Presenteeism propensity as a measure of health-related workplace attendance decisions: a validation study using vignette and survey data

Abstract Sickness presenteeism (SP), defined as working despite being sick, is a complex phenomenon that is influenced by health-related vulnerability and individual decision-making behavior. Traditional survey measures, such as the frequency of SP days, conflate these two factors, which limits their usefulness in research focusing on attendance decision-making behavior. Presenteeism propensity – a ratio of SP days to total sickness days (that is, the sum of SP and sickness absence days) – has been proposed as a less biased and more informative measure. This study validates the use of presenteeism propensity with data from the German BIBB/BAuA Employment Survey 2024 and a vignette study ( n = 2,350). We compare the predictive power of SP frequency and presenteeism propensity for explaining attendance decisions under experimentally controlled conditions. Our results show that presenteeism propensity correlates more strongly with vignette-based attendance decisions than SP frequency, particularly when virtual presenteeism is included. Truncating frequency measures (< 60 days) improves the predictive validity of frequency measures, but has negligible effects on propensity. While SP frequency measures are more closely linked to health-related vulnerability, presenteeism propensity captures individual tendencies to opt for SP over sickness absence. These findings highlight the utility of using presenteeism propensity as a measure in research on attendance behavior. This study contributes to the literature by offering a validated framework for distinguishing between health-related and decision-related factors in attendance research. Future research should more thoroughly determine whether frequency or propensity measures are appropriate for answering the research questions.