ORIGINAL ARTICLE

Effectiveness of a Combined Social and Physical Environmental Intervention on Presenteeism, Absenteeism, Work Performance, and Work Engagement in Office Employees Jennifer K. Coffeng, MSc, Ingrid J. M. Hendriksen, PhD, Saskia F. A. Duijts, PhD, Jos W. R. Twisk, PhD, Willem van Mechelen, PhD, and C´ecile R. L. Boot, PhD Objective: To investigate the effectiveness of a combined social and physical environmental intervention as well as the effectiveness of both separate interventions. Methods: In a 2 × 2 factorial design, 412 office employees were allocated to the combined social and physical environmental intervention, to the social environmental intervention only, to the physical environmental intervention only, or were part of the control group. Data on presenteeism, absenteeism, work performance, and work engagement were obtained with questionnaires at baseline, 6, and 12 months. Multilevel analyses were performed. Results: The combined intervention showed a decrease in contextual performance and dedication. The social environmental intervention showed an improvement in task performance. The physical environmental intervention revealed an improvement in absorption. Conclusion: Although the study showed some promising results, it is not recommended to implement the current interventions.

I

n Europe, the number of reported working days lost because of health-related problems is high.1 Specifically, the European Working Conditions Survey presented that 43% of the employees reported to be absent at least 1 day from work last year and 23% reported absenteeism for more than 5 days. The highest level of absenteeism is in public administration (52%) and financial services (49%). Moreover, the current economic crisis also demonstrated an increase in presenteeism (39%)2 ; employees tend not to call in sick, out of fear of losing their job, but are less productive at work because of health problems. These high absenteeism and presenteeism levels impose a large economic burden on society as a whole and employers in general.1,2 Recently, the World Health Organization and the European Union recommended that companies should endorse worksite health promotion (WHP) programs.3,4 Several systematic reviews have indicated that there is promising evidence for the benefits of WHP programs on improving lifestyle behaviors,5,6 such as physical activity and nutrition. In addition, studies have shown that WHP From the Department of Public and Occupational Health (Mrs Coffeng and Drs Duijts, van Mechelen, and Boot), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Body@Work TNO-VUmc (Mr Coffeng and Drs Hendriksen, van Mechelen, and Boot), Research Center Physical Activity, Work and Health, Amsterdam, the Netherlands; TNO (Expert Center Life Style) (Dr Hendriksen), Leiden, the Netherlands; Department of Epidemiology and Biostatistics (Dr Twisk), VU University Medical Center, Amsterdam, the Netherlands; and Department of Health Sciences (Dr Twisk), VU University, Amsterdam, the Netherlands. This project is part of a research program “Vitality in Practice,” which is financed by Fonds Nuts Ohra (Nuts Ohra Foundation). The trial is registered at the Dutch Trial Register (NTR) under trial registration number: NTR2553. Mrs Coffeng wrote the initial article. Drs Hendriksen, Duijts, Twisk, Mechelen, and Boot provided intellectual input and had a role in supervision. All authors have read and approved the final version of the article. The authors declare no conflicts of interest. Address correspondence to: C´ecile R. L. Boot, PhD, VU University Medical Center, Department of Public and Occupational Health, Van der Boechorststraat 7-C573, 1081 BT Amsterdam, the Netherlands ([email protected]). C 2014 by American College of Occupational and Environmental Copyright  Medicine DOI: 10.1097/JOM.0000000000000116

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programs are effective on improving outcomes such as absenteeism and presenteeism.5,7–9 A meta-analysis of WHP programs, focusing on improving physical activity, shows that participation has an effect on work attendance and job stress.5 Furthermore, it was found in a meta-analysis of Kuoppala et al8 that WHP programs involving exercise, lifestyle, and ergonomics reduced absenteeism and improved mental well-being in general. Cancelliere et al7 showed that successful WHP programs for reducing presenteeism were directed at organizational leadership, health risk screening, and a supportive workplace culture. A recent review by Rongen et al9 revealed that there were small positive effects of WHP programs, which were aimed at smoking cessation, physical activity, healthy nutrition, and obesity, on absenteeism and productivity. Moreover, research indicated an increase in programs addressing not only individual interventions but also interventions embedded within a socioecological model. McLaren and Hawe10 defined the socioecological model as “a model that assigns attention to individual and environmental determinants of behaviour.” The socioecological model of health promotion is set forth in interventions that focus on making changes to the individual, social, physical, and/or organizational environment. To illustrate, work engagement or work performance may be a function of individual factors, such as attitudes, but it could also be influenced by social factors such as peer pressure and organizational factors such as choices/facilities in company. Within the socioecological model, worksites are viewed as complex systems consisting of multiple social and physical and environmental conditions, which jointly influence physical and mental well-being. Following, it has been hypothesized that a combined social and physical environmental intervention has an advantage over individual interventions.11–15 Consequently, improving employees’ lifestyle through a social and physical environmental intervention can be considered promising to positively affect work-related outcomes. For this study, the intervention program was developed by means of the intervention mapping protocol.16 The main aim of the intervention program was to improve the need for recovery by stimulating physical activity and relaxation. Resulting from a needs assessment (ie, questionnaire on physical activity, relaxation, and need for recovery, individual interviews, and focus group interviews with target population), key determinants of physical activity and relaxation were selected and methods and strategies were selected to affect these determinants. This resulted in a social environmental intervention consisting of group motivational interviewing (GMI) and conducted by team leaders, and a physical environmental intervention consisting of environmental modifications (ie, table tennis and sitting balls). Aforementioned studies have shown that WHP programs improve lifestyle behaviors and various work-related outcomes such as absenteeism and presenteeism. It is hypothesized that improvements in physical activity and relaxation result directly from the social and physical environmental intervention. On the other hand, improvements in work-related outcomes can occur directly via the social and physical environmental intervention or indirectly via improvements JOEM r Volume 56, Number 3, March 2014

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in physical activity or relaxation. To illustrate, indirect impact is demonstrated when improved physical activity and relaxation lead (eg, to lower levels of absenteeism or presenteeism). In this study, the effectiveness of the combined social and physical environmental intervention was investigated at 6- and 12month follow-up on work-related outcomes (ie, presenteeism, absenteeism, work performance, and work engagement) compared with a control intervention, as well as the effectiveness of the social environmental intervention and the physical environmental intervention separately. It was expected that the combined intervention would be more effective than the separate interventions compared with the control group.

METHODS Study Design and Study Population

We used a 2 × 2 factorial design with four research arms. The four arms consisted of a combined social and physical environmental intervention, the social environmental intervention only, the physical environmental intervention only, and a control group. The social environmental intervention was randomized at the department level. The physical environmental intervention was stratified (ie, two strata were created: departments with environmental modifications and departments without these modifications). In September 2011, 1182 office employees of a financial service provider received an invitation for the project. Those on sick leave for more than 4 weeks were not eligible to participate. Participants received questionnaires at 6- (T1) and 12-month (T2) follow-up after baseline. Blinding of the participants and intervention providers for the social environmental intervention was impossible, although none of them had information about our design involving three intervention groups. Full details of the study design, the development, and content of the interventions of the study have been reported elsewhere.17 The study was approved by the Medical Ethics Committee of the VU University Medical Center, Amsterdam, the Netherlands.

Social and Physical Environmental Interventions Social Environment The social environmental intervention consisted of GMI. Team leaders of the departments were trained (ie, 2-day training in GMI conducted by a GMI professional) to deliver GMI to their team.18 The trained team leaders conducted three GMI sessions of 90 minutes with their own team, within a period of 6 weeks (ie, 3 weeks between each session). The main aim of the sessions was to stimulate physical activity and relaxation; for example, after GMI session 1, employees were asked to complete logs about their daily physical activity and relaxation behavior. In GMI session 2, enhancing self-regulation was a goal by means of the decisional balance sheet, which discusses the advantages and disadvantages of changing behavior. Two months after the final session, a booster session was given by the team leaders. All sessions took place during work hours.

Physical Environment The physical environmental intervention consisted of “Vitality in Practice” (VIP) zones that were created at work: (1) the VIP Coffee Corner Zone—the coffee corner was modified by adding a bar with bar chairs, a large plant, and a giant wall poster; (2) the VIP Open Office Zone—the office was modified by introducing exercise balls and curtains to divide desks to reduce background noise; (3) the VIP Meeting Zone—conference rooms were modified by placing a standing table and a giant wall poster; and (4) the VIP Hall Zone— table tennis tables were placed and lounge chairs were introduced in the hall for informal meetings. In addition, footsteps were placed on the floor in the entrance hall to promote stair walking.

Effectiveness of Social and Physical Environmental Intervention

Outcome Measures Presenteeism was assessed through self-report with the World Health Organization Health and Work Performance Questionnaire (HPQ). The reliability and validity of the Work Performance Questionnaire has been examined for several occupations and has shown good reliability and convergent validity.19,20 Absolute presenteeism was assessed by asking participants to rate their actual performance in relation to their possible performance (0 = total lack of performance; and 100 = top performance). Relative presenteeism consisted of a rating of their actual performance relative to the performance of colleagues (0 = total lack of performance; and 100 = top performance). Absenteeism data were retrieved from company records, 6 months before baseline, at baseline, at 6-, and 12-month follow-up. Work performance was assessed with the Individual Work Performance Questionnaire (IWPQ).21 The IWPQ consists of 16 questions in three subscales: task performance, contextual performance, and counterproductive work behavior. The IWPQ has a recall period of 3 months. The questions for task and contextual performance were assessed on a five-point rating scale, with a range from “seldom” to “always,” and counterproductive work behavior on a five-point rating scale, with a range from “never” to “often.” The psychometric properties of the IWPQ have been tested and results have indicated good to excellent reliability for task performance (α = 0.78), contextual performance (α = 0.85), and counterproductive work behavior (α = 0.79). Also, the IWPQ has shown good convergent and discriminant validity.22 Work engagement was measured using the Utrecht Work Engagement Scale, which consists of three scales—vigor (six items), dedication (five items), and absorption (six items)—23 measured on a seven-point scale from “never” to “always.” The psychometric properties of this questionnaire have been tested previously, and results have indicated an acceptable reliability of vigor (α = 0.83), dedication (α = 0.92), and absorption (α = 0.80).24

Covariates Age, sex, marital status (relationship or single), level of education (low, middle, or high education), ethnicity (native or nonnative Dutch), and work hours per week were investigated as covariates and potential confounders. In addition, job demands and supervisor support were assessed on a four-point scale from “totally agree” to “totally not agree” and were derived from the validated Dutch version of the Job Content Questionnaire.25 General health was measured by one item: “In general, how would you state your health condition?” on a five-point scale (0 = poor; and 5 = excellent), from the Dutch-validated version of the Rand-36.26 The total scale has shown reasonable validity and satisfactory reliability (α = 0.83).

Statistical Analysis All analyses were performed according to the intention-totreat principle. P values of less than 0.05 were considered to be significant. To evaluate the intervention effects, the differences in time between the intervention and control groups were analyzed using linear multilevel analyses for all outcome variables. In this study, four levels were identified: time (two measurements, ie, 6 and 12 months), employees (n = 365), team leaders (n = 49), and departments (n = 19). For each outcome measure, both crude and adjusted analyses (ie, adjusted for age, sex, education, marital status, general health, job demands, and social support) were performed and adjusted for the corresponding baseline measure of the outcome variable. When the overall intervention effect was significant, the results of the separate time points (ie, 6 and 12 months) were also demonstrated. The multilevel statistical analyses were performed using MLwiN version 2.27.

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RESULTS Of the 1182 office employees invited, 412 (35%) employees from 19 departments signed the informed consent form, completed the baseline questionnaire, and were included in the study. The responders were on average 41 years old (standard deviation = 10.2), worked 36 hours a week (standard deviation = 5.3), most were highly educated (56%), and 60% was male (Table 1). Information about the target population was retrieved from company records of the financial service provider. No differences in sex, age, and work hours were observed between the target population and the respondents. The randomization procedure allocated 92 employees to the combined intervention, 118 employees to the social environmental intervention, 96 employees to the physical environmental intervention, and 106 employees to the control group (Fig. 1). Because of the randomization at the department level, the intervention groups are not equal. At 6 months, 351 (85%) and at 12 months 331 (80%) participants completed the follow-up questionnaires. The main reasons for loss-to-follow-up were a job change toward a different employer or lack of motivation. We observed no differences between the four groups at baseline (Table 1). In both the intervention and control groups, males were slightly overrepresented (60%) and the majority was highly educated (57%). Descriptive results for presenteeism, absenteeism, work performance (ie, task performance, contextual performance, and counterproductive work behavior), and work engagement (ie, vigor, dedication, and absorption) at baseline and follow-up measurements are shown in Table 2. The overall intervention effects were all in the expected direction and in four cases they were found to be significant (Table 3). The combined intervention group was associated with an overall significant lower contextual performance and dedication. The social environmental intervention group showed an overall statistically significant higher task performance. For the physical environmental intervention group, an overall significant positive effect was found on absorption. No significant differences between the intervention and control groups were found for presenteeism and absenteeism. In Table 4, the effects of the interventions on contextual performance, dedication, task performance, and absorption are presented at 6 and 12 months separately. The combined interven-

tion group showed a significant lower contextual performance at 6 and 12 months, and a significant lower dedication was found at 6 months. The social environmental intervention group showed significant higher task performance at 12 months. For absorption in the physical environmental intervention group, no significant effects were demonstrated at the two respective follow-up moments.

DISCUSSION This study aimed to evaluate the effectiveness of a combined worksite social and physical environmental intervention on several work-related outcomes, as well of both interventions separately. In comparison with the control group, statistically significant, but small, changes in contextual performance, dedication, task performance, and absorption were found. The interventions did not demonstrate a significant effect on presenteeism and absenteeism, but all of them were in the expected direction.

Comparison With Other Studies Until now, most studies focused on evaluating individual interventions and not on evaluating a combination of a social and physical environmental intervention. Reviews aimed at individual WHP programs showed small effects on work-related outcomes.5,7–9 In this study, we found small, but significant, effects in all intervention groups. In the combined intervention group, a significant reduction was found on contextual performance (ie, additional role behaviors that support the organizational, social, and psychological environment, in which the central job tasks are performed).27 These scores on contextual performance indicate an average level of this behavior, according to norm scores as stated in a study among whitecollar employees.28 On the basis of the socioecological model, we hypothesized that the combined social and physical environmental intervention would be most effective. This hypothesis, however, was not supported by the present findings. Regarding the results of the social environmental intervention (ie, GMI), this study showed a significant improvement in task performance. The participants in the social environmental intervention group improved their task performance from high to very high in the average category, according to the norm scores, as presented in the study by Koopmans et al,28 Over the past years, it has been

TABLE 1. Baseline Characteristics of the Study Population

Baseline characteristics Number of departments Male, n (%) Age, yrs* Having a partner, n (%) Dutch nationality, n (%) Education level, n (%) Low Intermediate High Working hours per week* General health (range, 1–5)* Job demands (range, 1–5)* Supervisor support (range, 1–5)*

Social and Physical Environmental Intervention

Social Environmental Intervention

Physical Environmental Intervention

No Intervention (Control)

n = 92 3 51 (55.4) 38.0 (10.5) 74 (80.4) 82 (89.1)

n = 118 7 73 (61.9) 43.6 (10.3) 91 (77.1) 106 (89.8)

n = 96 3 60 (62.5) 42.2 (10.5) 82 (85.4) 87 (90.6)

n = 106 6 65 (61.3) 40.7 (9.2) 85 (80.2) 95 (89.6)

17 (18.7) 19 (20.9) 55 (60.4) 35.1 (6.1) 3.8 (0.9) 2.6 (0.3) 2.8 (0.5)

39 (33.1) 23 (19.5) 56 (47.5) 36.9 (4.1) 3.8 (0.7) 2.7 (0.2) 2.9 (0.5)

16 (16.7) 20 (20.8) 60 (62.5) 35.7 (5.6) 3.8 (0.7) 2.6 (0.3) 2.9 (0.4)

21 (19.8) 24 (22.6) 61 (57.5) 36.2 (5.3) 3.8 (0.7) 2.7 (0.3) 2.9 (0.5)

*Mean (standard deviation). n, number of employees.

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Effectiveness of Social and Physical Environmental Intervention

FIGURE 1. Flow diagram enrollment of participants. *All percentages are counted within each group on the basis of the baseline number of employees in that group.

shown that the technique of individual motivational interviewing has strong empirical support in improving lifestyle behaviors (ie, nutrition, physical activity, and smoking) at the worksite.29–32 Nevertheless, the effect of motivational interviewing adjusted to a group (GMI) on work-related outcomes has not been investigated before. With regard to the results of the physical environmental intervention, this study showed an overall significant positive effect on absorption (ie, being fully concentrated and immersed in work tasks).24 Nevertheless, it was shown that the control group reduced slightly in absorption and that the intervention group remained stable. This implies that the environmental modifications might have acted as a buffer against a reduction of absorption. Despite the increasing number of studies on environmental modifications, only one review was conducted by Engbers and colleagues,33 and this review was conducted more than 5 years ago. The review evaluated the effects of physical activity and nutrition, environmental modifications and showed small effects on improving nutrition, inconclusive evidence on physical activity, and no evidence on health risk indicators.

Also, the studies included in the review did not consider the social environment. Small improvements in task performance in the social environmental group were found, but no effects on the other work-related outcomes were demonstrated. This can possibly be explained by the fact that, in this study, four GMI sessions were conducted over a 3.5-month period, which could have been too few to produce significant effects. This reasoning is supported by a review indicating that developing the attitude and knowledge about GMI is not very time-consuming, but it is unclear how much time is needed to develop the proper skills.34 As team leaders solely received a GMI training of 2 days, it could be that the training of the team leaders was not sufficient, resulting in disappointing effects on work-related outcomes. Nonetheless, team leaders rated the GMI as good (average rating of 7.5), and the reach for giving the GMI sessions was reasonably good (61.5%).18 For future research, it is recommended to have more frequent GMI contacts. This recommendation is supported by findings of a recent review of Rongen et al,9 who revealed that for

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TABLE 2. Means and Standard Deviations for All Outcome Measures for the Intervention Versus Control Groups at Baseline, 6, and 12 Months Social and Physical Environmental Intervention n

M

SD

Absolute presenteeism (range, 0–100) Baseline 91 75.1 10.4 6 mo 53 74.2 11.5 12 mo 48 75.8 8.5 Relative presenteeism (range, 0–100) Baseline 91 1.1 0.3 6 mo 53 1.1 0.3 12 mo 48 1.1 0.2 Absenteeism (company records), d Baseline 77 4.1 16.2 6 mo 85 4.6 15.9 12 mo 85 3.5 12.7 Task performance (range: 1–5) Baseline 92 3.5 0.7 6 mo 53 3.5 0.7 12 mo 50 3.6 0.6 Contextual performance (range, 1–5) Baseline 92 3.3 0.8 6 mo 53 3.1 0.8 12 mo 50 3.2 0.7 Counterproductive work behavior (range, 1–5) Baseline 92 2.3 0.7 6 mo 53 2.3 0.8 12 mo 50 2.2 0.7 Vigor (range, 1–7) Baseline 92 4.9 0.9 6 mo 53 4.7 1.0 12 mo 50 4.6 1.1 Absorption (range, 1–7) Baseline 92 4.6 1.0 6 mo 53 4.3 1.0 12 mo 50 4.3 1.0 Dedication (range, 1–7) Baseline 92 4.9 1.1 6 mo 53 4.5 1.1 12 mo 50 4.6 1.1 Work engagement (range, 1–7) Baseline 92 4.8 0.9 6 mo 53 4.5 0.9 12 mo 50 4.5 1.0

Social Environmental Intervention

Physical Environmental Intervention

Control Intervention

n

M

SD

n

M

SD

n

M

SD

118 84 74

76.4 77.1 76.6

8.2 7.2 12.1

95 57 56

76.8 76.1 76.1

8.3 8.4 8.7

105 80 76

77.0 75.8 75.0

9.2 11.2 11.7

118 84 74

1.1 1.1 1.1

0.2 0.2 0.2

95 57 56

1.1 1.1 1.0

0.2 0.1 0.2

105 80 76

1.0 1.0 1.1

0.2 0.2 0.2

115 112 112

2.5 3.7 3.9

8.0 10.6 11.5

88 88 88

4.1 3.0 3.2

16.0 6.5 8.6

102 105 105

1.7 2.8 3.6

4.0 8.8 12.3

117 89 76

3.3 3.5 3.7

0.7 0.7 0.7

95 59 58

3.6 3.5 3.6

0.8 0.8 0.6

105 81 78

3.6 3.5 3.6

0.6 0.7 0.7

117 89 76

3.3 3.3 3.3

0.7 0.8 0.8

95 59 58

3.4 3.3 3.4

0.7 0.8 0.8

104 81 78

3.5 3.5 3.6

0.7 0.8 0.8

118 88 75

2.2 2.2 2.1

0.7 0.7 0.6

96 58 57

2.3 2.3 2.2

0.7 0.6 0.6

104 79 77

2.2 2.2 2.2

0.6 0.8 0.7

118 85 75

5.1 5.0 5.1

0.9 1.0 0.9

96 58 57

5.1 5.0 5.0

0.9 0.9 0.9

106 80 76

5.2 4.9 5.0

0.9 1.1 1.1

118 85 75

4.6 4.6 4.7

0.9 1.0 0.8

96 58 57

4.6 4.7 4.7

0.9 1.0 0.9

106 80 76

4.6 4.4 4.4

1.1 1.1 1.1

118 85 75

5.2 5.0 5.3

1.1 1.1 0.9

96 58 57

5.1 5.0 5.1

1.1 1.1 0.9

105 80 76

5.2 4.9 5.1

1.1 1.3 1.2

118 85 75

5.0 4.9 5.0

0.9 1.0 0.8

96 58 57

5.0 4.9 4.9

0.9 0.9 0.8

106 80 76

5.0 4.7 4.8

0.9 1.0 1.0

M, mean; n, number of employees; SD, standard deviation.

successful WHP programs, aimed at smoking cessation, physical activity, healthy nutrition, and obesity, at least weekly contacts were needed for improving work-related outcomes. Also, this reasoning can be applied to the physical environmental intervention. It could be that the relatively “simple” (eg, placing signs to enhance stair use) environmental modifications did not sort sufficient effect. Lastly, the small effects we found can be attributed as well to the fact that the context for implementation of the interventions was not sufficiently considered. That is, interventions were not 262

adequately embedded within the organization. In our study, relatively low organizational and supervisor support for the interventions was found (ie, employees gave an average rating for organizational support of 39.4% and for supervisor support of 43.2% on a scale of 0% to 100%). Furthermore, the team leaders evaluated the program more positively than the employees.18 Of interest is the study of Pronk and Kottke35 that designated attention to the best practice elements and policy initiatives for WHP considered in the context of a socioecological model. Some specific recommendations were to engage

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TABLE 3. Overall Crude and Adjusted Effects in All Outcome Measures Between the Intervention and Control Groups Over a 12-Month Follow-Up Period* Social and Physical Environmental Intervention

Absolute presenteeism Crude Adjusted Relative presenteeism Crude Adjusted Absenteeism Crude Adjusted Task performance Crude Adjusted Contextual performance Crude Adjusted Counterproductive work behavior Crude Adjusted Vigor Crude Adjusted Absorption Crude Adjusted Dedication Crude Adjusted Work engagement Crude Adjusted

Social Environmental Intervention

Physical Environmental Intervention

B

95% CI

P

B

95% CI

P

B

95% CI

P

0.3 0.4

−2.8 to 2.7 −2.5 to 3.2

0.85 0.76

1.9 2.0

−0.6 to 4.4 −0.5 to 4.6

0.13 0.10

−0.1 −0.2

−2.8 to 2.6 −2.9 to 2.6

0.94 0.91

0.0 0.0

−0.0 to 0.1 −0.0 to 0.1

0.27 0.27

0.0 0.0

−0.0 to 0.1 −0.0 to 0.1

0.60 0.56

−0.0 −0.0

−0.1 to 0.1 −0.1 to 0.1

0.97 0.70

0.4 0.4

−2.4 to 3.3 −2.4 to 3.3

0.76 0.77

0.3 0.2

−2.3 to 2.9 −2.4 to 2.8

0.83 0.91

−0.8 −1.0

−3.6 to 2.0 −3.8 to 1.2

0.58 0.47

0.1 0.1

−0.1 to 0.3 −0.1 to 0.3

0.34 0.29

0.2 0.2

−0.0 to −0.4 0.0 to 0.4

0.03 0.04

0.1 0.1

−0.1 to 0.3 −0.1 to 0.3

0.28 0.31

−0.2 −0.3

−0.4 to −0.1 −0.4 to −0.1

0.01 0.01

−0.1 −0.1

−0.3 to 0.1 −0.3 to 0.1

0.21 0.25

−0.1 −0.1

−0.2 to 0.1 −0.2 to 0.1

0.55 0.52

−0.1 −0.1

−0.3 to 0.1 −0.3 to 0.1

0.43 0.40

−0.1 −0.1

−0.3 to 0.1 −0.3 to 0.1

0.22 0.31

−0.0 −0.0

−0.2 to 0.2 −0.2 to 0.2

0.77 0.85

−0.0 −0.0

−0.3 to 0.2 −0.3 to 0.2

0.73 0.68

0.1 0.1

−0.1 to 0.3 −0.1 to 0.3

0.32 0.27

0.1 0.1

−0.1 to 0.4 −0.1 to 0.3

0.25 0.35

−0.1 −0.1

−0.4 to 0.1 −0.4 to 0.1

0.22 0.23

0.2 0.2

−0.0 to 0.3 −0.1 to 0.3

0.14 0.13

0.2 0.2

0.0 to 0.4 0.0 to 0.4

−0.2 −0.2

−0.5 to 0.0 −0.5 to 0.3

0.05 0.09

0.0 0.0

−0.2 to 0.2 −0.2 to 0.3

0.81 0.78

0.1 0.1

−0.1 to 0.4 −0.1 to 0.4

0.31 0.37

−0.1 −0.1

−0.3 to 0.1 −0.3 to 0.1

0.20 0.20

0.1 0.1

−0.1 to 0.3 −0.1 to 0.3

0.34 0.30

0.2 0.1

−0.0 to 0.4 −0.0 to 0.3

0.34 0.30

Effectiveness of a combined social and physical environmental intervention on presenteeism, absenteeism, work performance, and work engagement in office employees.

To investigate the effectiveness of a combined social and physical environmental intervention as well as the effectiveness of both separate interventi...
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