The illness flexibility model and sickness absence
Author: Johansson, Gun
Date: 2007-06-01
Location: Petrénsalen, Nobels väg 12 b, Karolinska Institutet, Solna
Time: 09.00
Department: Institutionen för folkhälsovetenskap / Department of Public Health Sciences
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thesis.pdf (6.466Mb)
Abstract
Research on sickness absence has repeatedly been described as
theoretically undeveloped. In this thesis the model of illness
flexibility is introduced. In this model, sickness absence is assumed to
be caused by people’s ability and motivation to work. Ability and
motivation will in turn be affected by conditions met in and outside
work. In the model, five basic components are discerned describing such
conditions. Adjustment latitude describes opportunities to adjust work to
health by e.g. choosing among work tasks. Attendance requirements
describe negative consequences of being absent that may make a person
attend work despite illness. Absence requirements are negative
consequences by attending work as signals of not being wanted at work.
Attendance incentives are positive consequences of attending work as
stimulating work. Absence incentives are positive consequences of being
absent as caring for relatives. The overall aim in the thesis is to test
predictions from the illness flexibility model on sickness absence and
sickness attendance.
In Paper I adjustment latitude and attendance requirements were studied
in relation to sickness absence and sickness attendance. In a
cross-sectional design data based on self-reports from a questionnaire
from inhabitants in the county of Stockholm were analysed. Low adjustment
latitude, as predicted, increased women’s sickness absence. However it
did not show any relation to men’s sickness absence and men’s and women’s
sickness attendance. Attendance requirements were strongly associated to
both men’s and women’s sickness absence and sickness attendance in the
predicted way. In paper II the aim was to study whether return to work
(RTW) after long-term sickness absence is affected by adjustment
latitude, and whether this effect differed between those returning
full-time and those returning part-time. A questionnaire was sent to
salaried employees who had been on sick-leave for at least 90 days in
2000. The year after they received a questionnaire. For both men and
women the likelihood to RTW increased, both among those returning
part-time and full-time, with increasing number of opportunities to
adjust. In paper III some components from the illness flexibility model
was studied in relation to sickness absence on longitudinal data. In
spring 2004 and in spring 2005 a random sample aged between 25 an 50
years from the Swedish population received questionnaires. The results
showed that an intermediate level of adjustment latitude, compared to a
high, was associated with an increased likelihood of being absent sick
for between 1-6 days and 7 days or more. Work with little stimulation was
associated with an increased likelihood of being absent sick for 7 days
or more. Low or intermediate scores on attendance requirements on work
were associated with an increased likelihood of being absent 7 days or
more. Financial attendance requirements and demanding home tasks were not
associated with the likelihood of being absent sick. In paper IV the
social gradient in sickness absence was studied in relation to some
components from the illness flexibility model. The sample is part of a
panel originating from 1994 of inhabitants of Stockholm County which
received a questionnaire 1994, 1998 and 2002. Only 2002 data was
analysed. The social difference found in sickness absence 31 days or more
a year decreased by 78% for women and 67% for men by adding
characteristics from the illness flexibility model and health.
In conclusion, the model of illness flexibility appears promising in
increasing our understanding of sickness absence. Future studies should
be directed to theoretical and methodological development of the
components as well as future testing of predictions from the model. Such
testing should be done with improved design and data as longitudinal
design, register-based data of sickness absence, and tested measurements
of the components of the illness flexibility model. Testing of the model
should also be directed to different actions taken when ill as the
inception of sickness absence, length of absence, RTW, and exclusion from
the labour market.
List of papers:
I. Johansson G, Lundberg I. (2004). "Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model." Soc Sci Med 58(10): 1857-68
Pubmed
II. Johansson G, Lundberg O, Lundberg I. (2006). "Return to work and adjustment latitude among employees on long-term sickness absence." J Occup Rehabil 16(2): 185-95
Pubmed
III. Johansson G, Härenstam A, Wikman A, Lundberg I. (1970). "Components of the illness flexibility model and sickness absence - a longitudinal study." (Submitted)
IV. (1970). "Components of the illness flexibility model as explanations of social class differences in sickness absence." (Submitted)
I. Johansson G, Lundberg I. (2004). "Adjustment latitude and attendance requirements as determinants of sickness absence or attendance. Empirical tests of the illness flexibility model." Soc Sci Med 58(10): 1857-68
Pubmed
II. Johansson G, Lundberg O, Lundberg I. (2006). "Return to work and adjustment latitude among employees on long-term sickness absence." J Occup Rehabil 16(2): 185-95
Pubmed
III. Johansson G, Härenstam A, Wikman A, Lundberg I. (1970). "Components of the illness flexibility model and sickness absence - a longitudinal study." (Submitted)
IV. (1970). "Components of the illness flexibility model as explanations of social class differences in sickness absence." (Submitted)
Issue date: 2007-05-11
Rights:
Publication year: 2007
ISBN: 978-91-7357-220-0
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