Abstract / Summary
Sickness presenteeism (SP), i.e., working while ill, and sickness absence (SA) reflect alternative responses to ill-health. Although both stem from the same attendance decision process, little is known about how illness severity interacts with workplace conditions, how remote work opportunities influence attendance decisions and what role personal motives play. We draw on data from a factorial survey experiment following the 2024 BIBB/BAuA Employment Survey in Germany (N = 3532). Respondents evaluated ten hypothetical scenarios describing acute illness episodes that varied in symptom severity, infectiousness, workload, team conditions, attendance pressure, and weather. Multilevel logistic models estimate effects on the likelihood of working on-site, working remotely (if available), or calling in sick. Illness severity appears to be the main determinant of attendance behavior: increasing body temperature from normal to 38.3°C reduces the probability of working on-site by 54 percentage points among respondents without a remote work option. The option of working remotely is associated with more SP (64% vs. 55%) and a shift from on-site to virtual SP. Effects of contextual factors, such as attendance pressure, colleagues’ workload and infectiousness are smaller and vary with illness severity and work arrangement: they are most pronounced at moderate illness severity, while remote work can shift their influence from whether to how individuals work. Under severe illness, decisions to work are linked mainly to career- and reputation-related motives. Attendance decisions thus seem to follow a hierarchical logic with illness severity as the primary determinant and other factors depending on illness severity and work arrangements.