“Whenever I can I push myself to go to work”: a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis

Abstract

Purpose: UK government policy emphasizes the importance of continuing to work for recovery from poor health, yet sickness presenteeism (going to work whilst ill) is commonly regarded as having negative consequences for organizations and individuals. Our study explores experiences of working after onset of rheumatoid arthritis (RA), a chronic musculoskeletal disorder characterized by high rates of work disability.

Materials and methods: An exploratory qualitative study consisting of in-depth interviews and six-month follow-up with 11 men and women with RA employed at disease onset.

Results: We expand upon previous models of sickness presenteeism by distinguishing between presenteeism that occurs voluntarily (wanting to work despite illness) and involuntarily (feeling pressured to work when ill). RA onset affected participants’ ability to work, yet motivation to remain working remained high. The implementation of workplace adjustments enabled participants to stay working and restore their work capacity. Conversely, managers’ misinterpretation of organizational sickness absence policies could lead to involuntary presenteeism or delayed return to work, conflicting with the notion of work as an aid to recovery.

Conclusion: Workplace adjustments can facilitate voluntary sickness presenteeism. To reduce work disability and sickness absence, organizational policies should be sufficiently flexible to accommodate the needs of workers with fluctuating conditions.

Implications for rehabilitation

• Individuals with rheumatoid arthritis (RA) are at high risk of work disability.

• Individuals’ motivation to remain in work following onset of RA remains high, yet sickness presenteeism (working while ill) has received largely negative attention.

• It is important to distinguish between voluntary and involuntary forms of sickness presenteeism.

• Workplace adjustments facilitate voluntary sickness presenteeism (wanting to work despite illness) and improve job retention and productivity among workers with RA.

• Involuntary presenteeism (feeling pressured to work while ill) may occur if organizational policies are not sufficiently flexible to accommodate the needs of workers with RA.

Keywords:

• Sickness presenteeism
• sickness absence
• rheumatoid arthritis
• musculoskeletal disorders
• workplace adjustments
• organizational policy

Notes

Acknowledgements

The authors wish to thank the study participants for sharing with them their experiences of working following onset of rheumatoid arthritis; and the UK National Rheumatoid Arthritis Society for helping with recruitment to the study.

Disclosure statement

The authors report no conflict of interest.

Notes

1 The Statement of Fitness for Work (“Fit Note”) allows clinicians to state a patient “may be fit for work” if employers implement appropriate workplace adjustments to working hours, duties or equipment.[8] Employers and general practitioners can refer workers on sick leave to Fit for Work for free occupational health and return to work support.[9]

2 Reasonable adjustments include technical accommodations (modified computer keyboards, voice recognition software), adjustments to increase workplace accessibility (ramps, lifts), and social support interventions (adjustments to working hours, tasks and the location of work).[33]

3 The UK’s Access to Work scheme supports workers with disabilities or chronic health conditions by funding workplace adaptations, personal assistance and travel to work.