further research on this issue. They suggested that the effects of presenteeism depend on whether salutogenic or destructive factors prevail in the work environment. In their model, absenteeism offers the chance for health recovery, but in the event of long-term illness, it also entails the risk of negative effects because potential positive effects of working are forsaken (e.g., maintaining employability). Although the graphic presentation of the model includes the decision between presenteeism and absenteeism, the authors do not mention the decision, let alone describe the decision-making process. Johns' (2010) model was already described in part above. Although Johns refrains from depicting a complete theory in his review, his model is the most comprehensive in terms of relevant variables, and he specifies key variables of a theory of presenteeism and absenteeism with regard to antecedents and consequences. The relevant contextual variables in his model are job demands, job insecurity, reward system, absence policy, absence/presence culture, teamwork, ease of replacement, and adjustment latitude. With regard to personal factors, he lists work attitudes, personality, perceived justice, stress, perceived absence legitimacy, proclivity for the sick role, health locus of control, and gender. As cumulative individual consequences, he postulates effects on productivity, selfand other attributions, attendance, tenure, and future health. Although he lists various variables that might influence the choice between presenteeism and absenteeism, he does not particularize the decision-making process. Cooper and Lu’s (2016) model addresses a gap in Johns' (2010) model (i.e., the description of the psychological factors that are responsible for the choice of either presenteeism or absenteeism). The authors draw on social cognitive theory (SCT; Bandura, 1986, 2001) and especially on self-referential thinking. A basic assumption of SCT is that behavior is determined by the individual's cognitive processes and the social situation. These components influence each other. Within this causal system, Cooper and Lu (2016) consider the social cognitive processes of self-efficacy, outcome expectations, and goals as significant for explaining presenteeism. With reference to goal achievement theory (e.g., Grant & Dweck, 2003), Cooper and Lu (2016) distinguish between mastery goals, which are directed toward competency development, and performance goals, which are aimed at outperforming others. From this theory, they derive that people with mastery goals will seek challenging situations, whereas people with performance goals will avoid the risk of incurring an unfavorable evaluation by others. This means the former are likely to choose presenteeism because they want to prove their strength, whereas the latter are likely to show presenteeism in order to prevent disapproval by others. The model distinguishes between personal variables that influence social cognitive processes (e.g., gender, personality traits, and work engagement) and contextual variables (e.g., cultural values, social norms, organizational support, and replacement arrangements; Cooper & Lu, 2016). In contrast to the other models, Cooper and Lu’s theory also covers the psychological relations involved in the process and is more comprehensive in this respect. It specifies the variables involved in the process and presents predispositions and interdependencies between these variables. However, it does not explain the decision-making process by which people choose presenteeism or absenteeism.

4.3. Process theories elaborating on the decision-making process by which people choose presenteeism or absenteeism With regard to the second group of theoretical approaches, which focus on the decision-making process, we identified only one model. This model, presented by Halbesleben et al. (2014), directly refers to the integrative decision-making process by which people choose between absenteeism and presenteeism. The authors describe it as a “dialectical theory of the decision to go to work” (p. 177). They draw on dialectical approaches to personal relationships, especially Baxter's (1990), and adapt these to the relationship between employee and supervisor. Their model recognizes absenteeism and presenteeism as the results of a decision-making process that arises out of tensions between employee and supervisor. These tensions are based on three key bipolar contradictions that are present in each person: autonomy–connection, openness–closedness, and predictability–novelty. Depending on personality and environment, a person's reaction (or individual preference) will be located closer to one or the other pole. Tensions between employee and supervisor might arise because their positions on these dimensions are different. Employees cope with this challenge by inventing special strategies as provided in the taxonomy by Baxter and Montgomery (1996; cf. Halbesleben et al., 2014): denial, disorientation, spiraling inversion, segmentation, balance, integration, recalibration, and reaffirmation. For each strategy, Halbesleben et al. (2014) propose the conditions under which an employee is more likely to choose absenteeism or presenteeism depending on the employee's and supervisor's respective locations on a particular continuum. Although this interesting approach justifiably and—in our view—unavoidably focuses on the integrative decision-making process, it is too restricted. It places too much emphasis on only the relationship between employee and supervisor and their different positions. Thus, it fails to explicitly incorporate other relevant factors (e.g., health conditions, motives, and environmental influences in a broader sense) into the decision-making process, even though the content models described above point to the relevance of these factors. In addition, Halbesleben et al.’s model does not consider that in many cases, employees do not have only one supervisor but are embedded in a vertically and horizontally stretched net of relationships inside the organization. Further, the model does not consider that presenteeism is shown not only by employees but also by self-employed workers, housewives (usually unpaid), and volunteers (e.g., Hansen & Andersen, 2008; Merchant et al., 2014; Vogt, Badura, & Hollmann, 2010).

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5. Empirical findings Research on presenteeism has grown exponentially during the past decade. However, it has been mostly atheoretical (Johns, 2010), and the variables under investigation have varied greatly. Even when the same variables were employed, the results were equivocal. Further, there are only a few longitudinal studies, which are needed to identify the antecedents and consequences of presenteeism. To date, Miraglia and Johns' (2016) meta-analysis offers the most comprehensive review but is restricted to the causes and correlates of presenteeism. Their study integrates 109 samples with nearly 176,000 participants and 55 variables for which they report effect sizes. They found positive correlations of presenteeism with strict absence policies (ρ = 0.39), absenteeism (ρ = 0.35), productivity loss (ρ = 0.28), depression (ρ = 0.20), affective commitment (ρ = 0.20), work engagement (ρ = 0.13), job satisfaction (ρ = 0.12), personal financial difficulties (ρ = 0.10), and job insecurity (ρ = 0.08). Role demands were also positively correlated with presenteeism, that is, workload (ρ = 0.28), understaffing (ρ = 0.25), number of patients or clients (ρ = 0.20), physical demands (ρ = 0.13), and having difficult patients (ρ = 0.09). Further, time demands were positively associated, that is, time pressure (ρ = 0.16), overtime (ρ = 0.15), and work hours (ρ = 0.11). Overall job demands had an effect size of ρ = 0.16. With regard to stress, they reported that presenteeism was positively correlated with emotional exhaustion (ρ = 0.36), experienced stress (ρ = 0.35), abuse (ρ = 0.20), family to work conflict (ρ = 0.18), harassment (ρ = 0.16), work to family conflict (ρ = 0.14), and discrimination (ρ = 0.10). Only moderate to weak positive correlations with presenteeism were found for supervisors (ρ = 0.05) and for role conflict (ρ = 0.05). Presenteeism was negatively correlated with health (ρ = −0.39), optimism (ρ = −0.22), organizational support (ρ = −0.17), quality leadership (i.e., capability to encourage participation, provide feedback, plan, and organize tasks, ρ = −0.13), ease of replacement (ρ = −0.13), and organizational justice (ρ = −0.13). Supervisor support (ρ = −0.10) and adjustment latitude (ρ = −0.09) were only moderately negatively correlated with presenteeism. Negligible or nonsignificant correlations with presenteeism were obtained for performance ratings, mental health, employment form (permanent vs. temporary), income, shift work, role ambiguity, collegial support and relationships, job control (i.e., overall job control, job control, decision authority, participation, and work significance), conscientiousness, gender, age, tenure, education, sector, and size of employer. Beyond Miraglia and Johns' (2016) analysis, only a few other variables have been found to be associated with presenteeism. These are self-efficacy (Lu, Peng, Lin, & Cooper, 2014) and lifestyle including regular physical activity and other health-related behaviors (e.g., Burton, Chen, Conti, Schultz, & Edington, 2006; Goetzel et al., 2009; Guertler et al., 2015; Merchant et al., 2014; Merrill et al., 2012; Pit & Hansen, 2016; Walker, Tullar, Diamond, Kohl III, & Amick III, 2017), kind of work or profession (e.g., Aronsson et al., 2000; Hansen & Andersen, 2008; Merrill et al., 2012; Pit & Hansen, 2016; Vogt et al., 2010; Vroome, 2006), organizational downsizing (Caverley et al., 2007), and paid sick leave policy (Baker-McClearn et al., 2010; Colla, Dow, Dube, & Lovell, 2014; Irvine, 2011). Notwithstanding the large scope of Miraglia and Johns' (2016) meta-analysis, it did not explore variables that are less proximal to the workplace such as environmental factors (e.g., political, economic, cultural, legal, and societal) and did not specify the consequences of presenteeism. With regard to effects of presenteeism, there are only a few studies that will be described subsequently. There is empirical evidence from longitudinal studies that presenteeism increases the rate of absenteeism due to sickness as well as the occurrence of long-term sickness in the future (e.g., Bergström et al., 2009; Gustafsson & Marklund, 2011; Hansen & Andersen, 2009; Janssens, Clays, De Clercq, De Bacquer, & Braeckman, 2013; Skagen & Collins, 2016; Vroome, 2006). The reported negative effects of presenteeism on employee health include declines in (subjective) physical (Gustafsson & Marklund, 2011; Taloyan et al., 2012) and mental health (Gustafsson & Marklund, 2011; Lu, Lin, & Cooper, 2013) such as emotional exhaustion (Demerouti, Le Blanc, Bakker, Schaufeli, & Hox, 2009), depersonalization (Demerouti et al., 2009; Lu, Cooper, & Lin, 2013), and an increased risk for depression among initially nondepressed participants (Conway, Hogh, Rugulies, & Hansen, 2014). Presenteeism has been shown to lead to individual productivity loss (Collins et al., 2005; Iverson, Lewis, Caputi, & Knospe, 2010; Warren et al., 2011), a reduced ability to work (Gustafsson & Marklund, 2011), and wage losses (Wada et al., 2013). Other effects for the individual were lower job satisfaction (Ybema, Smulders, & Bongers, 2010), lower work engagement, and a higher addiction to work (Karanika-Murray, Pontes, Griffiths, & Biron, 2015). With regard to effects of presenteeism for the organization, there is empirical evidence for uncovered cost caused by productivity loss (Collins et al., 2005; Evans-Lacko & Knapp, 2016; Iverson et al., 2010; Warren et al., 2011). We found only two studies that investigated the effects of presenteeism on coworkers. In their experiments with students, Luksyte et al. (2015) found lower work engagement and negative feelings due to the worry of becoming infected, however, these results applied only to fellow students of the same race as the person showing presenteeism. Asfaw, Rosa, and Pana-Cryan (2017) reported coworker absences related to the spread of influenza-like illness. To date, research concerning environmental influences on presenteeism and the effect of presenteeism on the environment has been sparse. Demonstrated drivers of presenteeism are legal regulations such as paid sick leave policy (e.g., Colla et al., 2014; De Paola, Scoppa, & Pupo, 2014) or a poor economic climate and performance, thus leading to increased organizational downsizing that subsequently causes health problems in employees (Theorell, 2017). Sumanen, Lahelma, Lahti, Pietiläinen, and Rahkonen (2016), for example, found that poor economic climate was associated with a lower rate of absenteeism due to fear of losing one's job. Further parameters are cultural influences that pertain to social norms such as gender roles (Gustafsson Sendén et al., 2016), a strong work ethic, and the conviction that working hard conveys honor to the family (e.g., Cooper & Lu, 2016; Lu, Cooper, & Lin, 2013). Documented effects of presenteeism beyond the individual and the employer are lower levels of export, import, and investments 6

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(Econtech, 2007). 6. Directions for future research Although the attention that academics and practitioners give to presenteeism has increased tremendously during the past few years, more scientific knowledge still needs to be collected on the phenomenon. In this section, we elaborate on the different areas in which we believe further research is required. 6.1. Relevance of the phenomenon Not only did the prior literature review document the global prevalence of presenteeism, but it also indicated the extensive consequences that are associated with the phenomenon. The significance of presenteeism is not confined to its financial implications for organizations. For some time now, various authors have been indicating that the costs of presenteeism now exceed those of absenteeism and that the foregoing of an effective management of presenteeism can mean the waiver of the use of a relevant competitive factor for businesses (e.g., Evans-Lacko & Knapp, 2016; Hemp, 2004; Pirkovitsch, 2007; Wang et al., 2010). Most research efforts refer to the antecedents of presenteeism in terms of personal and workplace characteristics and to the consequences of presenteeism with regard to health effects for the individual and to productivity loss in general. However, with regard to stakeholders, it seems obvious that the consequences are not restricted to the individuals who engage in presenteeism and their employers. The phenomenon of presenteeism is significant for the theory and practice of Human Resources (HR) Management in several ways. Whereby the value of effective HR practices in general is undisputed in the HR literature, there have been only a few previous attempts to identify risks for the success of businesses that go along with the absence, inappropriateness, or ineffectiveness of HR practices (Becker & Smidt, 2016). Becker and Smidt (2016) argue that risk management has become an important task of organizations because insecurities are constantly increasing in business environments. In their literature review on HR risks for businesses, the authors identify eight person-related risks that should be incorporated into businesses' strategic risk management processes. Presenteeism is associated with three of these eight risks: (a) productivity, (b) employee health and well-being, and (c) absence rates/ patterns. Becker and Smidt point out that the inclusion of presenteeism in addition to absenteeism widens the focus on risks that result from employees who come to work ill. This means that an effective management of presenteeism can contribute to reducing HR-related risks in three significant areas and can thus have a positive effect on the success of the business. Even the results with regard to the positive correlation between high performance work practices (HPWPs, i.e. integrated and mutually reinforcing HR practices) and company performance (e.g., Saridakis, Lai, & Cooper, 2017; Van De Voorde, Paauwe, & Van Veldhoven, 2012) indicate that presenteeism needs to be managed systematically to increase an organization's success. The longitudinal meta-analysis by Saridakis et al. (2017) identified a positive correlation (r = 0.29) between HR practices and firm performance, and Van De Voorde et al. (2012) reported a positive impact of HR practices on business success in almost 60% of the cases they studied. Moreover, they found a positive effect of HR practices on workers' well-being in 70% of the cases. There is an even wider range of stakeholders such as supervisors, coworkers, families, and other important entities in society including the social insurance system, the health system, and the national economy. Although some researchers have tried to estimate the costs of presenteeism not only for employers (e.g., Stromberg, Aboagye, Hagberg, Bergström, & Lohela-Karlsson, 2017) but also with regard to health systems and national economies (e.g., Econtech, 2007), the available data differ widely and do not allow reliable conclusions to be drawn (compare the results of Stewart et al., 2003, Econtech, 2007, and Goetzel et al., 2004, under the—fictitious—condition, that they had referred to the same monetary basis). Even less attention has hitherto been paid to the financial and immaterial burdens of the people who show presenteeism outside of paid work such as people engaged in homemaking and child-rearing and volunteer workers in all kinds of services. Their numbers are not negligible, and they deserve to be considered. Besides the stakeholder perspective, the long-term consequences of presenteeism on physical and mental health and the respective accumulated costs should be considered. Thus, more longitudinal studies are needed. As a prerequisite to more precise calculations in terms of both health and costs, presenteeism and absenteeism should be consistently viewed as interlinked, which means that accruing the burdens and costs of one alternative means avoiding the burdens and financial losses of the other. Of decisive relevance with regard to the decision to choose either presenteeism or absenteeism are the motives that drive an individual to choose one or the other. Whereas research in Scandinavian countries has focused on this perspective at least to some degree, less research exists in the US and other regions. However, operationalizations of motives vary, and it would be helpful to develop a standardized way of studying them. Knowledge of the motives behind presenteeism would show organizations and societal institutions how to steer the phenomenon, especially regarding preventive action. 6.2. Definitions The prior review refers to the two main definitions of presenteeism understood as the reduction in work productivity due to a person's health problems (e.g., Burton et al., 2004) and presenteeism understood as employees attending work while ill (e.g., Aronsson & Gustafsson, 2005). At first glance, they may look different. But this apparent difference is not due to opposing views of the topic but to the extent to which research goals have entered the definition of the phenomenon. The first definition focuses on the financial burdens presenteeism imposes on employers, the health system, and the national economy. This perspective is important, and thus, it would be fruitful if researchers worldwide adopted a stronger cost perspective as is common among American scholars. The latter definition, in principle, is open to a broad variety of investigations (e.g., why people show presenteeism, the extent to 7

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which people are aware they show presenteeism, the consequences of showing presenteeism for health, the costs to employers incurred by presenteeism). It is noteworthy that this definition does not obscure the often neglected positive impact of the phenomenon. We suggest that future research employ a single definition that does not incorporate the motives for or the consequences of presenteeism. It should also not assume that working while ill is necessarily associated with reduced productivity, and it should not preclude positive effects because, in some cases, presenteeism has personality-stabilizing outcomes and supportive effects on the social and economic status of the employee (Garrow, 2016; Johansen et al. (2014). Because these arguments hold for the second definition mentioned above, we suggest its consistent application in future research. 6.3. Measurement instruments Johns (2010) and other scholars have hinted that the instruments that are used to measure presenteeism have shortcomings. Support for this claim can be derived from the wide variability in the results reported from the large variety of existing instruments. Linked to this idea is the question of criterion validity, which Ospina et al. (2015) claim has still not been sufficiently established. In their analysis, Ospina et al. identify 21 different instruments for measuring presenteeism. They adopt an understanding of presenteeism as decreased productivity while at work and thus extend the standard definition to other reasons in addition to illness for lower productivity. The authors conclude that “the selection of a presenteeism instrument for research and management purposes currently depends on weak forms of validity” (p. 178). Also with regard to the predominant definition of presenteeism as working when ill, validity has still not been convincingly established. When asking employees how often they have attended work when their health status would have justified staying home, it cannot be ruled out that measures may be biased by false recollection or social desirability and might thus be confounded with memory performance or impression management. Another problem is the reliability of results obtained by the most common instruments described in the literature review. Because presenteeism in this understanding is not restricted to diseases officially diagnosed by physicians (and even their judgment would not be completely objective), we have to rely on the individuals' subjective assessment of their health and the number of times it was impaired during the survey period. This kind of measurement is vulnerable to distortion as is any kind of subjective assessment. However, assessments by others (e.g., supervisors or coworkers) are not reasonable alternatives either because health impairments are not always obvious to them, and in the daily work context, they might lack the opportunity to observe such impairments. However, it is possible to make improvements by standardizing measurement methods. This would mean applying uniform periods of time for recollecting incidents of presenteeism and the use of unequivocal scales. Hence, we ask for research to identify a suitable length for the period of recollection and to focus on the wording of scales as well as on the number and adequate distances of scale segments. Another issue of interest is the reliable and valid measurement of motives for engaging in presenteeism. Most studies have not investigated motives, but they are relevant for understanding the extent of the phenomenon shown by the employed and selfemployed populations as well as by volunteers and homemakers. Therefore, questions pertaining to this topic should be incorporated into self-report questionnaires only in a manner that can establish what the paramount motives behind presenteeism are. We thus suggest the development of a motives-for-presenteeism scale, which would allow for the measurement, quantification, and comparison of the motives of individuals who engage in presenteeism and would hence facilitate the goal-directed steering of presenteeism not only for employers but also for other relevant and concerned societal organizations. In line with Gerich's (2016) suggestions, we think it would be useful to employ propensity measures of presenteeism. “A propensity measure reflects the probability that an individual will opt for sickness absence or sickness presence in case of illness. Consequently, an estimation of an individual's presenteeism propensity is given by the ratio of presenteeism frequency divided by the number of health events” (p. 190). We also embrace the advice given by Miraglia and Johns (2016) who identified the application of experience sampling methods and qualitative research as promising approaches for future research to better probe the dual path dynamics (i.e., the tradeoff between health and motivation; e.g., Holland & Collins, 2018). 6.4. Theory development The theories of presenteeism mentioned and described above differ in their degree of elaborateness with regard to relevant factors pertaining to the phenomenon. First, only some of them cover the antecedents and consequences of presenteeism at the same time. Second, of those that include antecedents, some are restricted to one kind of factor (i.e., personal or contextual variables); however, all groups of factors are relevant. Third, of the models that incorporate both kinds of factors, the majority precisely distinguish between only these two categories (i.e., personal variables and contextual variables) with the latter encompassing all factors that do not refer to the person. We are convinced that a more detailed classification of contextual factors would be helpful not only for the investigation and understanding of the phenomenon of presenteeism but also for the design of well-targeted HR management and organizational health management interventions that are meant to address presenteeism. Fourth, only a few of the theories account for both presenteeism and absenteeism. However, as stated by Johns (2010), Gosselin et al. (2013), and Halbesleben et al. (2014), they are both necessary because the two phenomena are linked at the point when an employee is choosing between them. This link works through substitution (i.e., the decision to choose one unavoidably excludes the other; e.g., Caverley et al., 2007; Hirsch, Lechmann, & Schnabel, 2015). This does not exclude a positive correlation between the two phenomena (e.g., Aronsson et al., 2000) at different times, which might be due to variations in health status. Fifth, drawing on Johns' (2010) prescriptions for a theory of 8

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presenteeism, we argue that none of the theories that have been presented to date are sufficiently comprehensive and able to explain the occurrence of presenteeism satisfactorily. Sixth and perhaps most important, the vast majority of models do not specify the way in which the decision in favor of presenteeism (i.e., the explicit choice between presenteeism and absenteeism) is made. 6.4.1. A framework model of presenteeism In the following, we suggest a framework model that draws on Johns' (2010) prescriptions for a theory of presenteeism and integrates previous models. In addition to this, we categorize the contextual factors (i.e., all factors apart from person-related variables) into three groups. When possible, we indicate relevant and empirically established antecedents and consequences. The resulting content model (see Fig. 1) might serve as a framework for further research concerning factors preceding and succeeding presenteeism. The results established by Miraglia and Johns' (2016) meta-analysis are listed with effect sizes; additional factors not covered by their analysis but rather by singular studies are given without effect sizes. Further, we extend the compilation by adding plausible but not yet empirically supported factors, which, in our view, should be subject to future research (formatted in italics in Fig. 1). In this framework or content model, we subdivide the different kinds of contextual factors into more distal and rather proximal contextual factors. The more distal factors (i.e., the environmental variables) include cultural, economic, societal, political, and legal factors as well as the natural environment and the infrastructure. The more proximal contextual factors can be categorized as directly work-related factors and organization-related factors. Work-related variables pertain to the work itself and its direct periphery, such as the kind of work or profession (e.g., Aronsson et al., 2000; Hansen & Andersen, 2008; Merrill et al., 2012; Vogt et al., 2010; Vroome, 2006), working conditions (e.g., Deery et al., 2014; Elstad & Vabo, 2008; Johansson & Lundberg, 2004; Taylor et al., 2003), and team members' and supervisors' behavior (e.g., Caverley et al., 2007; Gosselin et al., 2013; Leineweber et al., 2011; Schmid et al., 2017; Yang et al., 2016; Zhou et al., 2016). Organizational variables include an organization's restructuring and downsizing, which usually go along with job insecurity (e.g., Aronsson et al., 2000; Caverley et al., 2007; Heponiemi et al., 2010; Preisendörfer, 2010), the organizational culture and climate, HR policies, reward systems, health-related offers for employees, and organizational justice (e.g., Baker-McClearn et al., 2010; Böckerman & Laukkanen, 2010a; Cho, Park, Lee, Min, & Baek, 2016; Dew, Keefe, & Small, 2005; Johns, 2011; Yildiz et al., 2015). Personal factors encompass attitudes, behaviors, aspects of the individual situation and personality as demonstrated by Miraglia and Johns (2016) as well as lifestyle and self-efficacy. Further, as suggested by Johns (2010), we assume that health locus of control, perceived legitimacy of absence, and the proclivity for the sick role influence the choice between presenteeism and absenteeism although empirical support is still lacking. Environmental factors have an influence on the more proximal factors involving the individuals, their work, and their employers. For example, the national culture might shape person-related factors such as the employees' work attitudes. It also affects workrelated factors (i.e., role understanding and kind of cooperation) and organizational factors (e.g., the severity of policies about absence and presence). Environmental pollution and a poor infrastructure might affect employees' health status and perceived stress, and labor laws create a framework for working conditions. Economic trends and the labor market situation affect HR policies (e.g., decisions about the level of staffing and whether to offer temporary or permanent employment contracts). Person-related and work-related variables might influence each other, for example, in the way that work attitudes have an effect on the team's work atmosphere and an individual's work engagement is at least in part determined by support from and relationships with coworkers (e.g., Conway, Clausen, Hansen, & Hogh, 2016). Organizational factors can have an impact on both person- and workrelated factors (e.g., a low staffing level might lead to a high workload, and a strict absence policy might increase perceived stress). However, we do not assume an influence of person- or work-related factors on organizational factors. Of course, such an effect cannot be ruled out completely, but it seems rather unlikely. The three groups of variables (i.e., organizational, work-related, and personrelated) together determine the decision to choose either presenteeism or absenteeism. Presenteeism and absenteeism have consequences for the individual as well as the organization as stated in the research results section of this review. Empirical evidence is mainly available for negative effects of presenteeism. But it can also have positive effects, mainly with regard to what Johns (2010) listed as self- and other attributions. Examples might be a boost in self-esteem due to the perception that one is highly productive at all times and able to work in spite of sickness or a favorable reputation of being “tough,” which might enhance a person's chances for career advancement or for gaining the admiration of coworkers. Effects for the organization are usually a higher level of productivity of a sick person in comparison with an absent employee. If workers' tasks are highly interdependent, it also implies that affected coworkers will be able to maintain a higher level of performance, again, in comparison with absence. In most cases, however, the performance of the sick employee will be lower in comparison with the person's performance when healthy. But presenteeism also bears several risks for the organization. Miraglia and Johns (2016) point to possible problems of presenteeism such as workplace accidents, serious mistakes, contamination of consumer goods, and the spreading of viruses. The possible consequences of these events are manifold, such as reworking or correcting defect products, customer complaints, poor organizational image, decreased customer retention, and sick leave of affected coworkers. All these consequences have financial implications for the organization. However, most of these effects are still not well studied. Niven and Ciborowska (2015) found higher rates of mistakes when presenteeism occurred at pharmacies. However, this outcome was indirect because presenteeism led to higher worries, and these led to a higher rate of mistakes. Although an effect of presenteeism on future performance could not be established (Lu, Lin, & Cooper, 2013), it would not be improbable for protracted disease to reduce future productivity. A very likely positive effect of absenteeism for individuals is the recovery of their health (Cooper & Lu, 2016). Most other effects seem to be rather negative for the individual. The more days an employee is absent, the more difficult it will be to achieve 9

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Environmental influences • Culture and society • Paid sick leave policy • Poor economic climate and organizational downsizing • Cultural norms: gender roles, strong work ethic

Person-related variables • • • • • • • • • • • • • • • •

• Economy • Policy and legislation • Environment and infrastructure

Work-related variables

Health (-.39) Emotional exhaustion (.36) Experienced stress (.35) Absenteeism (.35) Optimism (-.22) Depression (.20) Affective commitment (.20) Family-work conflict (.18) Work engagement (.13) Job satisfaction (.12) Financial difficulties (.10) Self-efficacy Lifestyle Health locus of control Proclivity for sick role Legitimacy of absence

Organizational variables

• Role demands: work load (.28), number of patients/clients (.20), physical demands (.13) • Time demands: time pressure (.16), overtime (.15), work hours (.11) • Overall job demands (.16) • Work-family conflict (.14) • Quality leadership (-.13) • Ease of replacement (.-13) • Supervisor support (-.10) • Adjustment latitude (-.09) • Having difficult patients/clients (.09) • Role conflicts (.05) • Having supervisory duties (.05) • Kind of work or profession

• • • • • • • • • • •

Strict absence policy (.39) Understaffing (.25) Organizational support (-.17) Harassment (.16) Organizational justice (-.13) Discrimination (.10) Job insecurity (.08) Organizational downsizing Paid sick leave policy Reward system Health-related measures

Decision Presenteeism

Individual consequences • Productivity loss • Absenteeism • Future health, i.e., worse health status, more physical health complaints, lower mental well-being • Emotional exhaustion • Depersonalization • Higher rates of depression • Reduced work ability • Wage losses • Lower job satisfaction • Lower work engagement • Higher addiction to work • Self-attributions • Maintain employability

Absenteeism

Organizational consequences

Individual consequences

Organizational consequences

• Productivity loss • Lower engagement of coworkers of same race • Negative feelings of coworkers of same race • Absence of coworkers due to spread of illness • Attributions by others • Higher productivity as compared with absenteeism • Risks of accidents, higher error rate, contamination, followed, e.g., by customer complaints and decreased customer retention

• Productivity loss • Lower job satisfaction • Absenteeism • Improved health, recovery • Lower chance for advancement in the organization • Risk of financial losses • Lower employability in case of longterm sickness

• Productivity loss • Lower return on assets • Lower morale of the work team • Lower risk of infection • Expenses and effort for replacement • Expenses for paid sick leave

Consequences for the environment • Lower levels of export, import, and investments • Burdens for the health system

• Culture and society • Economy • Policy and legislation (caption on next page)

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Fig. 1. Research framework for the content of a decision-integrated model of presenteeism. Variables listed with effect sizes were taken from the meta-analysis by Miraglia and Johns (2016). Variables without effect sizes were empirically supported in single studies. Variables formatted in italics are presumed by the authors to be relevant due to considerations of plausibility.

performance goals, which is likely to have an impact on at least the person's income but might also lower the person's chances of getting a raise (e.g., Chiu et al., 2017). With regard to self- and other attributions (Johns, 2010), it is to be expected that employees with high rates or prolonged periods of sick leave will be seen as less productive and efficient. This might lower their chances of career advancement. Longer periods of absence might have the additional negative effect of diminished employability (Fevang, Markussen, & Røed, 2014). On the part of the organization, positive effects of sick leave might be that there will be lower risks that workplace accidents will occur, that viruses will spread, that consumer food will be contaminated, and that grave mistakes will be made (Miraglia & Johns, 2016). These go along with the avoidance of the consequences already described above. However, it is worth mentioning that Rousculp et al. (2010) found that attendance and thus the spreading of germs by employees with severe influenza could be reduced by allowing them to work at home, which of course is not always possible. Kumar, Grefenstette, Galloway, Albert, and Burke (2013) reported that providing employees with 1 or 2 “flu days” of paid sick leave reduced workplace infections by one fourth to one third. Negative effects of sick leave include lower overall productivity, a lower return on assets (Godoy, 2016), possibly the cost and effort of finding a replacement, higher financial risks because of relapses of employees returning after long-term absences (Fevang et al., 2014), and lower morale and effort in the work team that has to cover for the absent colleague (Luksyte et al., 2015). Depending on HR policies and legal regulations, there might also be the cost of continued payment of wages in the case of sick leave. The consequences of presenteeism and absenteeism described for the individual and the organization have an influence on the broader environment to different degrees. For example, sick leave burdens social systems such as the public health system (e.g., with regard to health insurance benefits; Fevang et al., 2014; Markussen, Røed, Røgeberg, & Gaure, 2011) and higher insurance fees for all insured employees. However, there also seem to be indications that paid sick leave for contagious diseases would be beneficial for public health (Pichler & Ziebarth, 2017). It can also be assumed that cumulative effects of presenteeism and absenteeism affect the national economy (Econtech, 2007), politics and legislation (e.g., Colla et al., 2014; De Paola et al., 2014). In times of continual work intensification, it is certainly conceivable that an increase in presenteeism will go along with such developments, which in the long run will change social expectations and thus society and culture. The content part of a model of presenteeism describes the factors and variables that influence the choice between presenteeism and absenteeism and presents demonstrated and plausible consequences of both behaviors. It still needs more research to substantiate the influence of and effects on the environmental factors in particular. Also, as stressed above, more longitudinal studies are required to investigate the outcomes of presenteeism.

6.4.2. Approaches to the investigation of the decision-making process The process part of a model of presenteeism also needs further specification. It needs to explain how the actual decision to choose presenteeism or absenteeism is reached. Several approaches that refer to various areas of psychology are useful for this. In the following, we will outline some different alternatives. In our view, a fruitful path would be to refer to theories that explain the decision-making process as a choice between behavioral alternatives (e.g., Vroom's, 1964, expectancy theory of motivation. Expectancy-value theories are usually used to explain how behavior is motivated and how decisions are made in work environments (Nerdinger, 2014). According to expectancy theory, individuals behave as they do in response to their expectations of the future. They do things or respond to opportunities if a valuable reward can be expected as a consequence and, before making the decision to adopt or reject an action, they evaluate the costs and benefits. In explaining how behavior is motivated, Vroom's (1964) expectancy theory considers three variables in the decisionmaking process: valence, instrumentality, and expectancy. Valence refers to the value that individuals ascribe to the consequences of their behavior. These consequences of actions motivate behavior. However, they are not achieved directly. When balancing various action options, individuals estimate the probability that a certain behavior will lead to the targeted results (expectancy) and the likelihood that these results will be followed by the desired consequences (instrumentality). The relationship between actions, results, and consequences in Vroom's model is calculable and thus open to empirical verification: Motivation for a behavior is the product of expectancy, instrumentality, and valence (E × I × V). People will choose the option that, in their view, will be most likely to allow them to achieve their goals. This theoretical approach, for which most studies correctly predicted subjectively relevant decisions (see Nerdinger, 2014), can be used to explain the decision between presenteeism and absenteeism in the event of health problems with absenteeism and presenteeism as the two obvious behavioral alternatives. Another valuable approach with regard to the decision-making process might be the reference to original economic models that describe appraisals of consequences depending on the time of their occurrence. These models suggest that each consequence has a timeless value. This benefit is weighted by a subjective factor that represents the significance of the time of the occurrence of the consequence. The predominant discounting model supposes that the value of a consequence decreases with an increase in the time span between the current event and its consequences. Discounting rates have been investigated with regard to health-related decision making (Chapman, 2004). Transferred to the decision process between presenteeism and absenteeism, a possible explanation for why employees decide to work while sick and thus fail to choose the (preventive) health measure of staying home is that they discount any future (negative) outcomes of their current behavior (e.g., long-term sickness, chronification). There are interindividual differences with regard to temporal discount rates, and people who require a high percentage increase in value in exchange for a delay in 11

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obtaining the outcome are said to have high temporal discount rates (Chapman, 2004). They can be expected to show a higher rate of presenteeism than people with low temporal discount rates. But, of course, this does not take into consideration the potential positive consequences of presenteeism or the discounting of these consequences. Another possibility is the recourse to theories predicting behavior on the basis of attitudes. For example, the theory of planned behavior (Ajzen, 1991), which was developed to explain reflection and intentional behavior, might be used to predict attendance behavior in the case of a health event. According to this theory, the intention to act predicts behavior directly. Three factors influence the intention. One factor is attitudes toward the behavior (i.e., evaluating the behavior as positive or negative). A second influence is subjective norms, which refer to individuals' beliefs about how relevant reference persons assess the behavior. The third factor is perceived behavioral control, which is the individual's confidence in generally being able to execute the intended behavior. Similar to the two aforementioned factors, perceived behavioral control also directly affects intention, but in addition, it directly influences the behavior in the acute situation. In many studies, the theory of planned behavior accounted for large amounts of variation in intentions and behaviors (Armitage & Conner, 2001). Applied to the event of health problems, presenteeism and absenteeism are seen as behavioral alternatives, and the plan to either attend work or stay home while ill are possible intentions. Attitudes (e.g., work engagement or job satisfaction) and subjective norms affect intentions. The third factor, perceived behavioral control, depends on various factors, such as the severity of the health problem, coworkers who can cover the work, and absence policies. Future research is required to establish which kinds of theoretical approaches to the decision-making process are useful for explaining the choice between presenteeism and absenteeism and to specify the conditions under which one decision or the other is made. 7. Conclusion There seems to be no doubt that strain on workers will continue to increase in the future (Wohlers & Hombrecher, 2016). As stress has been identified as a significant factor in triggering presenteeism (Callen, Lindley, & Niederhauser, 2013; Coutu et al., 2015; Elstad & Vabo, 2008; Krpalek et al., 2014; Lauzier, Melancon, & Cote, 2017), and as presenteeism itself also generates stress (Lu, Cooper, & Lin, 2013), increases in both the number of cases of presenteeism and the length of time in which presenteeism is demonstrated must be anticipated. As many businesses are now allowing workers to work from home offices, this could indeed promote relaxation and stress reduction by means of self-determined work rhythms due to the disappearance of monitoring and control. Yet, the potential for the monitoring of computer use in the home office via installed software gives rise to additional stress with negative health impacts and more presenteeism behavior. Furthermore, superiors cannot supervise in the home office or intervene in the case of obvious presenteeism and arrange for sick leave in the interest of the employee's health. This could lead to an increase in hidden presenteeism. And even though high performance work systems (HPWSs) as described above are positively related to corporate performance, it must not be forgotten that they also involve increased work load, work intensification, and increased strain (Chandler, Keller, & Lyon, 2000; Orlitzky & Frenkel, 2005), all of which are correlated with presenteeism (Miraglia & Johns, 2016). Although presenteeism is continually gaining in its relevance for HRM scholars and practitioners, some important fundamentals of presenteeism research have yet to be satisfactorily clarified. Research on presenteeism suffers from differences in definitions and a variety of measurement approaches, research settings, and investigated variables. To date, Miraglia and Johns' (2016) meta-analysis is the most comprehensive review of the correlates of presenteeism. However, more research is still needed to separate the causes from the effects of presenteeism. We identified factors that can explain presenteeism and described how these factors have been employed in different kinds of models. In doing so, we drew not only on existing models of presenteeism but in particular on the prescriptions given by Johns (2010) in his comprehensive review of the topic. The framework for research delineated above is comprehensive with regard to the variables associated with presenteeism, and the finer classification of certain factors we propose is useful although it might not be unequivocal, at least in some cases (see also Gerich, 2016). In order to design goal-oriented measures of HRM or organizational health management (e.g., Cancelliere, Cassidy, Ammendolia, & Côté, 2011), it will be worthwhile to focus on the occurrence of both presenteeism and absenteeism. In future research, the decision-making process should be given priority for the purpose of clarifying the conditions under which individuals choose presenteeism instead of absenteeism and to quantify the relative weight of variables involved in the decision-making process. This knowledge might help to explain controversial research results on the effects of health-promoting measures aimed at reducing presenteeism and absenteeism (Block et al., 2008; Brown, Gilson, Burton, & Brown, 2011; Cancelliere et al., 2011; Coffeng et al., 2014; Harden et al., 2015; Justesen, Sogaard, Dalager, Christensen, & Sjoogard, 2017; Reffstrup Christensen, Overgaard, Hansen, Sogaard, & Holtermann, 2013). All in all, we hope this contribution inspires more research on presenteeism because as Johns (2010) stated, “the phenomenon is too interesting and too important for theoretical and practical reasons to be left in the sole hands of medical researchers and health care consultants” (p. 537). 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