title: "Whenever I can I push myself to go to work": a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis.
abstract: OBJECTIVE
  UK government policy emphasizes the importance of continuing to work for recovery from poor health, yet sickness presenteeism (going to work whilst ill) is commonly regarded as having negative consequences for organizations and individuals. Our study explores experiences of working after onset of rheumatoid arthritis (RA), a chronic musculoskeletal disorder characterized by high rates of work disability.
  
  
  METHODS
  An exploratory qualitative study consisting of in-depth interviews and six-month follow-up with 11 men and women with RA employed at disease onset.
  
  
  RESULTS
  We expand upon previous models of sickness presenteeism by distinguishing between presenteeism that occurs voluntarily (wanting to work despite illness) and involuntarily (feeling pressured to work when ill). RA onset affected participants' ability to work, yet motivation to remain working remained high. The implementation of workplace adjustments enabled participants to stay working and restore their work capacity. Conversely, managers' misinterpretation of organizational sickness absence policies could lead to involuntary presenteeism or delayed return to work, conflicting with the notion of work as an aid to recovery.
  
  
  CONCLUSIONS
  Workplace adjustments can facilitate voluntary sickness presenteeism. To reduce work disability and sickness absence, organizational policies should be sufficiently flexible to accommodate the needs of workers with fluctuating conditions. Implications for rehabilitation Individuals with rheumatoid arthritis (RA) are at high risk of work disability. Individuals' motivation to remain in work following onset of RA remains high, yet sickness presenteeism (working while ill) has received largely negative attention. It is important to distinguish between voluntary and involuntary forms of sickness presenteeism. Workplace adjustments facilitate voluntary sickness presenteeism (wanting to work despite illness) and improve job retention and productivity among workers with RA. Involuntary presenteeism (feeling pressured to work while ill) may occur if organizational policies are not sufficiently flexible to accommodate the needs of workers with RA.
authors.affiliation: a Division of Health Research, Faculty of Health and Medicine , Lancaster University , Lancaster , UK.|b Arthritis Research UK-MRC Centre for Musculoskeletal Health and Work , UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Holland
authors.affiliation: c Centre for Organizational Health and Wellbeing, Lancaster University , Lancaster , UK.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Collins
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000328:Adult; D001107:Architectural Accessibility; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D000069597:Presenteeism; D006113:United Kingdom; D014937:Work / Q000523:psychology*
keywords: Sickness presenteeism; musculoskeletal disorders; organizational policy; rheumatoid arthritis; sickness absence; workplace adjustments