3.3.1 Presenteeism.

Thirteen of the studies defined presenteeism [1,2,17,21,27,38–40,43,45–48]. Across most studies, the definition of presenteeism remained consistent, with most defining it as “working while ill” [17,27,38–40,42,43,46]. Moreover, two studies emphasized that illness should warrant sick leave [39,40]. See Table 3 for a summary of the themes.

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Table 3. Summary of major themes and sub-themes for presenteeism.

https://doi.org/10.1371/journal.pmen.0000300.t003

Similarly, a study defined presenteeism as being physically present in work but being mentally or emotionally absent due to sickness, stress, injury, or family obligations [21]. This understanding of presenteeism is more flexible, considering social obligations, psychological state, and working while sick. Essentially, these definitions of presenteeism consider the state of an individual’s health while working.

Two studies reported another manifestation of the definition known as online presenteeism, which can be defined as “a situation where employees feel under pressure to always be available online and responding to work-related tasks” or “[an] employee is online or logged into the working platform but does other things, like taking care of a toddler or an elderly person” [1,21]. These two definitions contrast from the other studies as they do not involve employees working while ill, showing how differently presenteeism can manifest during telework. One study, which explicitly did not define the term, understood presenteeism as solely “a loss of productivity” [48], while another study measured presenteeism as a general assessment of an individual’s productivity and how health problems interfered with it [47].

3.3.2 Absenteeism.

Four of the studies reported a definition for absenteeism [2,21,38,42]. The understanding of absenteeism is as follows: taking sick leave from work due to illness [38,42]; being late or leaving early because of physical or emotional illness [2]; being absent from the workplace [21]. Biron et al [2] did not give an explicit definition of presenteeism but measured absenteeism using a survey question: “number of work hours missed because of a physical or mental health issue being late or leaving early because of health issue (past 7 days)”. Illness was understood as a physical or mental health issue. Borge et al [38] understood absenteeism as sickness absence from work, where employees do not engage in work activity due to sickness. Employees followed the Norwegian standard definition of sick leave: “The general rules for sickness absence permit employees to self-certify four times each year for up to three consecutive days, while the [Inclusive Workplace Agreement] permits employees to self-certify 24 days in total during a 12-month period, where each spell can last up to 8 days” [38]. Grigore [21] used the following definition “Lack of presence from workplace even though there is a social expectation for the employees to be there” which includes conceptions of the social norm of being at the workplace. Mauricio and Laranjeira [42] measured absenteeism as sick leave, being absent from work that day because of a health problem. The following studies defined illness/sickness as follows: being physically or emotionally unwell [2], sickness in general, undefined [38,42].

3.4.1 Organizational antecedents (job demand, telework).

Nine studies found that organizational antecedents can be attributed to high presenteeism and absenteeism rates among teleworkers [1,17,27,38,40,42,45,46,48]. Organizational antecedents for presenteeism behaviours included excess job demands [1,17,40,42,48] and the structure of telework. While telework gave workers the opportunity to work in a more flexible manner and reduce the risk of infection, it also added pressure on them to work while even moderately ill. [17,27,45,46]. Meanwhile, reduced access to telework was an organizational antecedent for absenteeism among teleworkers [38].

Six of the studies found that, due to high job demands, workers felt compelled to continue working despite illness [1,17,40–42,48]. With the COVID-19 pandemic and public health restrictions in place, many employees were laid off which increased pressure for the remaining employees with workers reporting a significant increase in telephone calls, emails, online meetings, and training [1]. Keightley et al [41] reported that participants, whilst working remotely, would be faced with several meetings and calls during their worktime amidst the pandemic which prevented them from completing any required tasks. Not to mention, those meetings also assigned them additional tasks that they were expected to complete [41]. As a result, ill workers who were unable to complete tasks would engage in presenteeism behaviours to avoid an increasing workload [1,42].

The way telework is structured and organized for workers creates less barriers to work despite feeling unwell, thus increasing the likelihood of them engaging in presenteeism behaviours [17,27,40,45,46]. Telework offers greater flexibility, where workers can adjust their work schedules and breaks to suit their health condition and other personal needs [17,45]. For instance, teleworkers were able to take breaks and rest in bed when sick [17,45]. A study by Gerich [40] found that management strategies such as indirect work control and telework led to presenteeism. Indirect work control (goal-directed management) encouraged employees to increase work efforts to ensure goal-attainment [40]. Due to goal attainment, increased effort was seen through the use of telework as employees intensified their work through working overtime and working despite sickness while working from home [40]. One study by Borge et al [38] assessed the relationship between telework access and sickness absenteeism and found that workers who had lower access to telework showed a higher likelihood of absenteeism.

3.4.2 Environmental antecedents (work environments, home environments).

Five studies found that environmental antecedents contributed to presenteeism behaviours among teleworkers [1,21,42,44,48], with two studies identifying environmental antecedents to absenteeism [21,38].

In the context of presenteeism, three studies addressed environmental antecedents in relation to work environments [1,21,48]. Adisa et al [1] reported that employees working from home had a harder time adapting to their new workspace. Most employees struggled to convert their homes into a dedicated space for work or did not have a manageable space to balance both familial obligations and work-related activities. Being unable to adapt to new working environments is associated with presenteeism behaviour as many individuals found it hard to maintain a proper work-life balance as it negatively impact their performance and engagement [1]. Additionally, due to the nature of working remotely from home, many individuals reported that they invested more time and resources into their job since they were managing family-related activities (e.g., home schooling and childcare responsibilities) and coping with new work environments [1]. Another study by Grigore [21] found that stress from an unhealthy work environment led to presenteeism, with working hours and duties intersecting with personal and/or family relations outside of work. Many participants reported how isolation due to working from home was associated with concentration issues, distractions, and boredom which were associated with presenteeism behaviours such as being present but disengaged during work [48]. Ultimately, productivity decreased when workers were away from a physical work environment, which contributed to presenteeism behaviours [48].

In terms of absenteeism behaviours, there were two studies that reported environmental antecedents in relation to work environments [21,38]. According to Borge et al [38] who examined employees that either teleworked or performed their work from the office, office design impacted absenteeism behaviours. They discovered that those who worked in a conventional open plan office (i.e., shared office space) were more likely to engage in absenteeism compared to employees working in a private office [38]. Within the organizational environment, Grigore [21] found that employers often fail to recognize causes of absenteeism (e.g., depression and anxiety), and often underestimate the impact these factors have on job attendance and meeting job responsibilities. They also found that when the work environment does not encourage relationships between colleagues and work is unsupportive, it can result in absenteeism [21].

Two studies reported environmental antecedents of presenteeism in relation to home environments [42,44]. Home environments include an individual’s living situation (i.e., number of occupants in a household) and the state of one’s environment when working from home. According to Mauricio and Laranjeira [42], factors such as living with a partner contributed to presenteeism behaviours in teleworkers from Portugal. Moreover, a lack of room/space to work, inadequate lighting and ventilation, uncomfortable temperature, and prolonged sitting at a table were reported to cause work function impairments leading to presenteeism while working from home [44].

3.4.3 Individual antecedents (mental health, guilt, job perception, COVID-related).

The studies reported antecedents for presenteeism behaviour including poor mental health [2], guilt [39,47], time management issues [1,48], lack of goal directed behaviour [40,42], work productivity [41,42,47], COVID-related stressors [42], and job perception (e.g., job dissatisfaction) [42]. Antecedents for absenteeism behaviour include poor mental health [2,42], job perception (e.g., job dissatisfaction and insecurity) [21] and COVID-related stressors [21,27].

One study identified generally poor mental health of workers as an explanation for presenteeism behaviour [2]. Three studies identified stress related to job insecurity as antecedents to presenteeism, whereby job insecurity creates psychological distress and the pressure to continue to work virtually while ill due to fear of unemployment [1,42]. Anxiety and worry are an antecedent for presenteeism behaviour, specifically online presenteeism where an employee feels compelled to constantly be online [1]. Four studies identified fear as an antecedent [1,21,41,42], with one study emphasizing fear of unemployment as a driver for engaging in presenteeism, working while sick [42] and one highlighting fear that pressures people to always stay present on the job [41]. These factors contributed to the occurrence of presenteeism behaviour as they are associated with the perceived need to be constantly available at work virtually, in line with online presenteeism. A qualitative study found that the sudden transition from in person to telework modes of working during the pandemic creates stress [1]. Engaging in telework depletes social and personal resources that would have otherwise been obtained through in person work, creating poor employee engagement as a component of presenteeism behaviour [1].

Two studies identified general poor mental health as a reason for absenteeism [2,42]. Mauricio and Laranjeira [42] identified that around 8% of participants reported that their sick leave absence from work was due to mental health reasons, such as depression, anxiety, or burnout. Biron et al [2] revealed “health problems” as a reason for absenteeism, where health problems were understood as “any physical or emotional problem or symptom”. Both studies understand absenteeism as absence due to either physical or mental health reasons [2,42].

Guilt was another contributing factor for presenteeism [39,47]. Brosi and Gerpott [39] noted that guilt was associated with presenteeism as they felt that their own action of not showing up forwork would fail the organization standard. Employees describe guilt towards colleagues as feeling that they have let their colleagues down if they choose not to work from home while ill. Overall, employees choose to work from home despite being ill to avoid the guilt they may experience if absence is taken. Walker et al. [47] noted that employees feel guilt when they do not appear to be online, which leads to reduced rest breaks and reduced productivity.

Poor time management is an antecedent of presenteeism, as employees may feel stress when they feel that they do not have enough time to complete tasks of heavy workload and start worrying about time [1,45]. An increase in the assigned number of tasks increases time stress, and performance in completing the work decreases consequently [48]. Yildirim [48] further explored presenteeism arising from working from home noting concentration issues, boredom, distractions at home, technical difficulties as factors that decrease work productivity. Adisa et al. [1] also focused on online presenteeism, working from home, and noted the difficulty in balancing work and life, and a general poor adaptation to work from home environments. Employees found it challenging to maintain good routines while working from home [1]. Mauricio and Laranjeira [42] revealed a strong relationship between job dissatisfaction and presenteeism; employees arriving at work with physical or psychological illness would perform work tasks at a lower ability, poorer attention and a lack of involvement. In addition, employees indicated a high tolerance of poor working conditions and a “lack of possibilities” of other opportunities as contributors to being dissatisfied with one’s job and could relate to poorer productivity in the workplace [42]. Grigore [21] stated that the more satisfied an employee is with the job, the less absence there is. Job dissatisfaction sources that lead to absenteeism include unsupportive supervisors, not being acknowledged for work or skills in the workplace, and inflexibility with procedures used to accomplish work, such as solely in person modalities of completing tasks that could otherwise be completed at home. Grigore [21] further stated that perceiving the workplace as unsupportive and unfriendly can lead to absenteeism.

Adisa et al [1] found that an increase in job demands due to the pandemic was reported by participants, possibly due to the shift from in person to online work where employers expect employees to complete more work in a limited amount of time. Grigore [21] identified stress of contracting COVID-19 as a reason for being mentally absent from work, rather than physical absence. The constant preoccupation of worrying about getting sick and the consequences of COVID-19 illness during the COVID-19 pandemic creates fear of getting infected with COVID-19. In addition, Shafer et al [27] found that COVID-19 infection decreases the likelihood of working in person compared to other respiratory diseases, indicating the potential difference in perceived risk of COVID-19 infection compared to other illnesses.

Regarding absenteeism, Shafer et al [27] found that individuals with COVID-19 illness were less likely to work compared to individuals with non-COVID-19 acute infections. Grigore [21] discussed more general stress from the pandemic can lead to employees taking absence from work to solve the personal issues they are facing or to focus on improving their mental health. Epidemiological factors influencing absenteeism include social distancing rules at work, stressed more during the pandemic than usual, fear of getting infected at work and transmitting to family, technical support issues, and giving up usual activities to ensure safety. For each category most participants reporting always or often, indicating high stress generated by the pandemic that influences decision on taking an absence from work. 78% of participants felt more stress than usual because of the pandemic compared to before the pandemic. Overall, these pandemic related findings highlighted the significant impact COVID-19 has had on workers physical presence [27], absence [21,27] as well as mental presence [21] in the workplace, implicated in presenteeism and absenteeism behaviour.

4.1.1 Overview.

Our review found that most studies defined presenteeism as working while sick, resulting in productivity loss. We found that presenteeism and sickness presenteeism were often used interchangeably, and sickness presenteeism was found to emphasize sickness as the reason for deciding to work online [17,27,38–40,42,43,46]. Additionally, online presenteeism was defined as the behaviour of feeling pressured to be constantly present online for work, which arises during sickness presenteeism, and whilst working remotely respectively [1,21]. For absenteeism, the review revealed consistent definitions across studies, describing it as taking a sick leave from work due to an illness [38,42], being late or leaving early because of an illness [2], and being physically absent from the workplace [21]Absenteeism was broadly understood as “sick leave” or “absence” from work. Based on this review, we defined presenteeism as working while ill, which can result in a loss of productivity, and absenteeism as being absent from work due to sickness.

4.1.2 Defining presenteeism and absenteeism.

The findings from this review regarding the definition of presenteeism align with previous studies that have defined the phenomenon as working despite being sick, thus reducing overall work efficiency [53]. Our understandings of presenteeism are also consistent with older definitions that defined the phenomenon as “the problem of workers being on the job, but, because of illness or other medical conditions, not fully functioning” [54]. In the broader literature, presenteeism is defined in two ways, influencing how it is measured: as an act of presenteeism (i.e., attending work while ill) or as a consequence (i.e., loss in productivity) of attending work while ill [18]. Additionally, some studies distinguished online presenteeism, which refers to unproductive work behaviours in an online setting [1,21]. Our review found that existing definitions often reflect one of these perspectives, which may explain the variability in how presenteeism is conceptualized. Regarding defining absenteeism, two quantitative studies with the context of skilled trade workers utilized consistent definitions to our study findings: “Lack of physical presence at a given setting and time where there is a social expectation for the employee to be there” [55] and being absent from the workplace [55,56]. A difference to our study findings is that Sichani et al [55] defined absence as no less than 2 hours away from the workplace during scheduled time, which was decided in consultation with construction industry experts [57] emphasized that missing two or more hours of scheduled work time is as damaging to productivity and workflow of the group as missing an entire day of work [55]. Srour et al [56] defined absenteeism as absence from the workplace, which also aligns with our findings of understanding absenteeism as an absence from the workplace, although illness is not specified as the reason for absence. In the skilled trades industry absenteeism is not limited to sick leave, it can be due to any factor deemed by the employers to be excusable, though not specified [55,56]. Srour et al [56] discussed sickness as a plausible reason for absence among construction workers.These study populations did not engage in telework, thus were not a focus of our review [55,56]. Potential gaps within the literature persist regarding absenteeism definitions as there were only four papers that explicitly defined absenteeism, which warrants further investigation.

4.4.1 Limitations.

There are a few limitations to this review. All the studies were conducted in Europe and North America, regions which are dominated by High-Income Countries. This geographical concentration suggests a potential bias towards perspectives and experiences from the Global North, with a dearth of research from the Global South where Low- and Middle-Income Countries are more prevalent. As such, there are limitations to the generalizability of this study as it does not capture the full range of perspectives from other under-researched countries nor explore content written in other languages. In the Global South, there are various factors that can shape telework experiences that may not be reflected in the existing literature. For example, differences in access to technology and societal norms may impact how presenteeism and absenteeism occur in these regions. To address this imbalance, future reviews should include non-English articles to provide a more comprehensive understanding of presenteeism and absenteeism across diverse contexts. Additionally, due to the lack of research from the Global South, future research should conduct more studies in these regions to address this knowledge gap. Further, some articles identified in this review did not contain enough information on definitions related to presenteeism and/or absenteeism nor antecedents of it, which made interpretation of the results difficult to assess. Lastly, there were only four out of 18 articles that included a definition of absenteeism. Due to the low number of studies that reported this phenomenon, this may limit the ability to conceptualize a standard definition of absenteeism. Moving forward, a separate literature search can be conducted for absenteeism.

4.4.2 Recommendations.

Our study found that presenteeism and absenteeism during telework could result from a lack of social and coping resources and support that would have otherwise been obtained from in-person work interactions [1]. To address this, employers should ensure that teleworkers are effectively trained during onboarding in the first few weeks of orientation on how to navigate the virtual workspace, including how to access social supports, and provide general resilience strategies to support virtual work. In addition, Adisa et al [1] found a factor related to job perception and working online from home is difficulty in balancing work and life, and a general poor adaptation to work from home environments [1]. Employers could consider preparing employees for telework arrangements during onboarding. Resources such as training and work from home tips can be provided to new employees to ensure an effective transition from in person experience to virtual experience. This could also help address job dissatisfaction as an antecedent to presenteeism and can bolster employee productivity. Moreover, stress management and workplace mental health interventions from a top-down organization level to employee individual-level like cognitive behavioural therapy insurance coverage, meditation, and mindfulness breaks during working hours show promise for addressing poor mental health and productivity in the workplace [64]. Additionally, providing opportunities for both virtual and in person social connections could address loneliness that comes with working in a virtual environment.

4.4.3 Future directions.

This scoping review has identified several avenues for future research to address the limitations of the current review. Notably, the majority of studies included in this review were conducted in Western, high-income countries, highlighting a gap in the understanding of the presenteeism and absenteeism behaviours of teleworkers in the Global South. Future research should explore these behaviours within diverse cultural and geographic contexts to develop a more comprehensive framework for understanding the determinants of presenteeism and abstenteeism across different settings. Moreover, research on absenteeism among teleworkers remains limited, with few studies examining its underlying factors. Given this gap, future studies should priortize investigating the relationship between telework and absenteeism to generate more rigorous findings and inform strategies for mitigating absenteeism in telework settings. Additionally, since telework may be suitable for some workers to achieve work-life balance, it would be desirable to see future research on how employers can appropriately manage, and structure telework to be conducive to a work-life balance for employees. Lastly, teleworking can help increase employment opportunities for individuals with disabilities, making it essential for future research to examine best practices in this area [65].