Human Resource Management Review 29 (2019) 43–58

Contents lists available at ScienceDirect

Human Resource Management Review

journal homepage: www.elsevier.com/locate/hrmr

Presenteeism: A review and research directions

T
⁎
Daniela Lohausa, , Wolfgang Habermannb
a
University of Applied Sciences Darmstadt, Haardtring 100, Darmstadt 64295, Germany
b
H & L Karriereberatung, Auerbacher Weg 5, Lautertal 64686, Germany

AR TI CLE I NF O AB S T R A CT

Keywords: Presenteeism, often defined as going to work ill, is a global phenomenon. In contrast to ab-
Presenteeism senteeism, presenteeism has only recently gained attention as a major factor that affects orga-
Absenteeism nizational performance. This article shows that, to date, neither a uniform definition nor con-
Individual health sistent measurement methods have been employed in the research on presenteeism. Although
Individual performance
there have been several attempts at theory development, a comprehensive model that can explain
Organizational success
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: daniela.lohaus@h-da.de (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.
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 re-
quirements can serve to reduce absenteeism but will probably simultaneously produce an increase in presenteeism (e.g., Baker-
McClearn 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 con-
tributions 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 pre-
senteeism. 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

44
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 im-
pairments 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 pre-
senteeism 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 demands-
resources 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).

45
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 con-
tradictory. 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 pre-
senteeism or lead to conditions that precede presenteeism (mediators). Some models are restricted to the consideration of pre-
senteeism, 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 context-
related 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

46
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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. Pre-
senteeism-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, self-
and 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 en-
gagement) 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).

47
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 re-
placement (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 con-
sequences 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

48
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

(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 re-
search 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 stake-
holders, 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 organi-
zations 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 ac-
cruing 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

49
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 phe-
nomenon. 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 pre-
senteeism 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 in-
struments described in the literature review. Because presenteeism in this understanding is not restricted to diseases officially di-
agnosed 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 rea-
sonable 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 self-
employed 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 com-
parison of the motives of individuals who engage in presenteeism and would hence facilitate the goal-directed steering of pre-
senteeism 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 pro-
pensity 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

50
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 work-
related 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 work-
related 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 person-
related) 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 orga-
nization 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 perfor-
mance when healthy.
But presenteeism also bears several risks for the organization. Miraglia and Johns (2016) point to possible problems of pre-
senteeism 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

51
D. Lohaus, W. Habermann
• Paid sick leave policy
• Poor economic climate and organizational downsizing
• Cultural norms: gender roles, strong work ethic
Person-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
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
• Lower levels of export, import, and investments
• Burdens for the health system
Human Resource Management Review 29 (2019) 43–58
Environmental influences • Culture and society
• Economy
• Policy and legislation
• Environment and infrastructure
Work-related variables Organizational variables
• Role demands: work load (.28), • Strict absence policy (.39)
number of patients/clients (.20), • Understaffing (.25)
physical demands (.13) • Organizational support (-.17)
• Time demands: time pressure (.16), • Harassment (.16)
overtime (.15), work hours (.11) • Organizational justice (-.13)
• Overall job demands (.16) • Discrimination (.10)
• Work-family conflict (.14) • Job insecurity (.08)
• Quality leadership (-.13) • Organizational downsizing
• Ease of replacement (.-13) • Paid sick leave policy
• Supervisor support (-.10) • Reward system
• Adjustment latitude (-.09) • Health-related measures
• Having difficult patients/clients (.09)
• Role conflicts (.05)
• Having supervisory duties (.05)
• Kind of work or profession
Decision
Absenteeism
Organizational Individual Organizational
consequences consequences consequences
• Productivity loss • Productivity loss • Productivity loss
• Lower engagement of • Lower job • Lower return on
coworkers of same race satisfaction assets
• Negative feelings of • Absenteeism • Lower morale of
coworkers of same race • Improved health, the work team
• Absence of coworkers due recovery • Lower risk of
to spread of illness • Lower chance for infection
• Attributions by others advancement in • Expenses and
• Higher productivity as the organization effort for
compared with • Risk of financial replacement
absenteeism losses • Expenses for
• Risks of accidents, higher • Lower employability paid sick leave
error rate, contamination, in case of long-
followed, e.g., by customer term sickness
complaints and decreased
customer retention
Consequences for the environment • Culture and society
• Economy
• Policy and legislation
(caption on next page)
52
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 be-
havior is motivated and how decisions are made in work environments (Nerdinger, 2014). According to expectancy theory, in-
dividuals 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 decision-
making 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

53
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

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 in-
tentions 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).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

Agudelo-Suárez, A. A., Benavides, F. G., Felt, E., Ronda-Pérez, E., Vives-Cases, C., & García, A. M. (2010). Sickness presenteeism in Spanish-born and immigrant
workers in Spain. BMC Public Health, 10, 791.

54
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
Al Nuhait, M., Al Harbi, K., Al Jarboa, A., Bustami, R., Alharbi, S., et al. (2017). Sickness presenteeism among health care providers in an academic tertiary care center
in Riyadh. Journal of Infection and Public Health, 10, 711–715.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471–499.
Aronsson, G., & Gustafsson, K. (2005). Sickness presenteeism: Prevalence, attendance-pressure factors, and an outline of a model for research. Journal of Occupational
and Environmental Medicine, 47, 958–966.
Aronsson, G., Gustafsson, K., & Dallner, M. (2000). Sick but yet at work. An empirical study of sickness presenteeism. Journal of Epidemiology and Community Health, 54,
502–509.
Asfaw, A., Rosa, R., & Pana-Cryan, R. (2017). Potential economic benefits of paid sick leave in reducing absenteeism related to the spread of influenza-like illness.
Journal of Occupational and Environmental Medicine, 59, 822–829.
Baase, C. M. (2006). Auswirkungen chronischer Krankheiten auf Arbeitsproduktivität und Absentismus und daraus resultierender Kosten für die Betriebe (Effects of
chronic illness on work productivity and absenteeism as well as resulting costs for enterprises). In B. Badura, H. Schellschmidt, & C. Velter (Eds.). Fehlzeitenreport
2006 (pp. 45–62). Berlin: Springer. (Report on absenteeism for 2006) http://www.springer.com/de/book/9783540343677.
Baeriswyl, S., Krause, A., Elfering, A., & Berset, M. (2016). How workload and coworker support relate to emotional exhaustion: The mediating role of sickness
presenteeism. International Journal of Stress Management, 24(Suppl. 1), 52–73.
Baker-McClearn, D., Greasley, K., Dale, J., & Griffith, F. (2010). Absence management and presenteeism: The pressures on employees to attend work and the impact of
attendance on performance. Human Resource Management Journal, 20, 311–328.
Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the art. Journal of Managerial Psychology, 22, 309–328.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1–26.
Baxter, L. A. (1990). Dialectic contradictions in relationships development. Journal of Social and Personal Relationships, 7, 69–88.
Baxter, L. A., & Montgomery, B. M. (1996). Relating: Dialogues and Dialectics. New York: Guilford Press.
Becker, K., & Smidt, M. (2016). A risk perspective on human resource management: A review and directions for future research. Human Resource Management Review,
26, 149–165.
Bergström, G., Bodin, L., Hagberg, J., Aronsson, G., & Josephson, M. (2009). Sickness presenteeism today, sickness absenteeism tomorrow? A prospective study on
sickness presenteeism and future sickness absenteeism. Journal of Occupational and Environmental Medicine, 51, 629–638.
Bierla, I., Huver, B., & Richard, S. (2013). New evidence on absenteeism and presenteeism. The International Journal of Human Resource Management, 24, 1536–1550.
Block, G., Sternfeld, B., Block, C. H., Block, T. J., Norris, J., Hopkins, D., ... Clancy, H. A. (2008). Development of alive! (a lifestyle intervention via email); and its effect
on health-related quality of life; presenteeism, and other behavioral outcomes: Randomized controlled trial. Journal of Medical Internet Research, 10(4), e43.
Böckerman, P., & Laukkanen, E. (2010a). What makes you work while you are sick? Evidence from a survey of workers. European Journal of Public Health, 20, 43–46.
Böckerman, P., & Laukkanen, E. (2010b). Predictors of sickness absence and presenteeism: Does the pattern differ by a respondent's health? Journal of Occupational and
Environmental Medicine, 52(3), 332–335.
Bödeker, W., & Hüsing, T. (2008). iga Report 12, iga-Barometer 2. Welle, Einschätzungen der Erwerbsbevölkerung zum Stellenwert der Arbeit, zur Verbreitung und Akzeptanz
von betrieblicher Prävention und zur krankheitsbedingten Beeinträchtigung der Arbeit. (Health and Work Initiative Report 12, Health and Work Initiative barometer 2nd
wave, opinions of the working population on the significance of work, on the dissemination and acceptance of occupational prevention and on impairment on work related to
illness). Essen: BKK BV, DGUV, AOK-BV und AEV. http://www.bds-gewerbevereine.de/xFiles/Content/cadfd42e-5f9b-4dbc-b6fd-3b449a270333/Files/iga_report_
12.pdf, Accessed date: 14 September 2017.
Bronner, U., & Kraus, A. L. (2015). Präsentismus in Unternehmen: Eine qualitative Befragung unternehmensinterner Experten zu den Ursachen von Präsentismus.
(Presenteeism in companies: A qualitative survey of in-house experts on the causes of presenteeism). Wirtschaftspsychologie, 2, 53–62.
Brooks, A., Hagen, S. E., Sathyanarayanan, S., Schultz, A. B., & Edington, D. W. (2010). Presenteeism: Critical issues. Journal of Occupational and Environmental
Medicine, 52(11), 1055–1067.
Brown, H. E., Gilson, N. D., Burton, N. W., & Brown, W. J. (2011). Does physical activity impact on presenteeism and other indicators of workplace well-being? Sports
Medicine, 41(3), 249–262.
Burton, W. N., Chen, C.-Y., Conti, D. J., Schultz, A. B., & Edington, D. W. (2006). The association between health risk change and presenteeism change. Journal of
Occupational and Environmental Medicine, 48(3), 252–263.
Burton, W. N., Chen, C.-Y., Li, X., Schultz, A. B., & Abrahamsson, H. (2014). The association of self-reported employee physical activity with metabolic syndrome,
health care costs, absenteeism, and presenteeism. Journal of Occupational and Environmental Medicine, 56(9), 919–926.
Burton, W. N., Conti, D. J., Chen, C.-Y., Schultz, A. B., & Edington, D. W. (1999). The role of health risk factors and disease on worker productivity. Journal of
Occupational and Environmental Medicine, 41(10), 863–877.
Burton, W. N., Pransky, G., Conti, D. J., Chen, C.-Y., & Edington, D. W. (2004). The association of medical conditions and presenteeism. Journal of Occupational and
Environmental Medicine, 46(suppl), S38–S45.
Callen, B. L., Lindley, L. C., & Niederhauser, V. P. (2013). Health risk factors associated with presenteeism in the workplace. Journal of Occupational and Environmental
Medicine, 55(11), 1312–1317.
Cancelliere, C., Cassidy, J. D., Ammendolia, C., & Côté, P. (2011). Are workplace health promotion programs effective at improving presenteeism in workers? BMC
Public Health, 11, 395.
Caverley, N., Cunningham, J. B., & MacGregor, J. N. (2007). Sickness presenteeism, sickness absenteeism, and health following restructuring in a public service
organization. Journal of Management Studies, 44(2), 304–319.
Chandler, G., Keller, C., & Lyon, D. W. (2000). Unraveling the determinants and consequences of an innovation-supportive organizational culture. Entrepreneurship:
Theory and Practice, 25(3), 59–76.
Chapman, G. (2004). The psychology of medical decision making. In D. J. Koehler, & N. Harvey (Eds.). Blackwell handbook of judgment and decision making (pp. 585–
603). Cambridge, UK: Blackwell.
Chiu, S., Black, C. L., Yue, X., Greby, S. M., Laney, A. S., et al. (2017). Working with influenza-like illness: Presenteeism among US health care personnel during the
2014-2015 influenza season. American Journal of Infection Control, 45, 1254–1258.
Cho, Y.-S., Park, J. B., Lee, K.-J., Min, K.-B., & Baek, C.-I. (2016). The association between Korean workers' presenteeism and psychosocial factors within workplaces.
Annals of Occupational and Environmental Medicine, 28, 41.
Christensen, J. R., Overgaard, K., Hansen, K., Sogaard, K., & Holtermann, A. (2013). Effects on presenteeism and absenteeism from a 1-year workplace randomized
controlled trial among health care workers. Journal of Occupational and Environmental Medicine, 55(10), 1186–1190.
Coffeng, J. K., Hendriksen, I. J. M., Duijts, S. F. A., Twisk, J. W. R., van Mechelen, W., & Boot, C. R. L. (2014). Effectiveness of a combined social and physical
environmental intervention on presenteeism, absenteeism, work performance, and work engagement in office employees. Journal of Occupational and
Environmental Medicine, 56(3), 258–265.
Colla, C. H., Dow, W. H., Dube, A., & Lovell, V. (2014). Early effects of the San Francisco paid sick leave policy. American Journal of Public Health, 104, 2453–2460.
Collins, J. J., Baase, C. M., Sharda, C. E., Ozminkowski, R. J., Nicholson, S., Billotti, G. M., ... Berger, M. (2005). The assessment of chronic health conditions on work
performance, absence, and total economic impact for employers. Journal of Occupational and Environmental Medicine, 47, 547–557.
Conway, P. M., Clausen, T., Hansen, A. M., & Hogh, A. (2016). Workplace bullying and sickness presenteeism: Cross-sectional and prospective associations in a 2-year
follow-up study. International Archives of Occupational and Environmental Health, 89, 103–114.
Conway, P. M., Hogh, A., Rugulies, R., & Hansen, A. M. (2014). Is sickness presenteeism a risk factor for depression? A Danish 2-year follow-up study. Journal of
Occupational and Environmental Medicine, 56, 595–603.
Cooper, C. L., & Lu, L. (2016). Presenteeism as a global phenomenon: Unraveling the psychosocial mechanisms from the perspective of social cognitive theory. Cross
Cultural & Strategic Management, 23(2), 216–231.

55
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

Coutu, M., Corbière, M., Durand, M., Nastasia, I., Labrecque, M., Berbiche, D., & Albert, V. (2015). Factors associated with presenteeism and psychological distress
using a theory-driven approach. Journal of Occupational and Environmental Medicine, 57(6), 617–626.
De Paola, M., Scoppa, V., & Pupo, V. (2014). Absenteeism in the Italian public sector: The effects of changes in sick leave policy. Journal of Labor Economics, 32,
337–360.
Deery, S., Walsh, J., & Zatzick, C. D. (2014). A moderated mediation analysis of job demands, presenteeism, and absenteeism. Journal of Occupational and
Organizational Psychology, 87, 352–369.
Demerouti, E., Le Blanc, P. M., Bakker, A. B., Schaufeli, W. B., & Hox, J. (2009). Present but sick: A three-wave study on job demands, presenteeism and burnout. Career
Development International, 14(1), 50–68.
Dew, K., Keefe, V., & Small, K. (2005). ‘Choosing’ to work when sick: Workplace presenteeism. Social Science & Medicine, 60, 2273–2282.
Econtech (2007). Economic modelling of the cost of presenteeism in Australia. Canberra/Sydney: Econtech Pty Ltd.
Elstad, J. I., & Vabo, M. (2008). Job stress, sickness absence and sickness presenteeism in Nordic elderly care. Scandinavian Journal of Public Health, 36, 467–474.
Evans-Lacko, S., & Knapp, M. (2016). Global patterns of workplace productivity for people with depression: Absenteeism and presenteeism costs across eight diverse
countries. Social Psychiatry and Psychiatric Epidemiology, 51, 1525–1537.
Fernando, M., Caputi, P., & Ashbury, F. (2017). Impact on employee productivity from presenteeism and absenteeism: Evidence from a multinational firm in Sri Lanka.
Journal of Occupational and Environmental Medicine, 59, 691–696.
Ferrie, J. E., Kivimaki, M., Head, J., Shipley, M. J., Vahtera, J., & Marmot, M. G. (2005). A comparison of self-reported sickness absence with absences recorded in
employers' registers: Evidence from the Whitehall II study. Occupational Environmental Medicine, 62, 74–79.
Fevang, E., Markussen, S., & Røed, K. (2014). The sick pay trap. Journal of Labor Economics, 32, 305–336.
Fissler, E. R., & Krause, R. (2010). Absentismus, Präsentismus und Produktivität. (Absenteeism, presenteeism, and productivity). In B. Badura, U. Walter, & T.
Hehlmann (Eds.). Betriebliche Gesundheitspolitik – Der Weg zur gesunden Organisation (Operational health policy – The way to a healthy organization) (pp. 411–425).
(2nd ed.). Heidelberg: Springer. http://www.springer.com/de/book/9783642043369.
Garrow, V. (2016). Presenteeism: A review of current thinking. Brighton, UK: Institute for Employment Studies, Report 507. http://www.employment-studies.co.uk/
system/files/resources/files/507_0.pdf.
Gerich, J. (2016). Determinants of presenteeism prevalence and propensity: Two sides of the same coin? Archives of Environmental & Occupational Health, 71, 189–198.
Godoy, A. (2016). Profiting from presenteeism? Effects of an enforced activation policy on firm profits. Labour Economics, 43, 122–128.
Goetzel, R. Z., Carls, G. S., Wang, S., Kelly, E., Mauceri, E., Columbus, D., & Cavuoti, A. (2009). The relationship between modifiable health risk factors and medical
expenditures, absenteeism, short-term disability, and presenteeism among employees at Novartis. Journal of Occupational and Environmental Medicine, 51(4),
487–499.
Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hawkins, K., Wang, S., & Lynch, W. (2004). Health, absence, disability, and presenteeism cost estimates of certain
physical and mental health conditions affecting US employers. Journal of Occupational and Environmental Medicine, 46, 398–412.
Gosselin, E., Lemyre, L., & Corneil, W. (2013). Presenteeism and absenteeism: Differentiated understanding of related phenomena. Journal of Occupational Health
Psychology, 18, 75–86.
Grant, H., & Dweck, C. S. (2003). Clarifying achievement goals and their impact. Journal of Personality and Social Psychology, 85(3), 541–553.
Guertler, D., Vandelanotte, C., Short, C., Alley, S., Schoeppe, S., & Duncan, M. J. (2015). The association between physical activity, sitting time, sleep duration, and
sleep quality as correlates of presenteeism. Journal of Occupational and Environmental Medicine, 57(3), 321–328.
Gustafsson, K., & Marklund, S. (2011). Consequences of sickness presence and sickness absence on health and work ability: A Swedish prospective cohort study.
International Journal of Occupational Medicine and Environmental Health, 24, 153–165.
Gustafsson Sendén, M., Lovseth, L. T., Schenck-Gustafsson, K., & Fridner, A. (2013). What makes physicians go to work while sick: A comparative study of sickness
presenteeism in four European countries (HOUPE). Swiss Medical Weekly, 143, w13840.
Gustafsson Sendén, M., Schenck-Gustafsson, K., & Fridner, A. (2016). Gender differences in reasons for sickness presenteeism – A study among GPs in a Swedish health
care organization. Annals of Occupational and Environmental Medicine, 28, 50.
Halbesleben, J. R. B., Whitman, M. V., & Crawford, W. S. (2014). A dialectical theory of the decision to go to work: Bringing together absenteeism and presenteeism.
Human Resource Management Review, 24(2), 177–192.
Hansen, C. D., & Andersen, J. H. (2008). Going ill to work – What personal circumstances, attitudes and work-related factors are associated with sickness presenteeism?
Social Science and Medicine, 67, 956–964.
Hansen, C. D., & Andersen, J. H. (2009). Sick at work – A risk factor for long-term sickness absence at a later date? Journal of Epidemiology and Community Health, 63(5),
397–402.
Hansson, M., Bostrom, C., & Harms-Ringdahl, K. (2006). Sickness absence and sickness attendance – What people with neck or back pain think. Social Science and
Medicine, 62, 2183–2195.
Harden, S. M., You, W., Almeida, F. A., Hill, J. L., Linnan, L. A., Allen, K. C., & Estabrooks, P. A. (2015). Does successful weight loss in an internet-based worksite
weight loss program improve employee presenteeism and absenteeism? Health Education & Behavior, 42(6), 769–774.
Hemp, P. (2004). Presenteeism: At work – But out of it. Harvard Business Review, 82, 49–58.
Heponiemi, T., Elovainio, M., Pentti, J., Virtanen, M., Westerlund, H., Virtanen, P., ... Vahtera, J. (2010). Association of contractual and subjective job insecurity with
sickness presenteeism among public sector employees. Journal of Occupational and Environmental Medicine, 52(8), 830–835.
Hirsch, B., Lechmann, D. S. J., & Schnabel, C. (2015). Coming to work while sick: An economic theory of presenteeism with an application to German data. Bonn: IZA
Discussion Papers (No. 9015).
Holland, P., & Collins, A. M. (2018). "Whenever I can I push myself to go to work": A qualitative study of experiences of sickness presenteeism among workers with
rheumatoid arthritis. Disability and Rehabilitation, 40, 404–413.
Irvine, A. (2011). Fit for work? The influence of sick pay and job flexibility on sickness absence and implications for presenteeism. Social Policy & Administration, 45(7),
752–769.
Iverson, D., Lewis, K. L., Caputi, P., & Knospe, S. (2010). The cumulative impact and associated costs of multiple health conditions on employee productivity. Journal of
Occupational and Environmental Medicine, 52, 1206–1211.
Janssens, H., Clays, E., De Clercq, B., De Bacquer, D., & Braeckman, L. (2013). The relation between presenteeism and different types of future sickness absence.
Journal of Occupational Health, 55, 132–141.
Johansen, V., Aronsson, G., & Marklund, S. (2014). Positive and negative reasons for sickness presenteeism in Norway and Sweden: A cross-sectional survey. British
Medical Journal Open, 4, e004123.
Johansson, G., & Lundberg, I. (2004). Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness
flexibility model. Social Science & Medicine, 58, 1857–1868.
Johns, G. (2010). Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior, 31, 519–542.
Johns, G. (2011). Attendance dynamics at work: The antecedents and correlates of presenteeism, absenteeism, and productivity loss. Journal of Occupational Health
Psychology, 16, 483–500.
Justesen, J. B., Sogaard, K., Dalager, T., Christensen, J. R., & Sjoogard, G. (2017). The effect of intelligent physical exercise training on sickness presenteeism and
absenteeism among office workers. Journal of Occupational and Environmental Medicine, 59, 942–948.
Karanika-Murray, M., Pontes, H. M., Griffiths, M. D., & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective motivational states. Social
Science & Medicine, 139, 100–106.
Kessler, R. C., Ames, M., Hymel, P. A., Loeppke, R., McKenas, D. K., Richling, D., ... Üstün, T. B. (2004). Using the WHO health and work performance questionnaire
(HPQ) to evaluate the indirect workplace costs of illness. Journal of Occupational and Environmental Medicine, 46(Suppl. 6), S23–S37.
Kim, J., Suh, E. E., Ju, S., Choo, H., Bae, H., & Choi, H. (2016). Sickness experiences of Korean registered nurses at work: A qualitative study on presenteeism. Asian
Nursing Research, 10, 32–38.

56
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

Koopman, C., Pelletier, K. R., Murray, J. F., Sharda, C. E., Berger, M. L., Turpin, R. S., et al. (2002). Stanford presenteeism scale: Health status and employee
productivity. Journal of Occupational and Environmental Medicine, 44, 14–20.
Krane, L., Larsen, E. L., Nielsen, C. V., Stapelfeldt, C. M., Johnsen, R., & Bech, M. B. (2014). Attitudes towards sickness absence and sickness presenteeism in health and
care sectors in Norway and Denmark: A qualitative study. BMC Public Health, 14, 880.
Krpalek, D., Meredith, P., & Ziviani, J. (2014). Investigating mediated pathways between adult attachment patterns and reported rates of absenteeism and pre-
senteeism. Journal of Workplace Behavioral Health, 29(4), 259–280.
Kumar, S., Grefenstette, J. J., Galloway, D., Albert, S. M., & Burke, D. S. (2013). Policies to reduce influenza in the workplace: Impact assessments using an agent-based
model. American Journal of Public Health, 103, 1406–1411.
Laing, S. S., & Jones, S. M. W. (2016). Anxiety and depression mediate the relationship between perceived workplace health support and presenteeism – A cross-
sectional analysis. Journal of Occupational and Environmental Medicine, 58(11), 1144–1149.
Lauzier, M., Melancon, S., & Cote, K. (2017). The effect of stress seen on absenteeism and Presenteeism behavior: The mediating role of health. Canadian Journal of
Behavioural Science – Revuew Canadienne des Sciences du Comportement, 49, 221–230.
Leineweber, C., Westerlund, H., Hagberg, J., Svedberg, P., Luokkala, M., & Alexanderson, K. (2011). Sickness presenteeism among Swedish police officers. Journal of
Occupational Rehabilitation, 21, 17–22.
Lerner, D., Amick, B. C., Rogers, W. H., Malspeis, S., Bungay, K., & Cynn, D. (2001). The work limitations questionnaire. Medical Care, 39, 72–85.
Lu, L., Cooper, C. L., & Lin, H. Y. (2013). A cross-cultural examination of presenteeism and supervisory support. Career Development International, 18(5), 440–456.
Lu, L., Lin, H. Y., & Cooper, C. L. (2013). Unhealthy and present: Motives and consequences of the act of presenteeism among Taiwanese employees. Journal of
Occupational Health Psychology, 18(4), 406–416.
Lu, L., Peng, S.-Q., Lin, H. Y., & Cooper, G. (2014). Presenteeism and health over time among Chinese employees: The moderating role of self-efficacy. Work & Stress,
28(2), 165–178.
Luksyte, A., Avery, D. R., & Yeo, G. (2015). It is worse when you do it: Examining the interactive effects of coworker presenteeism and demographic similarity. Journal
of Applied Psychology, 100(4), 1107–1123.
Markussen, S., Mykletun, A., & Røed, K. (2012). The case for presenteeism – Evidence from Norway's sickness insurance program. Journal of Public Economics,
96(11−12), 959–972.
Markussen, S., Røed, K., Røgeberg, O. J., & Gaure, S. (2011). The anatomy of absenteeism. Journal of Health Economics, 30, 277–292.
Mattke, S., Balakrishnan, A., Bergamo, G., & Sydne, J. N. (2007). A review of methods to measure health-related productivity loss. The American Journal of Management
Care, 13(4), 211–217.
McGregor, A., Iverson, D., Caputi, P., Magee, C., & Ashbury, F. (2014). Relationships between work environment factors and presenteeism mediated by employees'
health. Journal of Occupational and Environmental Medicine, 56(12), 1319–1324.
McGregor, A., Magee, C. A., Caputi, P., & Iverson, D. (2016). A job demands resources approach to presenteeism. Career Development International, 21(4), 402–418.
McKevitt, C., Morgan, M., Dundas, R., & Holland, W. W. (1997). Sickness absence and ‘working through’ illness: A comparison of two professional groups. Journal of
Public Health Medicine, 19(3), 295–300.
Merchant, J. A., Kelly, K. M., Burmeister, L. F., Lozier, M. J., Amendola, A., Lind, D. P., ... Buikema, B. S. (2014). Employment status matters – A statewide survey of
quality-of-life, prevention behaviors, and absenteeism and presenteeism. Journal of Occupational and Environmental Medicine, 56(7), 686–698.
Merrill, R. M., Aldana, S. G., Pope, J. E., Anderson, D. R., Coberley, C. R., Whitmer, R. W., & the HERO Research Study Subcommittee (2012). Presenteeism according
to healthy behaviors, physical health, and work environment. Population Health Management, 15(5), 293–301.
Miraglia, M., & Johns, G. (2016). Going to work ill: A meta-analysis of the correlates of presenteeism and a dual-path model. Journal of Occupational Health Psychology,
21(3), 261–283.
Nerdinger, F. W. (2014). Motivierung (Motivation). In H. Schuler, & U. P. Kanning (Eds.). Lehrbuch der Personalpsychologie (Personnel psychology) (pp. 725–764). (3rd
ed.). Göttingen: Hogrefe.
Niven, K., & Ciborowska, N. (2015). The hidden dangers of attending work while unwell: A survey study of presenteeism among pharmacists. International Journal of
Stress Management, 22(2), 207–221.
Orlitzky, M., & Frenkel, S. J. (2005). Alternative pathways to high-performance workplaces. International Journal of Human Resource Management, 16, 1325–1348.
Ospina, M. B., Dennett, L., Waye, A., Jacobs, P., & Thompson, A. (2015). A systematic review of measurement properties of instruments assessing presenteeism. The
American Journal of Management Care, 2(2), e171–e185.
Pichler, S., & Ziebarth, N. R. (2017). The pros and cons of sick pay schemes: Testing for contagious presenteeism and noncontagious absenteeism behavior. Journal of
Public Economics, 156, 14–33.
Pirkovitsch, A. (2007). Wer fiebert macht Fehler. (Having a temperature causes mistakes). Wirtschaftswoche Süd, 2/2007, 32.
Pit, S. W., & Hansen, V. (2016). The relationship between lifestyle, occupational health, and work-related factors with presenteeism amongst general practitioners.
Archives of Environmental and Occupational Health, 71(1), 49–56.
Pohling, R., Buruck, G., Jungbauer, K., & Leiter, M. P. (2016). Work-related factors of presenteeism: The mediating role of mental and physical health. Journal of
Occupational Health Psychology, 21(2), 220–234.
Preisendörfer, P. (2010). Präsentismus. Prävalenz und Bestimmungsfaktoren unterlassener Krankmeldungen bei der Arbeit. (Presenteeism. Prevalence and determi-
nants of the failure to sign off sick from work). Zeitschrift für Personalforschung, 24(2), 401–408.
Reffstrup Christensen, J., Overgaard, K., Hansen, K., Sogaard, K., & Holtermann, A. (2013). Effects on presenteeism and absenteeism from a 1-year workplace
randomized controlled trial among health care workers. Journal of Occupational and Environmental Medicine, 55, 1186–1190.
Robertson, I., Leach, D., Doerner, N., & Smeed, M. (2012). Poor health but not absent prevalence, predictors, and outcomes of presenteeism. Journal of Occupational and
Environmental Medicine, 44, 1344–1349.
Rosvold, E. O., & Bjertness, E. (2001). Physicians who do not take sick leave: Hazardous heroes? Scandinavian Journal of Public Health, 29(1), 71–75.
Rousculp, M. D., Johnston, S. S., Palmer, L. A., Chu, B.-C., Mahadevia, P. J., & Nichol, K. L. (2010). Attending work while sick: Implication of flexible sick leave
policies. Journal of Occupational and Environmental Medicine, 52, 1009–1013.
Saridakis, G., Lai, Y., & Cooper, C. L. (2017). Exploring the relationship between HRM and firm performance: A meta-analysis of longitudinal studies. Human Resource
Management Review, 27, 87–96.
Schmid, J. A., Jarczok, M. N., Sonntag, D., Herr, R. M., Fischer, J. E., & Schmid, B. (2017). Association between supportive leadership behavior and the costs of
absenteeism and presenteeism. Journal of Occupational and Environmental Medicine, 59(2), 141–147.
Schnee, M., & Vogt, J. (2013). Burnout, Mobbing und Präsentismus – Zusammenhänge und Präventionsmaßnahmen. (Burnout, mobbing and presenteeism –
Correlations and preventive measures). In J. Böcken, B. Braun, & U. Repschläger (Eds.). Gesundheitsmonitor 2012 (Health monitor 2012) (pp. 99–117). Gütersloh:
Bertelsmann Stiftung.
Shikiar, R., Halpern, M. T., Rentz, A. M., & Khan, Z. M. (2004). Development of the health and work questionnaire (HWQ): An instrument for assessing workplace
productivity in relation to worker health. Work, 22(3), 219–229.
Skagen, K., & Collins, A. M. (2016). The consequences of sickness presenteeism on health and wellbeing over time: A systematic review. Social Science & Medicine, 161,
169–177.
Steinke, M., & Badura, B. (2011). Präsentismus – Ein Review zum Stand der Forschung (Presenteeism – A review of the status quo of research). Dortmund: Bundesanstalt für
Arbeitsschutz und Arbeitsmedizin. http://www.baua.de/de/Publikationen/Fachbeitraege/Gd60.html, Accessed date: 14 September 2017.
Stewart, W. F., Ricci, J. A., Chee, E., & Morganstein, D. (2003). Lost productive work time costs from health conditions in the United States: Results from the American
productivity audit. Journal of Occupational and Environmental Medicine, 45(12), 1234–1246.
Stromberg, C., Aboagye, E., Hagberg, J., Bergström, G., & Lohela-Karlsson, M. (2017). Estimating the effect and economic impact of absenteeism, presenteeism, and
work environment-related problems on reductions in productivity from a managerial perspective. Value in Health, 20, 1058–1064.
Sumanen, H., Lahelma, E., Lahti, J., Pietiläinen, O., & Rahkonen, O. (2016). Educational differences in sickness absence trends among young employees from 2002 to

57
D. Lohaus, W. Habermann Human Resource Management Review 29 (2019) 43–58

2013 in Helsinki, Finland. BMJ Open, 6, e008550.

Taloyan, M., Aronsson, G., Leineweber, C., Magnusson Hanson, L., Alexanderson, K., & Westerlund, H. (2012). Sickness presenteeism predicts suboptimal self-rated
health and sickness absence: A nationally representative study of the Swedish working population. PLoS One, 7(9), e44721.
Taylor, P., Baldry, C., Bain, B., & Ellis, V. (2003). “A unique working environment”: Health, sickness and absence management in UK call centres. Work, Employment
and Society, 17(3), 435–458.
Theorell, T. (2017). Downsizing in Europe: A social perspective. Scandinavian Journal of Public Health, 45(2) (Advanced publication).
Thun, S., & Løvseth, L. T. (2016). A health impairment process of sickness presenteeism in Norwegian physicians: The mediating role of exhaustion. Health, 8, 846–856.
Van De Voorde, K., Paauwe, J., & Van Veldhoven, M. (2012). Employee well-being and the HRM–organizational performance relationship: A review of quantitative
studies. International Journal of Management Reviews, 14, 391–407.
Vanni, K., Neupane, S., & Nygard, C.-H. (2017). An effort to assess the relation between productivity costs and presenteeism at work. International Journal of
Occupational Safety and Ergonomics, 23(1), 33–43.
Vingård, E., Alexanderson, K., & Norlund, A. (2004). Sickness presence. Scandinavian Journal of Public Health, 32, 216–221.
Vogt, J., Badura, B., & Hollmann, D. (2010). Krank bei der Arbeit: Präsentismusphänomene. (Ill at work: Presenteeism phenomena). In J. Böcken, B. Braun, & J.
Landmann (Eds.). Gesundheitsmonitor 2009 (Health monitor 2009). Gütersloh: Bertelsmann Stiftung.
Vroom, V. H. (1964). Work and motivation. New York: Wiley.
Vroome, E. (2006). Prevalence of sickness absence and ‘presenteeism’. http://eurofound.europa.eu/ewco/2006/07/NL0607019I.htm, Accessed date: 14 September
2017.
Wada, K., Arakida, M., Watanabe, R., Negishi, M., Sato, J., & Tsutsumi, A. (2013). The economic impact of loss of performance due to absenteeism and presenteeism
caused by depressive symptoms and comorbid health conditions among Japanese workers. Industrial Health, 51, 482–489.
Walker, T. J., Tullar, J. M., Diamond, P. M., Kohl, H. W., III, & Amick, B. C., III (2017). Association of self-reported aerobic physical activity, muscle-strengthening
physical activity, and stretching behavior with presenteeism. Journal of Occupational and Environmental Medicine, 59, 474–479 (advanced publication).
Wang, J. L., Schmitz, N., Smailes, E., Sareen, J., & Patten, S. (2010). Workplace characteristics, depression, and health-related presenteeism in a general population
sample. Journal of Occupational and Environmental Medicine, 52, 836–842.
Warren, C. L., White-Means, S. I., Wickes, M. N., Chang, C. F., Gourley, D., & Rice, M. (2011). Cost burden of the presenteeism health outcome: Diverse workforce of
nurses and pharmacists. Journal of Occupational and Environmental Medicine, 53, 90–99.
Wohlers, K., & Hombrecher, M. (2016). Entspann dich Deutschland – TK Stressstudie. (Relax Germany – Study of stress by the Techniker Krankenkasse). Hamburg: Techniker
Krankenkasse.
Wu, S., Wang, R., Zhao, Y., Ma, X., Wu, M., Yan, X., & He, J. (2013). The relationship between self-rated health and objective health status: A population-based study.
BMC Public Health, 13, 320–328.
Yang, T., Shen, Y.-M., Zhu, M., Liu, Y., Deng, J., Chen, Q., & See, L.-C. (2016). Effects of co-worker and supervisor support on job stress and presenteeism in an aging
workforce: A structural equation modelling approach. International Journal of Environmental Research and Public Health, 13, 72.
Ybema, J. F., Smulders, P. G., & Bongers, P. M. (2010). Antecedents and consequences of employee absenteeism: A longitudinal perspective on the role of job
satisfaction and burnout. European Journal of Work and Organizational Psychology, 19, 102–124.
Yildiz, H., Yildiz, B., Zehir, C., & Aykaç, M. (2015). The antecedents of presenteeism and sickness absenteeism: A research in Turkish health sector. Procedia – Social and
Behavioral Sciences, 207, 398–403.
Zhang, W., Bansback, N., & Anis, A. H. (2011). Measuring and valuing productivity loss due to poor health: A critical review. Social Science and Medicine, 72, 185–192.
Zhang, W., Sun, H., Woodcock, S., & Anis, A. (2015). Illness related wage and productivity losses: Valuing ‘presenteeism’. Social Science & Medicine, 147, 62–71.
Zhou, Q., Martinez, L. F., Ferreira, A. I., & Rodrigues, P. (2016). Supervisor support, role ambiguity and productivity associated with presenteeism: A longitudinal
study. Journal of Business Research, 69, 3380–3387.

58