インドネシアの正規雇用労働者におけるプレゼンティーズムとその要因：横断的研究
2025 年 47 巻 2 号 p. 45-54
詳細
2025 年 47 巻 2 号 p. 45-54
Sickness presenteeism is a condition in which an individual who is physically or mentally ill still comes to work. We obtained the prevalence of sickness presenteeism and contributing factors in formal sector workers in Indonesia. A cross-sectional study was done with 590 participants. Sickness presenteeism was determined by the health problems experienced in the last month before the study. Data analysis was done using the chi-square bivariate test and the logistic regression multivariate test. The majority of the participants were healthcare workers (33.9%) and from Jawa Island (64.1%). Out of 590 participants, the prevalence of sickness presenteeism was 26.1% (n=154). Multivariate analysis results showed that age (P =0.032), education level (0.026), and area of employment (Sumatera (P=0.022), and Kalimantan (0.031)) were statistically significant. This study found that the development of sickness presenteeism correlates with younger age, higher education level, and area of employment. These factors may affect work culture in the participating workplace and might result in the sickness presenteeism discovered in this study.
Sickness presenteeism is defined as a condition in which an individual who is physically or mentally ill and needs rest still comes to work [1]. Continuing to work in a sick state can be caused by an individual’s love of work, a sense of moral obligation, or job insecurity. The phenomenon of sickness presenteeism was first studied in depth by researchers in Sweden. At that time, sickness presenteeism was often found in work sectors such as pension homes and welfare sectors, where it was not easy to find a replacement for employees [1, 2]. The productivity of an individual who forces himself to work in a sick state can decrease by a third of normal productivity. These phenomena have consequences, such as increasing the risk of accidents at work and adversely affecting the health of workers [2, 3].
Both personal factors and work factors can contribute to sickness presenteeism [1]. Financial factors can trigger the occurrence of sickness presenteeism, usually more commonly found in workers who have low salaries and have financial problems outside their jobs. It is related to the absence of compensation that the company gives to sick workers or the cutting of wages when absent from work [4]. Psychosocial factors in the workplace are some of the more complex factors. Depression, fatigue, and physical illness are the psychosocial factors most experienced in the present. This is due to the lack of individual control over the work and the high psycho-social need of the individual to complete the work [5]. Other personal factors that also need to be taken into account are age, gender, education, and individual problems such as difficulty saying no or refusing a job [5, 6]. Three studies in a meta-analysis study mentioned that younger people had higher rates of sickness presenteeism than older people, and that more sickness presenteeism was found in females associated with higher levels of female commitment [5–7].
The work factor is divided into several levels: professional level, team level, and organizational level [8]. At the professional level, workers tend to avoid situations where the accumulated work left at the time of illness has to be completed when the worker returns to work [1]. At the team level, there is worker interdependence, especially in small companies, and when one of the workers is not in, the work left will be divided between the employees who are in [9]. At the organizational level, the culture of work and the commitment to the organization become a major influence in contributing to sickness presenteeism [8, 9].
Besides that, job insecurity often becomes the reason for sickness presenteeism. Some studies found that absence rates at work increase significantly for permanent workers when compared to contractual workers, as contractual employees had a greater risk of being fired from work. Employees will remain at work despite illness so as not to increase the number of absences which could be a risk factor for employee access to a company in crisis [8, 9]. Many companies pay their employees on the basis of how many days they work in a month, so absence will reduce the number of days they work. Some companies also have a policy that employees who do not take a leave day at all in a given period of time will get the benefit of incentive money or other benefits that motivate employees to stay at work. Another study found that contractual workers tend to go to work while sick because they do not have any social protection against illness [10].
Sickness presenteeism is often associated with acute, episodic, and chronic health problems. According to the Indonesian Health Profile in 2018, the most common infectious diseases that need attention are pulmonary tuberculosis, pneumonia, upper respiratory tract infections, and diarrhea. The most non-communicable diseases are diabetes, hypertension, heart disease, musculoskeletal disease, chronic kidney failure, asthma, allergies, and obesity [11]. A study in 2013 found that the prevalence of general sickness presenteeism in a population diagnosed with work-related musculoskeletal disorder (WMSD) was 59%, with females having a higher percentage of 60.4% [12, 13].
Previous studies have stated that one of the jobs that has sickness presenteeism is health care work, caused by high workloads, shift work, and the culture of the workplace. A study with 15,185 participants, and healthcare workers from various health facilities, found that as many as 88% had sickness presenteeism [14]. Another profession that suffers a lot from sickness presenteeism is teaching; one study found the prevalence of sickness presenteeism to be 65.2% [15]. In addition to those two professions, there is a study that found a wide occurrence of sickness presenteeism in industrial workers, with a prevalence rate of 57.6% [16]. A study that was conducted in Samarinda, Indonesia, on presenteeism among 136 health workers found a prevalence of sickness presenteeism of 31.6% [17]. However, no wide-ranging study across other areas of Indonesia involving other professions has been conducted yet.
According to the Indonesian Central Bureau of Statistics, the labor force is largely divided into two sectors: the formal sector and the informal sector. The formal sector is divided into several sectors: government officials, education, health, tourism, and various industries [18]. In February 2024, there are 58.05 million formal sector workers, or 40.83% of the total workers. Along with the informal sector, the formal sector is a major factor in Indonesian economic development, which means that the productivity of the workers in the formal sector will have an indirect impact on the economy of Indonesia [18, 19]. It is important to prevent the occurrence of sickness presenteeism in Indonesia so that the workers can always work productively. Therefore, this study aimed to identify: (1) the prevalence of sickness presenteeism in formal sector workers in Indonesia, and (2) contributing factors to sickness presenteeism in formal sector workers.
Study design and participants
This study was based on a cross-sectional study with convenience sampling. The targeted population was formal sector workers in Indonesia. For recruitment, this research contacted the Indonesian Employers’ Association (Asosiasi Pengusaha Indonesia (APINDO)), several companies, and also public as well as private institutes. A contact person in each participating company or institute was responsible for distributing online questionnaires. The online questionnaires were distributed by personal messenger tools. The data was collected between February to July 2023. The estimated sample size refers to a study about observational logistic regression with a large population, which stated that 500 is a representable number for the targeted population [20]. The inclusion criteria were permanent and contractual workers. Initially, 592 participants participated in this study, but we excluded individuals aged ≥60 years (n=2) as this is the retirement age.
Sickness presenteeism
Sickness presenteeism was determined by asking whether the respondent experienced any health problems and whether it disrupted their work or not in the last month before participating in the study. Participants who answered “yes” were categorized as sickness presenteeism, while participants who answered “no” were categorized as not presenteeism. The categorization was done referring to the definition of sickness presenteeism by Aronsson combined with studies by Mori and Adi [1, 21, 22]. Participants who answered “yes” chose one health problem that was the most disruptive to their work. The health problems were a combination of the most prevalent diseases in Indonesia and those mentioned in a previous presenteeism study by Mori et al (2020) [21]. Each health problem was given a definition, as it was assessed by subjective symptoms reported by the participant.
Independent Variables
The independent variables were age, gender, education level, formal sector, employment area, employment status, and employment period. Age was stated in numerical data based on the data retrieved from the online questionnaire. Sex was identified by self-report and categorized by male and female. Education level was divided into high school/equivalent and college/equivalent, according to a previous study about sickness presenteeism by Evans-Lacko in 2016 [5]. The area of employment was divided into five regions, according to the Indonesian Central Bureau of Statistics, namely Sumatera, Jawa, Kalimantan, Bali, and Nusa Tenggara, as well as Sulawesi, Maluku, and Papua. Employment status was the worker’s status at the time of participation in this study as a permanent worker or contractual worker. The employment period was the year of the respondent’s working period at the current job position at the time of completion of the questionnaire. For the employment sector, several sectors were included in this study, namely: government, education, health care, raw materials industry, and manufacturing industry.
Statistical Analysis
Data analysis for this study was done using Statistical Program for Social Science, version 22 (IBM, Armonk, NY, USA). Univariate analysis was used to see the distribution of each demographic data. The bivariate was analyzed using chi-square to see the association between each independent variable and the dependent variable. The logistical regression test was used to see the independent variables that were most related to sickness presenteeism.
Ethical Approval
This study was conducted with ethical approval from the Health Research Ethics Committee of the Faculty of Medicine Universitas Indonesia. The approval number is KET-114/UN2.F1/ETIK/PPM.00.02.2023. This study complies with the Declaration of Helsinki, and informed consent was provided in the questionnaire.
This study involved a total of 590 workers from government offices, the educational sector, healthcare centers, and industrial companies of Indonesia. The majority of the participants were healthcare workers (33.9%) and from Jawa Island (64.1%). Details are shown in Table 1.
| Variables | Sickness Presenteeism (n=590) |
Total n (%) |
P-value | |
|---|---|---|---|---|
|
No n (%) |
Yes n (%) |
|||
| Age (median 34 (18-60)) | ||||
| ≤ 34 years (reference) | 212 (48.6) | 95 (61.6) | 307 (52.0) | 0.005a |
| > 34 years | 224 (51.4) | 59 (38.4) | 283 (48.0) | |
| Gender | ||||
| Male (reference) | 255 (58.4) | 65 (42.2) | 320 (54.2) | <0.001a |
| Female | 181 (41.6) | 89 (57.8) | 270 (45.8) | |
| Education Level | ||||
| High school/equivalent (reference) | 89 (20.4) | 12 (7.8) | 101 (17.1) | <0.001a |
| College/equivalent | 347 (79.6) | 142 (92.2) | 489 (82.9) | |
| Formal Sector | ||||
| Health care (reference) | 137 (31.4) | 63 (40.9) | 200 (33.9) | (ref) |
| Government | 42 (9.6) | 15 (9.7) | 57 (9.7) | 0.453a |
| Education | 35 (8.0) | 22 (14.3) | 57 (9.7) | 0.315a |
| Raw materials industry | 117 (26.8) | 20 (13.0) | 137 (23.2) | <0.001a |
| Manufacturing industry | 105 (24.2) | 34 (22.1) | 139 (23.5) | 0.158a |
| Area | ||||
| Jawa (reference) | 282 (64.6) | 96 (62.3) | 378 (64.1) | (ref) |
| Sumatera | 67 (15.4) | 31 (20.2) | 98 (16.6) | 0.214a |
| Kalimantan | 17 (3.9) | 7 (4.5) | 24 (4.1) | 0.682a |
| Bali, Nusa Tenggara | 13 (3.0) | 6 (3.9) | 19 (3.2) | 0.547a |
| Sulawesi, Maluku, Papua | 57 (13.1) | 14 (9.1) | 71 (12.0) | 0.307a |
| Employment Status | ||||
| Permanent workers (reference) | 298 (68.3) | 109 (70.8) | 407 (69.0) | 0.575a |
| Contractual workers | 138 (31.7) | 45 (29.2) | 183 (31.0) | |
| Employment Period (median (minimal-maximal)) | 5 (1-25) | 8 (1-35) | – | 0.077b |
a: chi-squared test, b: Mann-Whitney test
Of the 154 participants who had complaints of either just one or several health problems in the past month, they chose one of the most disruptive health problems (Table 2). Among them, 34 (22.1%) participants had musculoskeletal disorders, followed by 24 (15.6%) with headaches, 20 (13%) with fatigue, 16 (10.4%) with upper respiratory tract infections, and 14 (9.1%) with obesity. Musculoskeletal disorders were the most common in the age group of 25–29, with 9 (26.5%) participants, and with 19 (55.9%) participants in the female gender.
| Health Problems | Frequency (n) | % |
|---|---|---|
| Musculoskeletal Disorders | 34 | 22.1 |
| Headache | 24 | 15.6 |
| Fatigue | 20 | 13.0 |
| Upper respiratory tract infections | 16 | 10.4 |
| Obesity | 14 | 9.1 |
| Depression/anxiety | 7 | 4.5 |
| Insomnia | 7 | 4.5 |
| Eye Diseases | 7 | 4.5 |
| Dental Problems | 6 | 3.9 |
| Hypertension | 4 | 2.6 |
| Allergy | 3 | 1.9 |
| Dermatitis | 3 | 1.9 |
| Diabetes Mellitus | 3 | 1.9 |
| Pneumonia | 2 | 1.3 |
| Asthma | 1 | 0.6 |
| Diarrhea | 1 | 0.6 |
| Occupational Accident | 1 | 0.6 |
| Tuberculosis | 1 | 0.6 |
The 154 (26.1%) participants who had health problems in the past month were categorized as having sickness presenteeism. Participants who did not had a complaint in the past month fell into the category of not having sickness presenteeism.
In the bivariate analysis, age, gender, education level, and raw materials industry (health care as reference) were statistically significant to sickness presenteeism. Table 3 shows the logistic regression analysis result between the contributing factors and sickness presenteeism. The results showed that age (P=0.032), education level (0.026), Sumatera area (P=0.022), and Kalimantan area (P=0.031) were statistically significant. Age >34 years had aOR 0.584 means, older age was a protective factor for sickness presenteeism. Education level (college/equivalent) had aOR 2.216, which implies that those with higher education were more likely to experience sickness presenteeism than those with lower education level. In addition to that, participants from Sumatera (aOR=2.493) and Kalimantan (aOR=2.143) were more likely to experience sickness presenteeism than participants from Jawa.
| Variables | aOR | CI 95% | P-value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Age (ref: ≤34) | ||||
| >34 years | 0.58 | 0.36 | 0.96 | 0.032 |
| Gender (ref: Male) | ||||
| Female | 1.42 | 0.92 | 2.19 | 0.110 |
| Education Level (ref: High school/equivalent) | ||||
| College/equivalent | 2.22 | 1.10 | 4.46 | 0.026 |
| Formal Sector (ref: Health care) | 0.068 | |||
| Government | 1.04 | 0.48 | 2.29 | 0.917 |
| Education | 2.04 | 0.97 | 4.31 | 0.061 |
| Raw materials industry | 1.12 | 0.60 | 2.10 | 0.723 |
| Manufacturing industry | 0.62 | 0.31 | 1.23 | 0.173 |
| Area of Employment (ref: Jawa) | 0.170 | |||
| Sumatera | 2.49 | 1.14 | 5.45 | 0.022 |
| Kalimantan | 2.14 | 1.07 | 4.28 | 0.031 |
| Bali, Nusa Tenggara | 2.97 | 0.96 | 9.24 | 0.060 |
| Sulawesi, Maluku, Papua | 1.75 | 0.54 | 5.71 | 0.352 |
| Employment Status (ref: Permanent worker) | 0.85 | 0.52 | 1.38 | 0.505 |
| Contractual worker | ||||
| Employment Period | 1.01 | 0.97 | 1.04 | 0.789 |
aOR: adjusted odds ratio, CI: confidence interval
In this study, the prevalence of sickness presenteeism among formal sector workers in Indonesia was 26.1% (n=154). Younger age, female, college/equivalent education level, and formal sector were significantly related to sickness presenteeism with a P-value <0.05 in bivariate analysis. In the least model of multivariate analysis, age, education level, and area of employment were associated with sickness presenteeism.
This prevalence finding is higher than a 2020 study in South Korea, where the prevalence of sickness presenteeism was 15.9% out of 23,164 employees. While the prevalence obtained in the present study was lower compared to another study conducted in Samarinda, Indonesia, in 2023 with 136 healthcare workers, the prevalence was 31.6% [17]. Furthermore, a 2010 study on the prevalence of sickness presenteeism that was conducted on 40,000 participants in 34 European countries revealed a 40% prevalence rate. The prevalence ranges from 23% in Italy, Portugal, and Poland, to 50% in Montenegro, Malta, and Denmark [23, 24]. Different kinds of participants and tools used in the studies could have resulted in the variety of prevalence. Cultural aspects also might play a role. One aspect of the work culture in Indonesia is to maintain good relationships with superiors and colleagues, and a pleasant atmosphere and good relationships may make employees feel reluctant to take time off from work. Avoiding conflict, which is also a work culture in Indonesia, employees shying away from situations such as unfinished tasks and the lack of someone to take over their responsibilities prevents them from taking time off from work [25].
We found that older age acted as a protective factor against sickness presenteeism in this study. In line with previous studies, younger workers tend to have sickness presenteeism. It has to do with the many working cultures that require a high presence of new and young workers. Young workers are also usually associated with unstable jobs, still low incomes, pressure from senior colleagues, and a high desire and spirit for work [26–29].
In this study, workers with a higher education background were more likely to develop sickness presenteeism than workers with lower education. We managed to recruit 101 participants with a high school education level or equivalent, while the remaining 489 had a college education or equivalent. That could have been one of the factors that affected the statistical test. Nevertheless, there are some theories that higher educational levels are associated with higher employment rates. A higher level of work requires high responsibilities and job demands. Employees in higher positions usually do not work physically but require higher cognitive capabilities [5]. Limited human resources in such positions make it difficult for employees not to go to work because no one can replace them during their absence. Higher-level positions also often require long working hours and extensive travel, which can make it difficult for employees to maintain a healthy work-life balance. This might increase sickness presenteeism [30].
Previous studies indicated that employees in the education sector have high job demands, time pressure, and a low number of human resources. This requirement makes it difficult for teachers to take time to rest from sickness without being burdened by the workload that accumulates upon returning [31, 32]. Several studies mention that there are several factors associated with sickness presenteeism in healthcare workers, including physical and emotional job demands, working under pressure, time stress, long working hours, conflicts in work and personal life, patient and family aggression, and exposure to infectious diseases and hazardous substances [3, 33, 34]. The main factor of sickness presenteeism in industrial workers was the fear of losing jobs. Workers tend to avoid absences from work because of the fears arising from the ongoing crisis and the constant threat of unemployment. In some companies, employees who do not take any days off for a year of work will get benefits like incentive money, so many workers intend to get those benefits [35, 36].
When considering the area of employment, the majority of the participants in this study were from Jawa. This variable was observed as the Indonesian population is concentrated in Jawa, which according to the Indonesian Central Bureau of Statistics takes up to 56.1% of the total population. Meanwhile, Sumatera is the second, with 21.68% of the population [37]. Because Indonesia consists of diverse ethnicities, work ethic and work culture might differ in each region [38]. When other areas were compared to Jawa in this study there were no statistically significant areas in bivariate analysis; in the multivariate analysis, however, participants from Sumatera and Kalimantan experienced sickness presenteeism more than 2 times compared to Jawa.
In this study, there was no difference between permanent and contractual workers in sickness presenteeism. In several other studies, there were inconsistencies regarding whether employment status has a significant association with sickness presenteeism. These findings suggest that the assumption that contractual workers are more likely to engage in presenteeism due to job insecurity or other factors may not be universally applicable. Instead, presenteeism may be influenced by a variety of factors, including individual characteristics, organizational policies, and economic conditions, which can affect both permanent and contractual workers equally [8, 9].
Recommendation
For employers, it is recommended to conduct a sickness presenteeism screening in the workplace as a basis for modifying the sick leave rules to reduce the rate of sickness presenteeism and increase the productivity of health workers. Create wellness programs within the company to promote healthy lifestyles to lower sickness presenteeism in the workplace, and also implement a return-to-work program to support sick workers to focus on recovery while being productive.
For workers, it is important to engage in better communication with colleagues and supervisors regarding their health condition in order to prevent sickness presenteeism and decreased productivity. It is also important to get proper treatment for each health condition to prevent further complications in the future.
For education and research, the data from this study can be taken to be a database on the prevalence of sickness presenteeism and related factors in Indonesia. Further research can be done specifically on each sector of work to look at differences in character and disease problems across sectors.
Strengths and Limitations
Much research has been done on the association between work and productivity in Indonesia, but not much research that focuses on health and work has been done. A strength of this research was that it looked at factors related to sickness presenteeism and health problems that are frequently experienced by the working population. It was spread over five formal sectors across several regions in Indonesia, so it is expected to describe the characteristics of participants in a varied manner.
A limitation of the study is that the completion of the questionnaire on the part of the health problem experienced was subjective and had no objective evidence that the respondent had correctly chosen the health problem. Each respondent’s understanding of the question was subjective. Workplace factors such as workplace stress and environmental, organizational, and interpersonal factors were not questioned in detail, as this study was more focused on looking at factors of health problems experienced in workers with sickness presenteeism. Another limitation is that the reference studies included in the comparisons in this study used different tools to define sickness presenteeism and were done in different backgrounds of participants. This could have affected the variety in the range of sickness presenteeism. Generalization of the results should be taken with precaution due to the use of convenient sampling in this study’s subject recruitment. In the process of participant recruitment, we did not collect the data of the company’s name, as some of the companies were not willing to be mentioned in the study, so researchers only asked about the sector of the work, and as a result, this may have caused a bias.
This study found that the prevalence of sickness presenteeism among formal sector workers in Indonesia was 26.1%. Multiple factors can influence the development of sickness presenteeism. In this study, the most relevant factors were age, education level, and area of employment. These factors may affect work culture in the participating workplace and might result in the sickness presenteeism discovered in this study. Seeing the number of sickness presenteeism discovered in this study, a similar study with samples representing a more diverse formal work sector is needed. The results of this study might help with controlling associated variables should they be met in a workplace. Although the data from this study can be used as a baseline to conduct further research about sickness presenteeism, specifically in each sector, generalization of the result should be taken with precaution due to the use of convenient sampling in this study’s subject recruitment.
No sources of funding were present in this study.
The authors declare no conflicts of interest.
This study was supported by the Indonesian Employers’ Association (Asosiasi Pengusaha Indonesia (APINDO)), several private companies, public institutes, and private institutes.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
