Critically Appraised Papers

Organizational leadership, health risk screening, individuallytailored programs, and supportive workplace culture mightreduce presenteeism

Synopsis

Summary of Cancelliere, C., Cassidy, J.D., Ammendolia,

C., & Cote, P. (2011). Are workplace health promotion

programs effective at improving presenteeism in work-

ers? A systematic review and best evidence synthesis of

the literature. BMC Public Health, 11, 395.

Objective of review: To determine if Workplace Health

Promotion programs (WHPs) are effective in improving

presenteeism. The secondary objective was to identify char-

acteristics of successful programmes and potential risk fac-

tors for presenteeism.

Search strategy: The Cochrane Library, Medline and other

electronic databases were searched from 1990 to January

2010 for all studies that examined WHP. A highly sensitive

search strategy was used including reference list checking,

hand searching, and contacting researchers.

Selection criteria: Studies: (randomised) controlled and

uncontrolled trials published in English. Participants:Unspecified diagnoses, studies with a minimum of 20 par-

ticipants 18 years or older. Interventions: Workplace-based

WHP programs aimed at promoting health and wellness,

or reducing the risk of ill-health. Primary outcome: presen-teeism.

Method of the review: Two reviewers independently identi-

fied relevant trials, assessed the methodological quality

of each trial using the Effective Public Health Practice Pro-

ject Quality Assessment Tool for Quantitative Studies and

extracted the following data: (1) country and workplace,

(2) study design, (3) characteristics of participants, (4)

inclusion and exclusion criteria, (5) intervention(s) and con-

trol(s), (6) outcome measurements and follow up periods,

and (7) key findings and limitations. A best evidence syn-

thesis was performed, (as there was insufficient homogene-

ity for a meta-analysis) based on the results of studies rated

as possessing strong and moderate methodological quality.

Main findings: Fourteen studies (four strong and ten mod-

erate methodological quality) were eligible for inclusion. A

further 33 were considered ineligible for inclusion due to

methodological weakness. The 14 eligible studies contained

preliminary evidence for a positive effect of some WHP

programs. Successful programs offered organizational

leadership, health risk screening, individually tailored pro-

grams, and a supportive workplace culture. Potential risk

factors contributing to presenteeism included being over-

weight, poor diet, lack of exercise, high stress, and poor

relations with co-workers and management.

Authors’ conclusions: There is preliminary evidence that

some WHP programs can positively affect presenteeism

and that certain risk factors are of importance. The presen-

teeism literature is young and heterogeneous.

Contact details of original author: Dr. Carol Cancelliere,

ccancell@uhnresearch.ca.

Esther Steultjens

CAPs Advisory Board MemberEmail: esther.steultjens@han.nl

Commentary

Presenteeism, or sickness presenteeism, is a relatively new

construct, and refers to being present at work in spite of

being ill, thus implying productivity loss (Brooks et al.,2010; Johns, 2010; Lack, 2011). Often presenteeism is seen

as the alternative to absenteeism, even though studies have

revealed a strong association between absenteeism and

presenteeism (Leineweber et al., 2012). Cancelliere and her

colleagues have completed a rigorous systematic review

which examined the effect of WHP on reducing presentee-

ism. The primary strengths of this review are the thorough

and informative description of each study. The authors

have also provided a very good overview of the interven-

tions involved in the 14 studies. Despite the rigor in study

design, the resulting article provides only limited utility

due to heterogeneity of interventions and outcomes in

available studies. The review seems therefore most suitable

to inform or enlighten practice (Aas & Alexanderson,

2012), not to determine the effectiveness of WHP in reduc-

ing presenteeism.

Cancelliere and her colleagues defined WHP as any pro-

gram that might affect presenteeism. The WHP evaluated

could include behavioural, physiological, organizational,

or environmental changes, or any combination of these. As

a result no two studies examined similar WHP, or even

included participants with similar disabilities. The ten

© 2012 TheAuthorsAustralianOccupational Therapy Journal© 2012OccupationalTherapyAustralia

Australian Occupational Therapy Journal (2012) 59, 247–250 doi: 10.1111/j.1440-1630.2012.01019.x

studies that were reported to have a positive effect on pre-

senteeism varied from worksite exercise program to ergo-

nomic interventions. The four studies not demonstrating a

positive effect had similar attributes to those found in the

positive studies. Delivery methods were also similar. Thus,

it is difficult to determine which WHP may be effective in

reducing presenteeism.

A few trends were apparent through the review. Seventy

per cent of successful programs screened employees, as

opposed to only 25% of non-successful studies. Seventy

per cent of successful programs tailored the program to the

employee, while only 50% of the non-successful programs

did. Other attributes that were common to the successful

programs included: involving employee supervisors and

managers; targeting organization and environmental fac-

tors to influence behaviour; improving supervisor/man-

ager knowledge regarding mental health; and allowing

exercise to occur during work hours. However, this list,

too, is very varied and provides limited applicability in

designing or implementing a WHP.

Since there is no consensus on how to best measure pre-

senteeism (Brooks et al., 2010; Terry & Min, 2010), the

authors were unable to compare the effectiveness of each

study on a common outcome measure. Studies using out-

come measures for work ability, work performance and

working role function were also interpreted as presentee-

ism. The interventions were primarily designed to promote

health and work ability, not reduce presenteeism.

There are many reasons for not being productive at

work. Some employees attend work with acute illnesses

which might limit their work capacity temporary. Others

with chronic diseases may have long term or varying

reduced productivity. One of the concerns related to the

construct of presenteeism is whether work should only be

available for people who can give 100% effort. Presentee-

ism research naturally stresses the monetary cost of presen-

teeism (Schultz, Chen & Edington, 2009), but does not

acknowledge the importance of work for health and well-

being (Baker & Jacobs, 2003). Consideration of all types of

societal costs in the calculation of the impact of reduced

work capacity may become an important factor as the con-

struct of presenteeism continues to be explored.

Nancy Baker

University of Pittsburgh,Pittsburgh, PA, USAEmail: nab36@pitt.edu

Randi W. Aas

PreSenter, IRISPreSenter, Oslo and Akershus University College,

Oslo, NorwayEmail: randi.aas@iris.no

References

Aas, R. W. & Alexanderson, K. (2012). Challenging evidence-

based decision-making: A hypothetical case study about

return to work. Occupational Therapy International, 19, 28–44.Baker, N. A. & Jacobs, K. (2003). The nature of working in the

United States: An occupational therapy perspective. Work,

20, 53–61.Brooks, A., Hagen, S. E., Sudhakar, M. S., Sathyanarayanan, S.,

Schultz, A. B. & Edington, D. W. (2010). Presenteeism: Criti-

cal issues. Journal of Occupational Medicine, 52, 1055–1067.Johns, G. (2010). Presenteeism in the workplace: A review and

research agenda. Journal of Organizational Behavior, 31, 519–542.

Lack, D. M. (2011). Presenteeism revisited. A complete review.

AAOHN Journal, 59 (2), 7789.

Leineweber, C., Westerlund, H., Hagberg, J., Svedberg, P. &

Alexanderson, K. (2012). Sickness presenteeism is more than

an alternative to sickness absence: Results from the

population-based SLOSH study. International Archives of

Occupational and Environmental Health, doi:10.1007/s00420-

012-0735-y.

Schultz, A. B., Chen, C. Y. & Edington, D. W. (2009). The cost

and impact of health conditions on presenteeism to employ-

ers: A review of the literature. Pharmacoeconomics, 27 (5),

365–378.Terry, P. E. & Min, Xi. (2010). An examination of Presenteeism

measures: The association of three scoring methods with

health, work life, and consumer activation. Population Health

Management, 13, 297–307.

© 2012 The AuthorsAustralian Occupational Therapy Journal © 2012 Occupational Therapy Australia

248 CRITICALLY APPRAISED PAPERS