CPD: Prevalence and causes of presenteeism among UK charity helpline workers

Providing expert psychological interventions, such as clinical supervision and access to counselling, can make a real difference when it comes to supporting charity helpline workers, argue Ann O’Flynn and Professor Gail Kinman. Occupational health professionals also have an important role to play.

This article reports on a study of presenteeism among UK home-based charity helpline workers. Sickness presenteeism, defined as continuing to work while feeling ill (Johns, 2010) is growing in the UK.

Individuals working while unwell because of both physical and mental health conditions is thought to be considerably more prevalent and more costly than absenteeism.

Hampson (2020) estimates the financial cost of presenteeism in the UK at £29bn, four times higher than sickness absence, due to decreased productivity, errors, accidents, injuries and duplicated effort.

Nonetheless, under certain conditions, presenteeism can benefit wellbeing, aiding recovery by offering employees structure, social connection and supporting self-esteem (Kinman and Grant, 2021). It is therefore important to distinguish between functional and dysfunctional presenteeism (Karanika-Murray and Biron, 2020).

Dysfunctional presenteeism can be driven by organisational, occupational and individual factors including cultures that stigmatise absence and incentivise presence, inadequate job resources or support, excessive demands, lack of control over work and personal choice regarding work attendance (Gerich, 2014; Kinman et al, 2019; Demerouti et al, 2009).

Terms and conditions of employment, such as the availability of sick pay and sanctions against absence can also discourage employees from taking sick leave (Oakley, 2023; DeRigne et al, 2016). Moreover, presenteeism is more common in occupations with a strong sense of duty or ethical responsibility, where service quality may be affected (Kinman, 2019).

Context and aims of this study

The home-based workforce in the study operates every day of the year, handling complex enquiries. Employees receive up to six months of full or half pay during sickness absence (depending on length of service) and have access to an employee assistance programme, private medical insurance, and various health and wellbeing-related products and services. The organisation’s absence policy includes trigger points for management intervention.

The Contact Centre Management Association (CCMA) provided comparative statistics for the organisation against other contact centres that are members, indicating higher salaries, shorter working weeks, lower turnover and three times more development and training hours than average for the sector.

Around 62% of staff have flexible working arrangements in place. The CCMA identified a high ‘occupancy’ rate of 86%, referring to the amount of time that staff spend engaging directly with customers, which is a measure of job demand.

They advised that this rate poses a risk of burnout due to insufficient recovery time between contacts. However, 85% of staff reported being able to manage their workload.

Wellbeing breaks and debrief time are provided, along with monthly clinical supervision and support from wellbeing champions, mental health first aiders, staff association representatives and safeguarding officers.

The organisation’s sickness absence rate is average for the sector. The average prevalence of presenteeism among participating sector organisations was 69%, but no comparative information is available on the organisation’s rate of sickness presenteeism.

To develop targeted interventions that reduce dysfunctional sickness presenteeism, it is crucial to understand its prevalence and the reasons people work while sick. The study aimed to explore these issues.

The method

An online survey was administered to 444 UK, home-based employees. The survey asked respondents if and why they had worked while ill, either with a mental health (MH) or physical health (PH) condition.

The prevalence of presenteeism was calculated and a thematic analysis conducted to explore the reasons provided for working while sick.

The sample

The response rate was 79%. Of the 350 respondents that completed the survey, 94% worked from home and 5% followed a hybrid pattern between home and the office.

Concerning occupation, 53% were helpline workers, 34% were first line managers, 8% were middle managers, and 5% were senior managers.

Analytical approach

The prevalence of self-reported presenteeism for both MH and PH was calculated representing the percentage of respondents who reported working while sick for these conditions, no time period was specified.

The reasons provided for doing so were analysed thematically using the six-step method developed by Braun and Clarke (2006) as it is well suited to inductive, experiential analysis of large qualitative datasets.

The study was not informed by a single theoretical approach but drew on Karanika-Murray and Biron’s framework described above that categorises presenteeism as potentially harmful (in other words, dysfunctional and overachieving) and potentially beneficial (in other words, functional and therapeutic).

Findings

Presenteeism was found to be common in this workforce, with 78% reporting having worked with an MH condition, and 62% with a PH condition.

The reasons employees provided for working while ill tended to differ from those identified in previous research.

Rather than dysfunctional reasons, presenteeism was largely attributable to two key themes aligned with the functional and therapeutic perspective:

1. the illness was not considered severe enough to require time off work, and
2. work served as a source of focus, motivation, or distraction when unwell.

The next section explores these themes in greater depth.

1. Not a legitimate reason for absence:

The primary reason for working while ill (for both mental health and physical health) was that respondents felt their condition was not severe enough to justify absence. One respondent described presenteeism as a “spectrum, and it doesn’t always feel like something that justifies being off sick”.

Another participant commented: “it has to be extreme” to take time off. Some sub-themes were identified that expanded on this issue.

Living with a long-term condition. A total of 30 people cited this multi-faceted sub-theme for MH and 13 for PH.

Examples of enduring health conditions experienced by participants included anxiety, cancer, chronic fatigue, migraines, functional bowel disorders and menopausal symptoms.

Some reported working when “the challenge was not enough to call in sick”, while others found it difficult to decide whether they were feeling sufficiently unwell to be off sick.

As one respondent commented in relation to MH symptoms: “It can sometimes feel like you’re well enough to be at work even if you can’t stop crying.”

Others were more fatalistic, recognising that their symptoms were not going to improve so they just “have to live with them”.

Working through short-term illness. A total of 21 people cited this as a reason for presenteeism related to PH but only one person for MH, who described having a temporary panic attack.

Respondents reported having worked with colds, ‘bugs’ and other ailments such as headaches, back pain and minor physical injuries, believing they were not bad enough to take time off work.

Others mentioned being able to perform selective work tasks when unwell, enabling them to work in some capacity. Disrupted sleep was mentioned by several people as impairing health but not considered sufficiently serious to take sick leave, for example: “I sometimes don’t sleep well, and this can make a workday more difficult.”

Taking time off being unsustainable. Some participants with a long-term condition observed that if they started to take time off “there would be no end to it”.

One commented: “It’s a long-term condition therefore I adjust and manage, even on bad days” and another “If I was off every time I experienced these (symptoms) I’d hardly be at work.”

2. Work being therapeutic for wellbeing:

This was the second most dominant theme overall, particularly for presenteeism related to MH, with 39 comments about MH and 11 for PH.

Participants generally observed that continuing to work was therapeutic for MH, being typically considered “a good distraction”. As one person commented: “By keeping going it can lift those negative emotions/feelings at times.” Some subthemes were also identified.

Feeling better at work and worse when not working. A total of 19 people cited this reason for continuing to work, for example: “Not being at work would have been worse for my mental health” and “When I feel this way I don’t feel like not being at work will help”.

Work as a distraction from difficulties. A total of 14 people considered work was a diversion or even a kind of sanctuary, with examples including: “Sometimes work can act as a distraction when other things in life are challenging” and “work can serve to take your mind off things that are going wrong in your personal life”, or “I feel work is a safe place to escape, sometimes”.

Work giving purpose and structure. A total of seven people reported that work provided them with a sense of purpose and self-esteem, which they considered beneficial for wellbeing.

For example: “Work is an area where I feel better about myself and my abilities, so it usually makes me feel good to work.”

Others found the routine and structure of work helpful when ill: for example: “Attending work, keeping to schedules and maintaining structure is helpful for my mental health.”

Several minor themes were also developed from the analysis, providing further insight into the reasons why participants worked while sick.

They included concerns about work ‘piling up’ during their absence, fears of initiating the absence management process, a sense of duty to people using the service or to colleagues, and not wanting to let people down.

Perhaps surprisingly, few people cited working from home as a reason for working while ill, with only one person citing it for MH.

Comments included: “Working from home allows me to work even with health challenges as I have no commute, can rest on breaks, and my health is not being put at risk by face-to-face interaction with others.”

Another respondent highlighted infection control as a benefit of home-based working: “because I am working from home I am not a risk to others from an infection control point of view so I am more likely to work with cold or flu.”

However, some less positive factors were identified, such as the blurring of boundaries while working at home encouraging dysfunctional presenteeism. For example: “I tend to push through when I can as feel it more difficult to determine where my limits are when I am home working.”

Very few people mentioned a lack of support from managers, peers or the organisation itself, indicating that they believed adequate support is available.

Summary of findings

This study found that presenteeism is commonplace among home-based UK charity helpline workers, especially for mental health issues.

The reasons given for presenteeism fell into two main themes. Firstly, work was viewed as a helpful source of distraction while ill, providing structure, a sense of meaning and connection with others. Secondly, individuals believed their condition, whether long-term or episodic, was not severe enough to justify absence.

Overall, the study’s findings contrast with previous research that identifies job demands, lack of resources and support, and poor organisational policy as factors that encourage presenteeism (Demerouti et al, 2009; Kinman et al, 2019).

Given the high work rate highlighted in the CCMA report, it is surprising that more respondents did not cite heavy job demands as a reason for presenteeism. Some did mention challenges in managing workloads and concerns about workload being left to be completed on their return.

To reduce the risk of presenteeism, Demerouti et al (2009) recommends providing task variety, adequate breaks and recovery time, and increasing autonomy regarding where, when and how work is completed.

In a study of the UK prison service that are likely to be relevant to other sectors, Kinman et al (2019) identified the need for an appropriate, equitable absence policy and maintaining adequate staffing levels, including cover for absence to reduce presenteeism.

The same study also highlighted the negative impact of poor communication on absent employees, who may perceive well-intentioned contact from managers as intrusive monitoring.

This perception is likely to stigmatise absence and contribute to increased presenteeism. In the current study, some respondents expressed concerns about triggering absence management processes and the potential burden on colleagues if they took sick leave. However, these were not the dominant themes, and the variety of effective support provided may mitigate the harmful effects of job design and demands.

The findings revealed that people often work while unwell for therapeutic and functional reasons, expressing a desire to maintain a sense of normality.

However, whether presenteeism is beneficial or potentially damaging can be difficult to detect in remote work settings, where signs of illness are less visible. As a result, presenteeism may remain hidden, leading to potential long-term consequences for both employee wellbeing and productivity.

Guidance produced for the Society of Occupational Medicine by Kinman and Grant (2021) recommends that managers of home-based workers are trained to detect signs of struggle and how to help employees set boundaries to detach themselves from work when ill.

Allowing people more control over when they work, especially individual scheduling, may help accommodate the needs of people with long-term health conditions.

Asynchronous working can be particularly helpful as it does not require the entire workforce to be present simultaneously, so offering greater flexibility in when tasks are completed and potentially alleviating work pressure (Gyekye, 2021). Kinman & Grant (2021) outline practical actions that organisations can take to reduce presenteeism.

These include identifying the causes and risks by consulting staff and involving them in decision-making, ensuring that policies and practice are appropriate, monitoring workload and providing flexibility in work patterns.

The key role of occupational health professionals in reducing dysfunctional sickness presenteeism is also highlighted. Perhaps most importantly, fostering a culture that promotes health and self-care while encouraging people to take sick leave when necessary is essential.

Conclusion

The finding that presenteeism in this case was not primarily driven by factors commonly identified in research, such as job design, policy, organisational culture, or work demands, has both practical and theoretical implications.

It suggests that appropriate support and interventions can act as buffers against these factors, potentially reducing the likelihood of dysfunctional presenteeism. Moreover, the availability of supportive wellbeing resources and a strong culture of support in the organisation may encourage employees to take time off sick to recover if they believe this is warranted.

The finding that prevalence of presenteeism was more common for mental health conditions than physical illness is significant, suggesting that more targeted support may be needed.

Providing expert psychological interventions, such as clinical supervision and access to counselling for roles with high emotional demands appeared to help employees in this case.

Occupational health has a clear role here in working with employees and managers to ensure that working while not fully fit is genuinely therapeutic and not due to pressure or unrealistically high expectations of the individual or others.

Finally, the findings for this specific workforce are important theoretically as they highlight distinct reasons for presenteeism provided by a homeworking, public facing workforce, contrasting with previous research that has focused mainly on office-based roles.

This may encourage employers to design work that offers agency, latitude and flexibility, while enhancing support to mitigate harm from high emotional demands.

• With thanks to Dr Jonathan Houdmont, assistant professor of occupational health psychology at the University of Nottingham, who supervised the research that fed into this article.

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