Correlation between chronic conditions and job absenteeism among healthcare administration employees at King Abdullah Medical City in Makkah,Saudi Arabia

Abstract

BACKGROUND:

Globally, chronic conditions are becoming more prevalent, both in general and within the workforce. Moreover, the appropriate workplace recognition and interventions are lacking for employees with chronic conditions, which may affect productivity and quality of work as a result of increased rates of absenteeism among such employees.

OBJECTIVE:

The main objective was to examine the correlation between healthcare administrators’ chronic conditions and job absenteeism at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia.

METHODS:

A cross-sectional study was conducted at KAMC in Makkah, Saudi Arabia. Data obtained from the responses of 225 administrative employees with a chronic condition working at KAMC. Data were analyzed using SPSS Statistics version 20.

RESULTS:

The results of this study indicated that a significantly relationship exists between chronic heartburn, as well as other chronic conditions, such as irritable bowel syndrome, severe anemia, chronic fatigue, and high blood pressure or hypertension with employees’ job absenteeism.

CONCLUSION:

According to the obtained results, employees’ chronic conditions have a significant impact on absenteeism. Therefore, we recommend that employers intervene to determine how employees’ chronic conditions affect their health and prevent them from attending work. Providing workplace health and wellness programs within an organization can improve employee health, thereby reducing the rate of absenteeism and increase the rate of productivity in the working environment.

Keywords

Noncommunicable diseases employees absenteeism occupational health workforce

1 Introduction

Chronic conditions are long-term (lasting for one year or more) or lifelong medical conditions or diseases, such as diabetes, hypertension, cancer, arthritis, asthma, migraines, and back pain, that affect the lifestyle of individuals [1]. Absenteeism occurs when an employee begins to chronically miss work, and can refer to a pattern of missing work [2, 3]. The World Health Organization (WHO) defines chronic conditions as noncommunicable diseases (NCDs) that last for a long duration with a generally slow progression, occurring as result of a combination of genetic, physiological, environmental, and behavioral factors [4].

Globally, the prevalence of chronic conditions is increasing, becoming more common within the workforce as the number of people living with a chronic condition increases. Moreover, appropriate recognition and interventions by organizations to care for their employees with chronic conditions in their work environment are lacking, which may affect the quality of work and work productivity by increasing the rate of absenteeism in employees with chronic conditions. Chronic conditions are considered an increasingly important issue in Saudi Arabia [5].

Why is it hard to work with a chronic condition? At least one employee with a chronic condition exists in most workplaces. Chronic conditions and associated low energy levels can limit the working capacity of employees and how much they can perform in a day. Additionally, pain and other problems accompanying chronic conditions, as well as low levels of awareness among employers, can lead to absence from work [6]. Chronic conditions are among the various reasons why employees may be absent from work.

Chronic conditions are considered to be increasingly common and have many epidemiological and individual impacts. In addition to their impact on the health condition and quality of life of individuals, chronic pain conditions have public health and social impacts that need to be discussed [7]. The pain accompanying chronic conditions is one of the most common reasons for individuals seeking healthcare services for treatment and medication [7]. The absence of illness is considered an important indicator of the rate of employee absenteeism [8]. However, the association between chronic conditions and employee absenteeism is still not evident [7], and research on absenteeism in recent decades has mainly focused on moral hazards and health problems related to acute diseases [9].

Previous studies, such as those by Collins and Lacroix, have shown an association between employees’ chronic conditions and absenteeism from their job [9, 10]. Studies have also been conducted on the impact of employees’ chronic conditions on their work environment, such as the study by Mesas [7].

Two studies conducted in the United States found that chronic conditions, such as migraines, asthma, allergies, diabetes, depression, and joint and back pain (the most common chronic condition among workers, according to the studies), substantially affect employee absenteeism [9, 10]. One of these studies showed that 65% of workers reported a chronic condition, and absenteeism ranged from 0.9 to 5.9 h over four weeks [10]. The focus of the other study was mainly chronic migraines and associated depression and how a lack of awareness of such a chronic condition in employees can lead to absenteeism [9].

Another study in the United States examined the association between working limitations caused by employees’ chronic conditions and absenteeism, including seven chronic diseases, such as arthritis, heart disease, lung disease, and diabetes. Data were generated from the National Health Interview Survey (NHIS); the result was a significant increase in absent workdays among employees with one of the seven studied chronic diseases. Despite the results, the rate of absenteeism among employees with chronic conditions can vary depending on the severity of their conditions [11].

The pain associated with chronic conditions can have a negative impact on working outcomes according to a review conducted in a European work environment [7].

In Spain, a cross-sectional study was conducted to examine the relationship of chronic neck pain, low back pain, and migraines with employee absenteeism. According to the results, employees with these chronic conditions were 44% more likely to be absent from work for more than 30 days compared to employees without chronic pain [7].

Furthermore, a study among Italian employees found an association between the number of employees with chronic conditions and absenteeism. They also found that employees with more than one chronic condition were associated with more frequent and prolonged absences than other employees. However, the study stated that the association between chronic conditions and absenteeism remains unknown in some specific employee categories [8].

Chronic conditions are strongly correlated with job absenteeism in the working environment. Therefore, organizations must implement changes to reduce the rate of absenteeism among employees with chronic conditions. Casimirri mentioned that addressing the chronic health problems of employees can effectively reduce the rate of absenteeism [8].

The aim of this study was to examine the correlation between healthcare administrators’ chronic conditions and job absenteeism at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia by measuring the impact of chronic conditions on employee working hours and identifying the real cause of absenteeism, as well as to provide recommendations to reduce absenteeism related to chronic conditions.

2 Materials and methods

2.1 Research design

The first phase of the research included identifying and defining the problems and establishment objective of the study and development research plan. The second phase included a summary of the comprehensive literature review. The third phase of the research included a field survey, which was conducted with “examine the correlation between healthcare administrators’ chronic condition and their job absenteeism". The fourth phase focused on distributing questionnaire, which was used to collect the required data in order to achieve the research objective. The fifth phase was data analysis and discussion, Statistical Package for Social Sciences (SPSS) version 20 was used to perform the required analysis. The final phase includes the conclusions and recommendations.

2.2 Research method

A cross-sectional study was conducted, employing a quantitative method at KAMC in Makkah, Saudi Arabia, information gathered at one point in time without any follow-up.

2.3 Sampling and data collection

The study population consists of 500 healthcare administrative employees working at KAMC in Makkah, Saudi Arabia, with a 95% confidence level and 5% margin of error. We calculated the sample size to be 218 administrative employees.

We collected the primary data needed for this research by distributing questionnaires to the study population using simple random sample to increase generalizability, in order to examine the correlation between healthcare administrators’ chronic conditions and job absenteeism. After the KAMC Ethics Committee and Institutional Review Board (IRB) approved the data collection (protocol code, 21–801; date of approval, 5 July 2021), considering participant confidentiality and permission, a self-administered questionnaire was distributed by email to the administrative employees of KAMC through the KAMC research center. The questionnaire was provided with a cover letter explaining the purpose of the study, how to respond, and details about information security in order to encourage a high response rate. The questionnaire included multiple-choice questions, as well as open questions about other chronic conditions. A variety of questions were formulated to meet the study objectives and to facilitate collection of all necessary data to support discussion, results, and recommendations. Study data were obtained from the responses of 225 administrative employees with chronic conditions. The questionnaire used in the study was previously approved and adapted from the World Health Organization Health and Work Performance Questionnaire [12, 13].

2.4 Statistical analysis

To achieve our objectives, SPSS Statistics version 20 [14] was used to manipulate and analyze the data. In addition to frequencies and percentiles, we used the Cronbach’s alpha test to measure the reliability of the items of the questionnaire, Pearson’s correlation coefficients to find relationships between variables, chi-square tests to find relationships between groups, and independent sample t-tests to find differences in individual absenteeism between sexes (male and female).

3 Results

The study sample consisted of the healthcare administrators working at King Abdullah Medical City in Makkah, Saudi Arabia. Questionnaires were distributed to the research participants, and 225 were completed and received. As shown in Table 1, 54.7% of the participants were women and 45.3% were men.

Table 1
Frequencies and percentages of the demographic variables

Sex Frequency Percentage

Male 102 45.3

Female 123 54.7

Sex	Frequency	Percentage
Male	102	45.3
Female	123	54.7

Table 2 shows that the most common chronic condition among employees was back/neck pain (44.9%; 22.2% never received professional treatment), followed by other chronic conditions such as irritable bowel syndrome and severe anemia (44%; 22.2% never received professional treatment), chronic heartburn (31.1%; 13.3% received previous professional treatment), migraine headaches (23.1%; 12.4% never received professional treatment), high blood pressure or hypertension (18.2%; 8.4% never received professional treatment), diabetes (13.3%; 8% currently receiving professional treatment), arthritis (12%; 5.8% received previous professional treatment), and asthma (7.5%; 4.9% received previous professional treatment).

Table 2

Descriptive statistics for chronic conditions

			Yes
Chronic condition	No, I do not have this condition		I never received professional treatment		I received previous professional treatment		Yes, and I currently receive professional treatment		Total
	n	%	n	%	n	%	n	%	n	%
Arthritis	198	88.0	10	4.4	13	5.8	4	1.8	27	12
Chronic back/neck pain	124	55.1	50	22.2	43	19.1	8	3.6	101	44.9
Migraine headaches	172	76.4	28	12.4	16	7.1	8	3.6	52	23.1
High blood pressure or hypertension	184	81.8	19	8.4	5	2.2	17	7.6	41	18.2
Chronic heartburn	155	68.9	27	12.0	30	13.3	13	5.8	70	31.1
Asthma	208	92.4	5	2.2	11	4.9	1	.4	17	7.5
Diabetes	195	86.7	3	1.3	9	4.0	18	8.0	30	13.3
Any other chronic condition	122	55.1	50	22.2	20	8.9	29	12.9	99	44
	1360	75.55	192	10.64	147	8.16	98	5.46	437	24.3

Table 3 shows that the majority of employees with chronic conditions at King Abdullah Medical City in Makkah worked between 30 and 60 h per week (71.11%), followed by 90 h or more (13.78%), between 60 and 90 h (11.56%), and less than 30 h (3.56%). The table also shows that the majority of employers expect employees to work between 30 and 60 h per week (76%), followed by 90 h or more (12.44%), 60 to 90 h (9.78%), and less than 30 h (1.78%). Finally, Table 3 shows that most individuals at the hospital worked 150 to 200 h per four weeks (42.67%), followed by 100 to 150 h (25.33%), 50 to 100 h (9.33%), 250 to 300 h (7.56%), 300 h or more (4%), and less than 50 h (3.11%).

Table 3

Descriptive statistics for employee working hours

Total individual working hours in the past 7 days	Frequency	Percentage
Less than 30 h	8	3.56
30 to 60 h	160	71.11
60 to 90 h	26	11.56
More than 90 h	31	13.78
Employer-expected working hours per week	Frequency	Percentage
Less than 30 h	4	1.78
30 to 60 h	171	76.00
60 to 90 h	22	9.78
More than 90 h	28	12.44
Total individual working hours in the past 4 weeks	Frequency	Percentage
Less than 50 h	7	3.11
50 to 100 h	21	9.33
100 to 150 h	57	25.33
150 to 200 h	96	42.67
200 to 250 h	18	8.00
250 to 300 h	17	7.56
More than 300 h	9	4.00

As shown in Table 4, 96.44% of employees missed part of between 1 and 10 workdays because of problems with their health, followed by any other reason, including vacation (95.11%). A total of 94.67% of employees missed between 1 and 10 entire workdays because of problems with their health, followed by any other reason, including vacation (92.89%). Finally, 88.4% of employees came in early, went home late, or worked on their day off on between 1 and 10 occasions.

Table 4

Descriptive statistics for individual working situations

Days	1 to 10 days		10 to 20 days		20 to 30 days
Work situation	F	%	F	%	F	%
Missed an entire workday because of problems with your health	213	94.67	10	4.44	1	0.44
Missed an entire workday for any other reason (including vacation)	209	92.89	8	3.56	2	0.89
Missed part of a workday because of problems with your health	217	96.44	6	2.67	2	0.89
Missed part of a workday for any other reason (including vacation)	214	95.11	8	3.56	2	0.89
Come in early, go home late, or work on your day off	199	88.4	16	7.11	6	2.67

A total of 7.11% of surveyed hospital employees came in early, went home late, or worked on their day off on between 10 and 20 occasions. A total of 4.44% of employees missed between 10 and 20 entire workdays because of problems with their health situation, followed by any other reason, including vacation (3.56%). Among the surveyed employees, 2.67% missed part of between 10 and 20 workdays because of problems with their health, and 3.56% for other reasons, including vacation.

Finally, six employees (2.6%) came in early, went home late, or worked on their day off on between 20 and 30 occasions. Only one employee (0.44%) missed between 20 and 30 entire workdays because of problems with their health, followed by any other reason, including vacation (0.89%). Two employees (0.89%) missed part of between 20 and 30 workdays because of problems with their health, and two (0.89%) for any other reason, including vacation.

We used the chi-square and correlation tests to determine the relationship between employee absenteeism and chronic conditions. Table 5 illustrates that we found a statistically negative relationship between chronic heartburn and employee working hours (p < 0.01) and a statistically negative relationship between any other chronic condition and working hours (p < 0.05). We also found a relationship between high blood pressure and hypertension and working hours (p < 0.05).

Table 5

Relationship between employee absenteeism and chronic conditions

Chronic condition	Employee working hours
	Chi-square	Correlation
Arthritis	88.09	–0.048
Chronic back/neck pain	95.32	–0.053
Migraine headaches	101.90	0.107
High blood pressure or hypertension	123.53^**	0.083
Chronic heartburn	127.52^**	–0.154^*
Asthma	53.96	0.065
Diabetes	135.01	0.018
Any other chronic condition	191.37	–0.164^*

^**p < 0.05; ^*p < 0.01.

To find differences between male and female participants, we used an independent sample t-test. Table 6 illustrates that we found no statistical differences between men and women in terms of employee absenteeism, with the p-values for each group being greater than 0.05.

Table 6

Differences in employee absenteeism between men and women

Employee absenteeism	Sex	N	Mean	Std. deviation	t-test	p-value
Working hours	Male	102	53.24	20.5	0.357	0.721 >0.05
	Female	123	52.25	20.8

4 Discussion

Employee health contributes to performance outcomes in all workplaces and organizations and should be considered from different perspectives in order to achieve optimal investment in employee skills.

Although research on this topic has been performed in countries around the world, little has taken place in Saudi Arabia. This study was conducted with the aim of examining the correlation between the chronic conditions experienced by healthcare administrators and job absenteeism. Studies of this type can help employers to focus on offering the tools needed for employees to self-manage their chronic conditions and to provide strategies to improve productivity and performance quality.

Some limitations of our study may have affected the results. First, we conducted a cross-sectional study, although a longitudinal study may have provided more generalizable results. Second, the questionnaire asked employees to provide information about working hours and their working situation within a four-week recall period. The relationship between employees’ chronic conditions and job absenteeism may have been different if a longer period of recall had been used.

The results of this study indicated that a significantly negative relationship exists between chronic heartburn, as well as other chronic conditions, such as irritable bowel syndrome, severe anemia, chronic fatigue, and high blood pressure or hypertension, and employee working hours. This means that we observed an increased rate of absenteeism among employees with these chronic conditions. Increased rates of absenteeism among individuals with chronic conditions were also reported in previous studies. Mesas indicated a significantly negative relationship between back and neck pain, as well as migraines and employee working hours [7]. Also, in another study by Serranheira an increased rate of absenteeism was significantly higher in individuals with lower back pain [15]. However, in this study, we did not find a relationship between back/neck pain and migraines and employee working hours. These differences may be attributable to the sociodemographic characteristics, lifestyle, or occupation of the participants, as well as the use of analgesics.

Some of the investigated employees in the current study never received professional treatment for their chronic conditions. Never receiving treatment for long-term medical conditions can cause more complications and health problems that affect individuals with a chronic condition, which can lead to functional limitations and increased absenteeism. Vuong reported that functional limitations because of a chronic condition can cause a significant rate of absenteeism [11]. Additionally, Asay and Mitchell found that individuals with chronic conditions had a high rate of absenteeism, which increased with the number of health risk factors [16, 17].

The results of this study indicates that the most common reason for days absent from work among employees with chronic conditions was problems related to their health, followed by other reasons, such as vacation. These results are similar to those reported in a study conducted by Zhang, in which chronic conditions, such as asthma, diabetes, migraines, heart disease, and bowel disorders, were found to be associated with a significantly increased rate of individual absenteeism due to health-related problems [18].

When comparing men and women in this study, we found no statistical differences between the two groups in terms of employee absenteeism. These results contrast those of a previous study conducted by Casimirri, where women had a lower rate of absenteeism than men [8]. The absence rate among men and women can differ according to country, social class, age, and professional group. Therefore, our results reflect the specific characteristics of the study population.

In reviewing the literature, comparing different studies may be challenging because of differences in population and sample size, materials and methods used, and health promotion from one workplace to another. Moreover, sick leave and absenteeism policies and regulations differ widely between employers and between countries across the world.

Job absenteeism because of chronic conditions is common among all types of jobs and can have an adverse effect on the workforce. Therefore, we need to better understand chronic conditions and their potential impact on employees’ ability to meet the demands of their jobs. Further studies are needed to analyze the circumstances underlying absenteeism and their influence on productivity and efficiency among employees with chronicconditions.

5 Conclusion and recommendations

In conclusion, according to the obtained results, employees’ chronic conditions have a significant impact on absenteeism. Therefore, we recommend that employers intervene to determine how employees’ chronic conditions affect their health and prevent them from attending work. We must understand the relationship between the two variables so we can provide the necessary care and recommendations to help both employers and employees to reduce the rate of absenteeism and enhance workplaceperformance.

Providing workplace health and wellness programs within an organization can improve employee health, thereby reducing the rate of absenteeism. Such programs have the potential to benefit both employers and employees in the workplace and to increase the rate of productivity in the working environment.

Ethical approval

This study was exempt from review by the King Abdullah Medical City (KAMC) Institutional Review Board (IRB), registered at the National BioMedical Ethics Committee King Abdulaziz City for Science and Technology on 4 June 2012 (registration no., H-02-K-001), followed GCP-ICH regulations (OHRP registration no., IORG0007625), and was approved by the IRB of King Abdullah Medical City in Holy Capital (protocol code, 21-801; date of approval, 5 July 2021).

Informed consent

Not applicable.

Conflict of interest

The author declares no conflict of interest.

Footnotes

Acknowledgments

The author gratefully acknowledges the support and guidance of Prof. Dr. Omar Zayyan Alsharqi during the course of this study.

Funding

This research received no external funding.

References

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