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Down with the Sickness:

Measuring the Propensity to Work While Sick

Zenopia Aghajanian and Christopher R. Warren

California State University, Long Beach​

Western Psychological Association Annual Conference​

Las Vegas, Nevada

2025

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Over 80% of People attend work while sick, despite believing they should have stayed home (Aronsson et al., 2000)

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Introduction

  • Sickness Presence: the action of attending work while physically unwell.
  • Prior measurement of this construct relied on a single item (Aronsson et al., 2000)
    • This limits insights into sickness presence, highlighting a need for a larger scale.
  • During the pandemic, fear of spreading illness and concerns about workplace safety reduced employees’ likelihood of working while sick (Luksyte et al., 2015).
  • Research shows that COVID-19 shifted decision-making from self-focused concerns to concerns about infecting others, leading to fewer instances of working while ill (Johnson et al., 2021).

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Purpose of the Current Study

To validate a new measure of Sickness Presence, investigate relationships between sickness presence and other related constructs, and assess changes in sickness presence from pre- to post-pandemic.

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Self Esteem and Sickness Presence

According to Rosenberg (1965a), self-esteem is one's positive or negative attitude toward oneself and one's evaluation of one's own thoughts and feelings overall in relation to oneself.

High levels of self-esteem will relate to lower levels of showing up to work during illness and higher levels of concern regarding infecting others.

Hypothesis 1

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Work Ethic and Sickness Presence

Work ethic is one of the most notable constructs that has endured over a long period of time. Among other things, it indicates the extent to which a person considers work as his or her central life interest (Blood, 1969).

High levels of work ethic will correlate with a higher degree of showing up to work with an illness and a lower degree of concern regarding potentially infecting others.

Hypothesis 2

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Conscientiousness and Sickness Presence

Conscientiousness is the Big Five personality trait capturing individual differences in the degree of organization, persistence, and motivation in goal-directed behavior: people high in conscientiousness are described as organized, reliable, and ambitious (Costa et al., 1992, John & Srivastava, 1999).

A higher score on conscientiousness will correlate positively with showing up to work during illness and more concern about affecting others.

Hypothesis 3

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Prosocial Behavior and Sickness Presence

The Prosocial scale is designed to measure individual differences in a global tendency to behave in prosocial ways during late adolescence and adulthood (McNeely & Melingo, 1994)

Higher scores on the Prosocial scale will correlate negatively with showing up to work during illness and concern about infecting co-workers.

Hypothesis 4

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Participants and Procedures

Phase 1 (pre-COVID)

Phase 2 (post-COVID)

Phase 3 (post-post COVID)

441 respondents took a 59-item survey based on a Likert type Scale ranging from disagree to strongly agree (ɑ = .75).

Approximately 125 respondents, aged 18-30 who are working, were recruited to determine if any proposed items should be eliminated or further altered to better measure SP (ɑ = .78).

200 respondents took the final version of the scale for overall validity, assessing its distinctiveness from related constructs.

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Sickness Presence Items

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My workload would be affected if I took sick days, so I generally work through illness.

I would show up to work even though I had a contagious illness.

Due to job financial concerns, I would consider showing up to work knowing that I might infect co-workers.

I feel selfish while taking a sick day, because I could have gone to work and performed well.

A contagious illness affects my decision of showing up to work.

If a co-worker has a cold or flu, they should stay home.

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Sickness Presence Items

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I use sick days when I feel like I could be contagious and affect co-workers.

When/if I go to work while being contagious, I am concerned about infecting my co-workers.

When/if I go to work while being contagious, I take precautions to prevent spreading my illness.

If my work task depends on others, I would avoid showing up if I was contagious.

If I have noticeable symptoms of a contagious illness (e.g., flue), but don’t feel like it would affect my work performance, I would go to work.

If I have noticeable symptoms of a contagious illness (e.g., flu), I would take a sick day, even if it would affect my salary..

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Scales/Measures

Blood’s Protestant Work Ethic Scale (1969)

Propensity to Work Sick Scale

Rosenberg Self-Esteem Scale (1965)

Prosocial Scale by McNeely & Melingo (1994)

Sarnoff’s Survey of Attitude Towards Life Scale (Bray & Grant, 1966)

Turnover Intent Inventory (Adams & Beehr, 1998)

Conscientiousness (John & Srivastava, 1999)

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Correlations

Time 1

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Time 2

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Time 3 Correlations

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Sickness Presence Item Means

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Sickness Presence Item Means

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Sickness Presence Item Means

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Sickness Presence Item Means

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Key Findings

  • Exploratory factor analysis identified two dimensions:
    1. Concern for Personal Loss (working while sick)
    2. Concern for Sickness Effects on Others (infecting others)
  • The Sickness Presence scale demonstrated strong reliability

(α = .78 at time, α = .77 at time 2, and α = ..88 at time 3).

  • Sickness presence correlated with past sick attendance and means related to Concern for Personal Loss declined post-COVID-19, reflecting shifting workplace attitudes.
  • Correlations with known variables support the construct validity of the measure, such as showing up to work while sick in the past year (r = .32, p < .001)

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Next Steps

  • Further research is needed to explore links between sickness presence, motivation, and ethical decision-making.

Practical Implications

  • The measure can enhance workplace safety and support equitable sick leave policies.
  • Organizations should use findings to establish ethical health norms and reduce sickness presence.

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Thank You!

Acknowledgements:

Thank you to my graduate research assistants Muskan Jumani, David Guirgus, the Research, Scholarly and Creative Activities funding, and my many research assistants and survey participants!

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