The decision-making process of presenteeism – a diary study

Lack of understanding regarding how individuals make attendance decisions is a severe limitation on effective management of attendance behaviour. This study provides an in-depth examination of how the end-to-end decision-making process unfolds in context and over time by employing the Presenteeism Decision-making Process model within a daily diary study. In total, 121 working adults completed the diary every working day for 1–20 days, capturing 476 attendance decisions. Thematic Analysis and Thematic Trajectory Analysis were used to identify within- and between-person trends over time, extending knowledge of the complex presenteeism decision-making process. Findings highlight that whilst high symptom severity often predicts sickness absence, it is by no means a direct nor automatic path, nor necessarily a voluntary or “free” choice. Many employees also perceive limited options, particularly those with chronic conditions, resulting in potential resource loss-spirals. Avoidance motives dominate decisions, which under inflexible conditions, lead to dysfunctional presenteeism. Our findings reveal the idiosyncratic, context-dependent nature of decision-making, with four different decision-making patterns, including heuristic-driven and deliberative. Findings advance theory through qualitative processual insights into the “how” and “why” of presenteeism decisions, highlighting the need for more reflective practices and adaptive work strategies to facilitate functional presenteeism.