CME AVAILABLE FOR THIS ARTICLE AT ACOEM.
ORG
Measuring Presenteeism From Work Stress
The Job Stress-Related Presenteeism Scale
Cynthia Mathieu, PhD, and Brad Gilbreath, PhD
Objective: Presenteeism can result from a variety of causes, one of which is job
stress. This study examined the factor structure and validity of the Job Stress-Related
Presenteeism Scale (JSRPS). Methods: Using three organizational samples,
the study aimed to determine the factor structure of the JSRPS, its relationship
to a sickness presenteeism scale, and the association between the JSRPS and asso-
ciated concepts. Results: Exploratory and confirmatory factor analyses supported a
reliable 6-item, 2-factor model for the JSRPS. JSRPS scores were associated with
higher levels of psychological distress, workplace harassment, and turnover inten-
tions and lower levels of job satisfaction, and work engagement. The JSRPS had
stronger associations with psychological distress and workplace harassment than
did the Stanford Presenteeism Scale. Conclusions: Results suggest that the JSRPS
provides a valid measure of presenteeism resulting from job stress.
Keywords: job stress-related presenteeism, presenteeism, engagement,
sickness, psychological distress, workplace harassment
P resenteeism is often believed to be a bigger problem than
absenteeism.1–3 The construct we are studying—job stress-related
presenteeism—may therefore be useful for both researchers and man-
agers. Researchers want to characterize the way work environments af-
fect employees, and managers want to maximize employee productiv-
ity. For both aims, assessing the degree to which job stress-related
presenteeism is occurring in a workforce could be useful.
Job stress-related presenteeism “occurs when employees are at
work, but, because of job stress, only a portion of their cognitive energy
is devoted to their work.”4 In other words, mental resources that other-
wise would be devoted to work are being drained by efforts to cope with
stressors. Constructs related to job stress-related presenteeism include
daydreaming,5 off-job focus,6 and off-task attention.7 Scales designed
to measure those constructs are general in nature; that is, they are not
cause-based but seek to measure the proportion of time employees are
not thinking about their work, unrelated to any particular stimulus.
Presenteeism seems to have always been tied to a cause. The cause of
presenteeism we focus on in this article is job stress.
Research thus far suggests that job stress-related presenteeism
has strong associations with well-being. Karimi and colleagues8 found
strong associations between nurses’ reports of their well-being and
how often they experienced job stress-related presenteeism on the job.
Gilbreath and Karimi4 found job stress-related presenteeism to be cor-
related with, but not redundant to, a measure of job stress. They also
found negative supervisor behavior to be strongly associated with em-
ployees' job stress-related presenteeism.4 Employees' job stress-related
presenteeism was related to negative supervisor behaviors such as fail-
ing to properly monitor and manage group dynamics, making decisions
that affect employees without seeking their input, showing disinterest in
From the Business School, Université du Québec à Trois-Rivières, Trois-Rivieres,
Quebec, Canada (Dr Mathieu); and Hasan School of Business, Colorado State
University–Pueblo, Pueblo, Colorado (Dr Gilbreath).
Mathieu and Gilbreath have no relationships/conditions/circumstances that present
potential conflict of interest.
The JOEM editorial board and planners have no financial interest related to this research.
Address correspondence to: Cynthia Mathieu, PhD, Business Department, Universite
du Quebec a Trois-Rivieres, P.O. Box 500, Trois-Rivieres, Quebec, Canada G9A
5H7 (cynthia.mathieu@uqtr.ca).
Copyright © 2022 American College of Occupational and Environmental Medicine
DOI: 10.1097/JOM.0000000000002753
210
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
CME Learning Objectives
After completing this enduring educational activity,
the learner will be better able to:
 Examine the factor structure and validity of the Job-
Stress-Related-Presenteeism Scale (JSRPS)
 Discuss the structure of the JSRPS and its relationship
to a sickness presenteeism scale
 Explore the association between the JSRPS and associated
concepts
employees’ ideas and projects, being easily threatened by competent
employees, remaining aloof from employees, and ignoring employees’
suggestions.4 The more frequently an employee’s immediate boss en-
gaged in those behaviors, the higher the employee's job stress-related
presenteeism.
The overall goal of the present manuscript is to introduce the
Job Stress-Related Presenteeism Scale (JSRPS) to a wider audience
and test its validity. The need for a measure of presenteeism, as we dis-
cuss in the following paragraphs, stems from the predominant focus
on physical illness symptoms and the lack of consideration of mental
health symptoms when defining the concept of presenteeism.
Limitations of Research on Presenteeism
While our focus is job stress-related presenteeism, in this section
of the article we aim to contribute to the field by raising what we consider
to be limitations of the current stream of research on presenteeism: It
has not acknowledged one of the earliest scholarly conceptualizations
of presenteeism, it has under-emphasized non-sickness-based causes
of presenteeism, and it lacks a validated scale for assessing job
stress-related presenteeism.
According to the Oxford English Dictionary (OED), the earliest
use of the term “presenteeism” dates to 1931. Although researchers typ-
ically do not use dictionary definitions of constructs, how the OED’s
lexicographers defined presenteeism is interesting: The fact or condition
of being present, esp. at work; (Brit.) (a) the practice of working more
hours than is required by one’s terms of employment, or of continuing
to work without regard to one’s health, esp. because of perceived job in-
security; (b) the practice of attending a job but not working at full capac-
ity, esp. because of illness or stress (emphasis added).
Cooper,9 who introduced the concept of presenteeism to manage-
ment and psychology, referred to it as “the huge costs to public and private
sector organizations of people turning up to work, who are so distressed
by their jobs or some aspect of the organizational climate that they contrib-
ute little, if anything, to their work.” The gist of Cooper's conceptualiza-
tion of presenteeism is that although physically present at work, em-
ployees suffering from presenteeism are somewhat mentally absent, and
this mental absence is linked to workplace stressors.
Cooper's9 definition (ie, employees who contribute little to their
work because they are distressed about some aspect of their work-
place) was an aside included in a book chapter that dealt with creat-
ing healthy work organizations. The fact that this was not a highly
visible or keyword-searchable definition for presenteeism must have
contributed to how Cooper's definition of job stress was superseded
JOEM • Volume 65, Number 3, March 2023
JOEM • Volume 65, Number 3, March 2023
by a sickness-based slant on presenteeism. So although he was one of
the earliest commentators on presenteeism,10 Cooper's version of pre-
senteeism was displaced by conceptualizations linking presenteeism ex-
clusively with illness (sickness).1,11 We believe this oversight has led to
unnecessary arguments to consider presenteeism as an exclusively
illness-based construct.12
Researchers who study sickness presenteeism define it as when
“employees choose to attend work despite symptoms of illness that
should prompt them to take sick leave”13 and “the phenomenon of
attending work when sick or ‘working through’ illness.”14 It is inter-
esting to note that some researchers are opting for terms other than
presenteeism in reference to that behavior.15 Claes,16 for example,
used the term sickness presence, defined as “the phenomenon that
people, despite complaints and ill-health that should prompt them
to rest and take sick leave, go to work in any case.”
Our investigations of the literature have revealed that scholarly
articles that investigate presenteeism from perspectives other than
sickness are in the minority. This is supported by Werapitiya, Opatha,
and Fernando,17 who found that within a sample of articles on
presenteeism, 58 percent of them were sickness based. Researchers fo-
cusing only on sickness as a cause of presenteeism may be capturing
only a small proportion of presenteeism occurring in organizations’
workforces. We believe that the prevalence of research on sickness
presenteeism is a function of the lack of validated scales for measuring
other forms of presenteeism, whereas there are well-established scales
for measuring sickness presenteeism.18 It also likely is a function of
the influence of the most widely cited article on presenteeism by
Aronsson, Gustafsson, and Dallner.19
Recent studies often differentiate presenteeism according to its
source.20,21 Acknowledging that the definition of presenteeism has
been extended beyond health-related causes, Yang et al22 (p. 2) define
presenteeism as “reduced productivity at work due to health problems
or other events that distract one from full productivity and are often re-
lated to health outcomes for employees and stress-related factors at
work.” Woo and Postolache23 define it as “reduced work productivity
while present at work.” Although the scope of this article does not per-
mit a review of every definition of presenteeism that has been offered,
we bring up some of the conceptualizations of presenteeism because it
is helpful to consider the broader pattern of research; considering the vary-
ing conceptualizations of presenteeism may help researchers who are in-
terested in presenteeism in particular and in lost productivity at work in
general. The different forms of presenteeism have distinct sources. They
also may have different consequences and solutions. For example, reduc-
ing sickness-based presenteeism may involve health education, improving
health practices, increasing social support, decreasing time pressure, and
appropriate staffing, whereas reducing stress-related presenteeism may
involve identifying and addressing stressors and helping employees
develop and implement coping strategies.
To summarize, several conclusions can be drawn from the litera-
ture. First, there have been differing conceptualizations of presenteeism.
Researchers, as a whole, have not viewed presenteeism as an exclusively
illness-based concept. Second, there has been significant interest in the
topic. Presenteeism is a phenomenon that seems to have been solidified
in the domain of research concepts. Third, simply using the term
presenteeism without clarifying what one is referring to could be mis-
leading. It would be helpful for presenteeism researchers to acknowl-
edge the different conceptualizations of presenteeism and to specify
what form of presenteeism they are investigating, including it in the ti-
tle of their articles. It is worth noting that the influential Aronsson
et al19 article did so, using the term “sickness presenteeism” in its title.
The Need for a Scale for Assessing Presenteeism
From Job Stress
We believe that a measure for assessing presenteeism resulting
from work stress would be useful because, like Cooper,9 we suspect a
© 2022 American College of Occupational and Environmental Medicine
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
Job Stress-Related Presenteeism
great deal of lost productivity at work is a function of job stress that is
taxing employees’ resources and diverting their attention. Given Cooper's
early characterization of presenteeism, and research showing that em-
ployees with high stress are more likely to experience presenteeism,1,24,25
this is an important research avenue. Stress is prevalent in the work-
place,26,27 and we suspect that job stress is a significant source of
presenteeism. Yang and colleagues22 (2015) support our suspicion with
their finding that, in a sample from the United States, “stress-related fac-
tors at work significantly impact presenteeism.”
In terms of the nomological network, the antecedent of job
stress-related presenteeism is, by definition, job stress. Job stress can
trigger stress hormones, anxiety, and tension,28 which can reduce em-
ployees’ ability to focus on their work. Among related constructs, job
stress-related presenteeism has been predicted to have non-causal negative
correlations with job satisfaction and work engagement, and positive cor-
relations with other psychological strains (eg, burnout).4 Consequences of
job stress-related presenteeism are hypothesized to be reduced quality and
quantity of work.4 However, these relationships have yet to be empirically
tested. To test these hypotheses, researchers need a sound measure of
job-related stress presenteeism. Gilbreath and Frew29 developed such a
measure that they called the JSRPS. In the interest of readability, when re-
ferring to the construct we use job stress-related presenteeism, but when
talking about the measure, we use JSRPS.
Research Objectives
The JSRPS has been used in studies8,30,31 but has not been val-
idated. It seems that researchers have an interest in job stress-related
presenteeism and are making use of the only known measure, but
the contribution of this research is likely to be constrained unless we
know more about the measure at the center of this research.
Our primary objective was to learn more about the validity of
the JSRPS. We, therefore, set out to test its factor structure and internal
consistency as well as its construct and criterion validity. Another objec-
tive was to explore how job stress-related presenteeism relates to sickness
presenteeism. It would help presenteeism researchers to know more about
the discriminant validity between job stress-related presenteeism and sick-
ness presenteeism. We contribute in this regard by comparing employees’
responses on the JSRPS and a measure of sickness presenteeism.
We also had some secondary questions that—though not a pri-
mary goal of our research—we were nonetheless interested in: Which
construct, sickness presenteeism or job stress-related presenteeism,
would have stronger relations with our predictor and outcome vari-
ables? Given its relative newness, it will be helpful to begin building
knowledge of the criterion validity of the JSRPS. One way to progress
on that is to see how the JSRPS and a measure of sickness presenteeism
relate to antecedents and outcomes. In this study, we test how the two
measures are associated with workplace harassment and psychological
distress. Investigating those issues allows us to contribute some useful
knowledge for both researchers and managers.
Research Hypotheses
Stress, through its effects on attitudes such as job satisfaction,
indirectly influences turnover intentions.32 Furthermore, job stress-related
presenteeism is a condition that employees generally will find unpleasant
as it interferes with their concentration and ability to work. In some cases,
the amount of stress at work will affect employees' satisfaction with
their work, and they may blame the organization for not addressing
the stressors or providing support to alleviate their job stress-related
presenteeism. That may lead them to reduce their efforts and work
engagement. Others may decide to retire or seek a job where stress
levels and job stress-related presenteeism are not as high. We, there-
fore, expect that:
Hypothesis 1: Job stress-related presenteeism will be negatively as-
sociated with employees' job satisfaction.
211
Mathieu and Gilbreath
Hypothesis 2: Job stress-related presenteeism will be negatively as-
sociated with employees' engagement with their work.
Hypothesis 3: Job stress-related presenteeism will be positively as-
sociated with employees' turnover intentions.
Both stress and illness can reduce well-being.33,34 Furthermore,
when employees are finding it necessary to expend mental resources to
cope with stressors, for most, it seems this would be distressing. The
same seems likely for employees who are finding it more difficult to ac-
complish work because of health problems. For many of us, work is an
important part of our self-concept, and we are often judged by our work
performance.35 It seems plausible that both types of presenteeism can
result in psychological distress, a condition of emotional suffering typi-
cally involving anxiety and depression. We, therefore, expect that:
Hypothesis 4: Job stress-related presenteeism will be positively as-
sociated with self-reports of psychological distress.
Hypothesis 5: Sickness presenteeism will be positively associated
with self-reports of psychological distress.
Although we expect that sickness presenteeism will be strongly
associated with employees' psychological distress, we believe that job
stress-related presenteeism will have a stronger association with em-
ployees' psychological distress. This is based on our own experiences
in the work world, coupled with Cooper's9 (1994) observation of the
number of people who are distressed by their jobs or the organizational
climate where they work. Utilizing the definition of job stress-related
presenteeism offered by Gilbreath and Karimi,4 we think that employees
would find employees would find distressing the fact that - because of
job stress - they are able to devote a diminished proportion of their cog-
nitive energy to their work. We expect that:
Hypothesis 6: Job stress-related will have a stronger association
with employees’ psychological distress than sickness presenteeism.
Our research intentions necessitated finding an independent
variable that would be a strong source of job stress. Harassment at work
seemed to be a good fit. Research has shown that harassment has strong
associations with employees' self-reports of stress36 and is negatively
related to employee well-being.37 Workplace harassment, therefore,
should be related to both job stress-related presenteeism and sickness
presenteeism. However, because stress-related illnesses will take some
time to develop, we expect the association to be stronger between ha-
rassment and job stress-related presenteeism. Certainly, harassment at
work could be expected to manifest, over time, in illnesses, but that is
based on a more distal or longer-term relationship than that between ha-
rassment at work and stress-related diversion of cognitive energy away
from work tasks. Said another way, it seems likely that harassment at
work would cause potentially large redirections of mental resources that
otherwise would be devoted to work. We, therefore, predict that
Hypothesis 7: Workplace harassment will be positively related to
job stress-related presenteeism.
Hypothesis 8: Workplace harassment will be positively related to
sickness presenteeism.
Hypothesis 9: Workplace harassment will have stronger associations
with job stress-related presenteeism than with sickness presenteeism.
METHOD
First, we investigated the factor structure of the JSRPS. Second,
we tested the relationship between the JSRPS and employee job satis-
faction, psychological distress, work engagement, and turnover inten-
tions. Third, we compared employee responses on the JSRPS with a
measure of sickness presenteeism. That was followed by assessing
212
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
JOEM • Volume 65, Number 3, March 2023
how job stress-related presenteeism and sickness presenteeism were
associated with workplace harassment and psychological distress.
Procedure
Study Samples
To test the validity and factor structure of the JSRPS, we conducted
analyses using three different samples. Samples 1 and 3 were collected
within the same organization but at different times (2 years apart), as part
of two different studies.
Sample 1 was composed of employees from the public service sec-
tor in Canada. All of the employees (N = 536) including white-collar
workers, blue-collar workers, and managers were asked by their orga-
nization to participate in this project by completing self-report mea-
sures of job stress-related presenteeism, psychological distress, job
satisfaction, organizational engagement, and turnover intention. The
questionnaire, which took about 45 minutes to fill out, was completed
by employees during work hours. In total, 491 employees completed the
questionnaire, with a participation rate of 91.6%. Of the participants,
62.3% were men (n = 306) and 37.7% women (n = 185). The ages
ranged from 19 to 66 (mean = 45.3). On average, employees were in
their current jobs for 8.3 years and had been employed by their company
for 14.0 years (minimum = 1 month and maximum = 39 years).
Sample 2 was composed of employees from the finance indus-
try. All of the employees from a branch of a large Canadian financial
institution (N = 136) were asked by their organization to participate
in this project by completing our questionnaire online during work
hours. In total, 116 employees did so, a participation rate of 85%. Of
these, 17 (13.9%) were men and 99 (86.1%) were women. Age varied
from 19 to 60 years (mean = 41.4).
Sample 3 was composed of Canadian employees from a public
service organization. Two hundred eleven employees were asked by
their organization to participate in this project and complete self-report
measures of job stress-related presenteeism, sickness presenteeism,
workplace harassment, and psychological distress during work hours.
Of the 211 participants, 84.4% were men (n = 178) and 15.6% women
(n = 33). The ages ranged from 18 to 64 (mean = 43.59).
Measures
Job Stress-Related Presenteeism
The JSRPS29 includes the six items shown in Table 1 which
employees respond to by using a Likert-type scale (1, never; 5, all the
time). Scale reliability has been reported in three research studies.4,8,30
Internal consistency (Cronbach's alpha) for the scale has ranged from
0.83 to 0.91. Alpha coefficients for our samples are as follows: sample
1 = 0.88; sample 2 = 0.86; sample 3 = 0.91. Mean Inter-item Correla-
tions (MIC): sample 1 = 0.55; sample 2 = 0.51; sample 3 = 0.63.
TABLE 1. Items in the JSRPS and Factor Loadings
Factor
Items Loadings
(1) I'm unable to concentrate on my job because of 0.85
work-related stress.
(2) I spend a significant proportion of my workday coping 0.87
with work stress.
(3) Work stress distracts my attention away from my job tasks. 0.86
(4) Mental energy I'd otherwise devote to my work is squandered 0.86
on work stressors.
(5) I delay starting on new projects at work because of stress. 0.69
(6) I spend time talking to coworkers about stressful work situations. 0.66
JSRPS, Job Stress-Related Presenteeism Scale.
© 2022 American College of Occupational and Environmental Medicine
JOEM • Volume 65, Number 3, March 2023
Psychological Distress
38
We used the General Health Questionnaire-12, a 12-item mea-
sure frequently used to screen for symptoms of nonpsychotic psychiatric
disorders. It should be noted that the Genreal Health Questionnaire
(GHQ-12) is a measure of negative well-being; it produces assessments
on three factors: anxiety and depression, social dysfunction, and loss of
confidence39. Many researchers have used it as a single unidimensional
score to represent overall psychological distress.40 The GHQ-12 has
been found to have good validity for individuals in the workforce.41
Sample items include “I think of myself as worthless,” and “I have been
unable to concentrate,” which are rated on a four-point Likert-type
scale. Alpha coefficients for our samples are as follows: sample
1 = 0.87; sample 3 = 0.84; MIC: sample 1 = 0.35; sample 3 = 31.
Work Engagement
We used the short version of the Utrecht Work Engagement
Scale.42 This measure assesses the degree to which employees “have
a sense of energetic and effective connection with their work activities
and they see themselves as able to deal well with the demands of their
job” (p. 4). The measure is composed of nine items which are rated on
a seven-point Likert-type scale ranging from 0 (never) to 6 (always).
The alpha coefficient for sample 1 was 0.91, and the MIC was 0.48.
Sickness Presenteeism
As noted earlier, we chose to measure sickness presenteeism
because it would enable a comparison of its relations with our other study
variables, particularly the JSRPS. Sickness presenteeism was measured
with the Stanford Presenteeism Scale.43 The most-frequently-cited mea-
sure of presenteeism, the Stanford scale uses a self-report format with
six items to assess “a worker's ability to concentrate and accomplish work
despite health problems”43 (p. 15). Participants rate their degree of agree-
ment (1 = strongly disagree and 5 = strongly agree) with statements on
presenteeism associated with a health problem. An illustrative item from
the measure is “because of my (health problem), the stresses of my job
were much harder to handle.” The alpha coefficient from Sample 2 was
0.73, and the MIC was 0.31.
Turnover Intention
The turnover intention was measured with an adaptation of
Simon et al's instrument.44 It is composed of four items using a
five-point Likert-type scale measuring how often participants think of
leaving their job (1) to do the same job in another department, (2) for
another type of job within the same organization, (3) to do the same
job for another organization, or 4 - for a career change (1 = never to
5 = every day). The alpha coefficient and MIC from Sample 1 were
0.82. and 0.53, respectively.
Job Satisfaction
Job satisfaction was measured using a short version of the
Minnesota Satisfaction Questionnaire (MSQ45). This well-validated in-
strument includes 20 items rated on a 6-point Likert-type scale (1 = very
low level of satisfaction and 6 = very high level of satisfaction). Sample
1 provided an alpha coefficient of 0.90 and an MIC of 0.33.
Workplace Harassment
Workplace harassment was measured with the Generalized
Workplace Harassment Scale.46 The scale is a Likert-type 20-item
measure for which participants must rate the frequency at which their
supervisor or coworker has perpetrated harassment behaviors toward
them on a scale from 1, never to 5, once a week or more. Sample 3
yielded an alpha coefficient of 0.89 and a MIC of 0.28.
Data Analytic Plan
Exploring the factor structure of the JSRPS. Using Sample 1,
we conducted exploratory analyses to delineate the factor structure
© 2022 American College of Occupational and Environmental Medicine
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
Job Stress-Related Presenteeism
of the JSRPS using Mplus.47 We used Mplus rather than SPSS or
SAS because Mplus can more easily handle non-linear (ie, ordinal)
data in factor analytic procedures.47–49 We used the Maximum Likeli-
hood extraction method as it is considered more efficient than the Un-
weighted Least Squares extraction method.47
We then conducted a confirmatory factor analysis (CFA) using
Sample 2. Finally, we compared a one-factor model to the two-factor
model to see which of the two model solutions obtained the best model
fit. For both the exploratory factor analysis (EFA) and CFA, MPlus
gives out global fit measures for the tested models. As recommended
by Hu and Bentler,50 we used a two-index strategy to assess model fit:
the Incremental Comparative Fit Index (CFI), and an absolute fit index,
the root mean square error of approximation (RMSEA). We also used
the Tucker-Lewis Index (TLI) and the Standardized Root Mean Square
Residual (SRMR) to test model fit. Traditionally, CFI at or above 0.90
and SRMR and RMSEA at or below 0.08 suggest acceptable model
fit.50 In addition to assessing fit for the model of the JSRPS, we also
checked the correlations among the factors to ensure that they were
at least moderately strong and thus would allow us to model job
stress-related presenteeism as a single (higher-order) unidimensional
latent factor for future research.
Exploring the Validity of the JSRPS
To examine the validity of the JSRPS, first, using sample 2, we
correlated it with measures of employee attitudes such as job satisfac-
tion, turnover intentions, and psychological distress. Next, using sample
3, we correlated the JSRPS with a widely used measure of presenteeism,
the Stanford scale.43 We believe that, although the two measures should
correlate, they will have different associations with workplace variables.
We, therefore, correlated the JSRPS and the Stanford with employees'
psychological distress and workplace harassment.
RESULTS
Exploratory Analyses
To explore the underlying dimensions of the JSRPS, we analyzed
the data from sample 1 using an EFA procedure. With the EFA, we iden-
tified a preliminary six-item, two-factor scale for the JSRPS. The next
step was to confirm this factor structure and its reliability. We conducted
a CFA on the six-item model (two factors) using Sample 2. The best
model fit pointed toward a two-factor solution with three items loading
on each factor. Model fit indices were excellent for the two-factor model
(TLI = 0.99, CFI = 0.99, SRMR = 0.03, RMSEA = 0.07). Geomin ro-
tated factor loadings ranged from 0.66 to 0.86 (see Table 1).
Reliability for both Factor 1 (α = 0.85) and Factor 2 (α = 0.73)
was good considering the fact that each factors had only three items.
TABLE 2. Mean, SD and Intercorrelations Between Study Variables
(Sample 1: N = 491)
Mean (SD) JSRPS
Latent intercorrelations between work attachment constructs
JSRPS 5.67 (4.12)
GHQ-12 21.92 (5.26) 0.47*
Correlates with work constructs
Job satisfaction 73.29 (11.10) −0.30*
Work engagement 45.94 (8.56) −0.24*
Turnover intentions 6.80 (3.31) 0.27*
Correlates with personal and work-related constructs
Age 45.27 (10.18) −0.09
*P ≤ 0.01; **P ≤ 0.05.
GHQ-12, Genreal Health Questionnaire; JSRPS, Job Stress-Related Presenteeism
Scale; SD, standard deviation.
213
Mathieu and Gilbreath
FIGURE 1. JSRPS confirmatory factor analysis (N = 116). TLI = 0.99, CFI = 0.99, SRMR = 0.02, RMSEA = 0.04. Note: Factor loading for
the first item of every factor was fixed at 1 to identify the metric of the latent variable. CFI, Comparative Fit Index; RMSEA, root mean
square error of approximation; TLI, Tucker-Lewis Index; SRMR, standardized root mean square residual.
The total scale had good reliability (α = 0.88). Table 2 shows the means
and standard deviations.
Confirmatory Factor Analyses
The CFA of the JSRPS 6-item model (two factors, three items
per factor) had an excellent fit with the data (TLI = 0.99, CFA = 0.99,
SRMR = 0.02, RMSEA = 0.04). One factor seemed to be related to
failure in productivity; therefore, we named it unproductivity, and the
second factor, which was associated with putting off tasks, we named
procrastination. In addition to assessing fit for this two-factor model,
we also checked the correlations between these two factors to ensure
that they were at least moderately strong and thus would allow us to
model the JSRPS as a single (higher-order) unidimensional latent fac-
tor in subsequent research studies. Factor inter-correlation was strong
(0.92; P ≤ 0.001). The pattern of factor correlations suggests that the
first-order factors are indicators of a second-order superordinate fac-
tor. Based on a method used by Neumann et al51, we ran an SEM load-
ing the two JSRPS factors onto the superordinate factor and found that
the second-order factor accounted for the majority of the variance in
each of the first-order factors (0.96 for Factor 1 and 0.74 for Factor 2).
The item-based CFA results are shown in Figure 1. We also conducted
a CFA loading all six items onto one factor and, although the results
were good, they were not as good as for the two-factor model
(TLI = 0.98, CFI = 0.99, SRMR = 0.02, RMSEA = 0.07). Nevertheless,
this indicates that the measure can be used as either a two-factor or
one-factor model.
Testing Construct and Criterion Validity
Hypotheses 1 to 3
First, using Sample 1, we ran correlations between the JSRPS,
psychological distress, turnover intentions, and job satisfaction (see
Table 2). As predicted in our hypotheses (1 through 3), the JSRPS
was negatively associated with job satisfaction (hypothesis 1), and
work engagement (hypothesis 2), and positively associated with turn-
over intentions (hypothesis 3).
Hypotheses 4 to 9
Second, using Sample 3, we ran correlations between the Stanford
Presenteeism Scale, the JSRPS, psychological distress, and general work-
place harassment. Results shown in Table 3 indicate that the JSRPS and
the Stanford were significantly and positively correlated with employees’
psychological distress, confirming hypotheses 4 and 5. The JSRPS had
a stronger relationship with psychological distress than the Stanford, con-
firming hypothesis 6. Moreover, only the JSRPS had a significant relation-
214
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
JOEM • Volume 65, Number 3, March 2023
ship with general workplace harassment, failing to support hypothesis 8,
but confirming hypothesis 9. These results indicate that job stress-related
presenteeism has a stronger relationship with employee psychological dis-
tress and general workplace harassment than sickness presenteeism, as
should be the case for presenteeism resulting from work stress.
DISCUSSION
The primary aim of our study was to learn more about the char-
acteristics of the existing measure of job stress-related presenteeism,
the JSRPS. Results provide initial empirical evidence for a six-item,
two-factor model. We tentatively labeled the two factors unproductivity
and procrastination. Results also indicated the possibility of using the
scale as a unidimensional measure of job stress-related presenteeism.
These two factors help our understanding of the concept of job
stress-related presenteeism, and we believe that they give additional
information as to how stress can affect employees.
High scores on the JSRPS were associated with higher levels of
psychological distress and turnover intentions and lower levels of job
satisfaction. We believe that these results highlight the importance of
this measure of employee presenteeism. This is not to say that traditional
measures of presenteeism focusing on physical illness are not useful;
however, it indicates that the concept of presenteeism should include,
as a cause, work-related stress. In these times when employees need to
adapt to new work realities, organizations need to provide their work-
force with an environment that will increase job satisfaction and psycho-
logical well-being to increase employee productivity and retention.
Although the JSRPS was significantly correlated with the Stanford
Presenteeism Scale, a widely used and validated measure of sickness
presenteeism, the JSRPS was more strongly associated with employees'
psychological distress than the Stanford scale. Furthermore, although
the JSRPS was significantly associated with reports of workplace harass-
ment, the Stanford Presenteeism Scale was not. Movements, such as
TABLE 3. Mean and SD and Intercorrelations Between the
JSRPS, the Stanford Presenteeism Scale, Psychological Distress,
and Generalized Workplace Harassment (Sample 3, N = 211).
Mean SD 1 2 3
Psychological distress 22.81 4.98
Workplace harassment 10.47 3.94 0.31*
Stanford presenteeism 16.15 4.82 0.20* 0.11
JSRPS 5.49 4.59 0.33* 0.33* 0.27*
*P ≤ 0.01.
JSRPS, Job Stress-Related Presenteeism Scale; SD, standard deviation.
© 2022 American College of Occupational and Environmental Medicine
JOEM • Volume 65, Number 3, March 2023
#MeToo and Black Lives Matter, and news reports of toxic workplaces,
have played a great part in the interest and focus put on creating inclusive
and violence-free workplaces. The fact that the JSRPS presents a strong
relationship with workplace harassment indicates the impact of such
negative behaviors on employees. The JSRPS could be used as an in-
dication that there are sources of stress within workplaces, making this
measure different from other presenteeism scales that focus on physi-
cal health-related problems. These distinctions highlight the need for
this relatively new measure of job-related stress presenteeism. The
costs of absenteeism caused by employees' psychological distress have
been identified.12 However, many employees remain at work while
presenting symptoms of psychological distress, and we believe it is
time to look at the impact and prevention of presenteeism from work
stress. This new field of research will profit from a valid and psycho-
metrically sound measure such as the one presented here. We suggest
that employers add the measure to their repertoire of work factors used
in employee attitude surveys, as the JSRPS can be used not only to iden-
tify presenteeism but also as an indicator of work-related stress. Em-
ployers could also educate their workforce about job stress-related
presenteeism, ask managers to monitor for it, and encourage employees
to inform the appropriate staff members when it is becoming an intru-
sive aspect of their job. As for scholars, the next step could be to catalog
organizational factors that contribute to job stress-related presenteeism
and individual differences among employees that make them suscepti-
ble or resistant to it. Another research avenue is to explore the extent
to which job stress-related presenteeism is a construct that is transferra-
ble to or operant in other national cultures.
Although further validation of the JSRPS could be helpful, our
results indicate that the JSRPS presents good psychometric properties
and can be used to effectively measure job-related stress presenteeism.
The JSRPS may be useful in applied action research to indicate orga-
nizational subgroups or psychosocial factors needing intervention. We
say this because job stress-related presenteeism is a construct with po-
tential value for improving workplace psychosocial conditions; em-
ployers may care more about work stress when they realize how much
“mental absence” it is causing. Because job stress-related presenteeism
can be dealt with—in part—by organizations, we believe that a reliable
instrument, such as the one presented in this study could be useful for
those seeking to measure the effects of work and stress and those seek-
ing to improve work environments.
Limitations of the Study
Employees provided the information used to score the study
variables, raising the possibility that some of the results were a reflection
of common-method variance. Some commentators have suggested that
the effects of common-method variance are overstated.52,53 Nonethe-
less, it is important to minimize these effects as much as possible.54
One recommendation for doing so is to consider “both respondent con-
sequences for providing data, and their ability to report on the constructs
of interest as sources of hypotheses regarding measurement biases.”52
(p. 360) In the present study, participants remained anonymous, giving
them latitude to express their true perceptions, attitudes, and intentions.
We used robust measurement scales and constructed the questionnaire
so that similar measures or those likely to heavily correlate with one
another were located in different sections of our questionnaire.
Implications of our Study
A primary implication of our study relates to the construct of in-
terest, job stress-related presenteeism. Although discussed by Cooper9
and others,55 this construct has only recently been operationalized. The
operationalization seems pertinent to both researchers and managers be-
cause presenteeism, as noted by both employees30 and advocates of psy-
chologically healthy work, is a large drain on organizational productiv-
ity.56 It seems odd that this form of presenteeism has not received more
attention, as it may be one of the biggest effects of stressful workplace psy-
© 2022 American College of Occupational and Environmental Medicine
Copyright © 2023 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited.
Job Stress-Related Presenteeism
chosocial environments. Furthermore, job stress-related presenteeism
may be a phenomenon that employers can relate to and find of sufficient
concern to motivate them to consider measuring what is happening in
the work environment and to reduce controllable stress.
CONCLUSION
Because the Stanford scale was constructed with physical health
problems in mind such as back pain, cardiovascular problems, stomach
problems, or other physical ailments, it does not account for another im-
portant source of diminished productivity: the siphoning away of mental
resources to cope with job stress. Job stress is a part of work that we
must learn to cope with, but in many workplaces, there are unnecessary
or inappropriate sources of stress that should be reduced (eg, poor su-
pervision, incivility among employees, harassment and bullying, poor
equipment, safety concerns, diminished job control because of overly
restrictive rules, procedures, or “micromanagement”). We believe that
job stress-related presenteeism is a potentially significant factor affect-
ing productivity that has been mostly neglected.
Bringing attention to presenteeism resulting from job stress
provides organizations with an opportunity to act upon a source of
presenteeism over which they have some control, perhaps allowing
them to prevent the problem from occurring. In other words, showing
how much stress-related presenteeism is occurring in the work environ-
ment may convince employers that interventions to reduce job stress are
good investments. Also, by reducing job stress, employers may reduce
presenteeism resulting from stress-related distraction and stress-related
illnesses. Employees will have less stress to cope with, and employers
will have fewer stress-related absenteeism, presenteeism, health care
costs, and medical retirements.
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