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Workplace

ORIGINAL ARTICLE

Time pressure, working time control and long-term sickness absence Jouko Nätti,1 Tomi Oinas,2 Timo Anttila2 1

School of Social Sciences and Humanities, University of Tampere, Tampere, Finland 2 Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland Correspondence to Dr Timo Anttila, Department of Social Sciences and Philosophy, PO Box 35, University of Jyväskylä, Jyväskylä FI-40014, Finland; timo.e.e.anttila@jyu.fi Received 2 July 2014 Revised 3 December 2014 Accepted 14 December 2014 Published Online First 6 January 2015

ABSTRACT Objectives Perceived time pressure at work has increased in most European countries during recent decades. Time pressure may be harmful for employees’ health and well-being. The aim of this register-based follow-up study is to investigate whether the effects of time pressure on long sickness absence vary by the level of working time control. Methods The data are taken from the Finnish Quality of Work Life Survey 2003 (n=3400), a representative sample of Finnish employees, combined with a registerbased follow-up from Statistics Finland covering the years 2002–2006. In the 2003 survey, employees were asked about their perceived time pressure and to what extent they had control over working time. The register data included information on long-term (more than 10 days) sickness absence. A negative binomial model was used in the analysis of long-term sickness absence days during 2004–2006. The results are adjusted for several background and work-related factors and controlled for baseline absenteeism in 2002. Results High working time control decreased and high time pressure increased long-term sickness absence. The highest incidence of long-term sickness absence was found in time strain situations (high time pressure, low time control). However, there was no statistical interaction between working time control and time pressure. Conclusions Establishments that use working time control as a human resource instrument may benefit from reduced absenteeism. However, following the ‘strain’ hypothesis it is insufficient to focus solely on working time control as high time pressure maintains its detrimental effect on employees’ health.

INTRODUCTION

To cite: Nätti J, Oinas T, Anttila T. Occup Environ Med 2015;72:265–270.

Perceived time pressure at work has increased in most European countries during recent decades.1 2 In comparison with Europe as a whole, the level of time pressure is above the average in the Nordic countries.3 New forms of work organisation, such as high-performance and high-involvement management practices, which include incentives combining effort with pay, have been linked to the intensification of work.4 Time pressure may be harmful to employees’ health and well-being, although the evidence on the relationship between time pressure and absenteeism is still inconclusive.5 6 Psychosocial time pressures, such as tight deadlines, perceived time pressure, or a time famine, may be more important for health than hours spent on the job.7 Time

What this paper adds ▸ Perceived time pressure at work has increased in most European countries during recent decades. ▸ Time pressure may be harmful for employees’ health and well-being. There is some evidence for the moderating role of working time control in the relationship between work demands and health outcomes. However, the evidence on the relationship between time pressure, working time control and absenteeism is still inconclusive. ▸ The aim of this register-based follow-up study is to investigate whether the effects of time pressure on long sickness absence vary by the level of working time control. ▸ The present study showed that time pressure and working time control were independently associated with medically certified long-term sickness absence lasting over 10 days. High perceived time pressure increased long-term sickness absence, while high working time control decreased long-term sickness absence. However, there was no interaction effect between working time control and time pressure on long sickness absence.

pressure can be expected to increase employees’ negative emotions, stress and fatigue. These reactions may spill over into family life, which may increase work-to-family conflict by limiting employees’ abilities to perform family duties.8 One of the most influential models in research on the relationship between work and health has been the Job Demand-Control ( JDC) model.9 The model identifies two main aspects in the work situation: job demands and job control. Job demands refer to the mental workload needed to perform work tasks; job control or decision latitude refers to possibilities to control these tasks. According to the strain hypothesis, a combination of high demands and low decision latitude leads to job strain, which in turn causes ill health. The most negative outcomes should be found in the high strain situation, which could be the result of either additive or interaction effects between job demands and control. The buffer hypothesis addresses that job control can buffer the negative effects of high demands on health. The latter hypothesis explicitly assumes interaction, that is,

Nätti J, et al. Occup Environ Med 2015;72:265–270. doi:10.1136/oemed-2014-102435

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Workplace job control moderates the effect of job demands.10 11 Following the JDC model, the adverse effects of a high level of job demands such as time pressure could be offset by increasing the level of employees’ job resources, such as control over the job.9 12 However, previous research has shown that only aspects of job control that correspond to the specific demands of a given job are able to buffer the impact of high demands on well-being.11 Thus, control over work time is especially important for the health and well-being of contemporary employees, given the increasing time pressures many are experiencing.7 Job demands are often measured with items addressing time pressure or time pressure is conceptualised as a subdimension of quantitative job demands.12–14 Time strain (high time pressure, low time control) is a significant risk factor for health, over and above conditions of high job demands and low job control.7 There is empirical evidence showing that high job demands and low job control are important predictors of well-being and motivation. Support for the buffer hypothesis (ie, that control can moderate the negative effects of high demands on well-being) is less consistent.15–17 Working time control (WTC) is defined as the possibility to meet the needs of employees, providing them with autonomy regarding factors in the start and end times of their shifts, breaks, days off, holidays and the total number of work hours.18 19 WTC is often associated with the better mental and social well-being of employees, especially in situations where they have to be flexible for the needs of their employer or company.20 21 A prospective Finnish public sector cohort study showed that low control over daily working hours predicted medically certified sickness absences and high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences.22 Based on a recent Cochrane review,23 the evidence from 10 different studies tentatively suggests that flexible working time interventions that increase worker control and choice are likely to have a positive effect on health. Nijp et al24 have presented two separate mechanisms that potentially explain WTC’s favourable associations with well-being. The first relates to the timeregulation potential of WTC, because control over working time helps people align their work commitments with their private life. The second mechanism is based on recovery-regulation. WTC can prevent work overload and sustain a favourable effort-recovery balance. WTC facilitates both on-the-job recovery (breaks during the day) and external recovery (in-between working periods). The positive influence of WTC on psychosocial and health outcomes may also be indirect. Hughes and Parkes25 found that WTC was not only directly related to reduced work-family interference, but high control also buffered the negative effect of longer hours on work-family relations. Similarly, Geurts et al26 found that workers who could take days off and vacations according to their own needs (leave control) were less likely to be required to neglect family activities due to work duties. In addition, control regarding starting and finishing times (flexitime) buffered the adverse impact of long contractual hours on work-family relations.

Aims The objective of this study is to examine the relationships between time pressure, WTC, and long-term sickness absence of more than 10 days. There is some evidence for the moderating role of WTC in the relationship between work demands and health outcomes. In order to study the possible combined 266

effects of time pressure and WTC on chronic health problems, the aim of this study is to investigate whether high time pressure more strongly predicts long-term sickness absence among employees with low WTC, compared to those with high WTC.

METHODS Sample and participants The data consist of the Finnish Quality of Work Life Survey (FQWLS) from 2003 linked to a register follow-up on longterm sickness absence over 3 years. The sample is based on 5270 employees, of whom 4104 participated in face-to-face interviews in 2003, the response rate being 78%. The questionnaire comprised a comprehensive set of questions dealing with various features of work life. The FQWLS is a representative sample of Finnish employees covering all sectors and occupations. The sample in 2003 was based on respondents in the October and November Labour Force Survey who were 15–64 years old with weekly working time of at least 5 h (in Finland normal working time is 40 h per week). According to Statistics Finland, non-response does not seriously undermine the representativeness of FQWLS data.27 The present study was restricted to 18–64-year-old employees who had worked in their current job at least 1 year (N=3436).

Register-based follow-up data To study long-term sickness absence in relation to time pressure and WTC, the FQWLS was merged with register-based follow-up data held and maintained by Statistics Finland. The combination of the survey and register-based data was approved by Statistics Finland and performed by Statistics Finland. Information on the participants in the FQWLS was obtained by following the information logged against their personal social security number by Statistics Finland. The survey and the combined material did not include any identification data. Accordingly, the ethical standards of Statistics Finland were followed when conducting the study.

Measures Long-term sickness absence Long-term sickness absence information was drawn from the register data. The Finnish Social Insurance Institution (KELA) keeps records on sickness allowances paid for medically certified sickness absences of more than 10 days for the entire population. Sickness allowance is payable for a maximum of 300 working days, after which one can apply for a disability pension. In 2006, the most common causes for sickness allowance were musculoskeletal diseases, mental and behavioural disorders and external causes (eg, fractures). Maternity leave and absence from work to care for a sick child are not included in the sickness absences. Long-term sickness absence in previous year (2002) was treated as baseline absenteeism, and the accumulated number of days on long-term sick leave between 2004 and 2006 was used as an outcome measure. This measure corresponds to length of absence—that is, total number of days an individual has been absent from work over a specific period— regardless of the number of absence spells. Absence duration is generally considered to measure ‘involuntary absenteeism’ that results from inability rather than unwillingness to work.28 The accumulated long-term sickness absence days may result from one or several sickness absence episodes exceeding 10 days, in the latter case the sickness absences are not consecutive days. The register data do not include information about the number of sickness absence spells. Nätti J, et al. Occup Environ Med 2015;72:265–270. doi:10.1136/oemed-2014-102435

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Workplace Time pressure Time pressure was measured with four items addressing the occurrence of tight time schedules and the mismatch between time and task demands. This measure is very similar to the job demands measure used by Gimeno et al16 in their article. Participants were asked to what extent time pressure and tight time schedules were perceived as an adverse factor in a work environment (1=not at all, 5=very much) and to what extent they agreed with the statements (1=untrue, 4=true) “my work contains tight time schedules”, “I often have to stretch my working day to get all work done” and “I do not have time to do my work as well and conscientiously as I would like to”. All individual variables were rescaled to range from 0 to 1 before constructing the index. A 4-item composite variable was constructed by summing up the response scores to the rescaled questions (Cronbach’s α 0.70, mean 0.45 and SD 0.22). The participants were classified into quartiles to indicate lower and higher levels of time pressure.

Working time control WTC was measured with four items by asking respondents how much they could influence their working time on a scale of one to four (1=not at all, 4=much/), to what extent they agreed with the statement “I can use flexible working hours sufficiently for my own needs” (1=untrue, 4=true), to what extent they had the possibility of taking brief absences from work in the middle of the working day to run personal errands (1=never, 4=always when necessary) and whether they could change the starting and ending times of a workday (yes, no). All individual variables were rescaled to range from 0 to 1 before constructing the index. A 4-item composite variable was constructed by summing up the response scores to the rescaled questions (Cronbach’s α 0.74, mean 0.58 and SD 0.30). The participants were classified into quartiles to indicate lower and higher levels of WTC. This index is very similar to the index developed in previous studies,20 excluding questions about control over vacations and days off.

Background, work and health-related factors Major background, work and health-related factors that are generally known to influence sickness absence were controlled for in the analyses. The five background factors were age (18–34, 35–49, 50–64 years old), gender, marital status (living with a partner, 1=yes, 0=no) and dependent children (1=yes, 0=no). Work-related factors consist of weekly working hours, job tenure, employer sector and occupation. Weekly working hours were examined by asking participants how many hours they usually worked at their main job. Job tenure was measured by asking participants how many years they had worked for their current employer. Employer sector was measured by asking participants if they work in the private or public sector. Respondent occupation (ISCO-88) was derived from Labour Force Survey preceding participation in FQWLS and coded to four major groups according to the skill level of the job (managers, professionals, experts/technicians and clerks/workers). Health-related factors consist of long-standing illness. Longstanding illness was measured by asking participants whether they suffered (no, yes) from any permanent injury or medically diagnosed chronic illness, such as cardiovascular, pulmonary, or muscular-skeletal disease, disease of the digestive system, or some other long-term illness.

Statistical analysis The relationships between background factors and WTC, and time pressure and long-term sickness absence days were Nätti J, et al. Occup Environ Med 2015;72:265–270. doi:10.1136/oemed-2014-102435

examined by using analyses of variance. The effects of time pressure and WTC on long-term sickness absence were analysed using a negative binomial (NB) model. Long-term sickness absence days were clearly overdispersed—that is, the variance was higher than the mean and there was an excess of zeroes— which made a simple Poisson model unsuitable for the analysis. The NB model is also more appropriate than the Poisson when the events of interest are not independent,29 which is the case for sickness absence days. In order to take into account the individual differences in time at risk of long-term sickness absence, for example, some retiring or becoming unemployed during follow-up, we included the natural logarithm of the months in employment during 2004–2006, derived from registers, as an offset variable. The results are represented as incidence rate ratios (IRR) and their 95% CIs. To study the joint effects of WTC and time pressure, we constructed a combination variable by cross-tabulating the time pressure and the level of WTC (median-split). The effects of the resulting four combinations on long sickness absence were studied using the hypothetically most adverse conditions (high pressure with low control) as the reference category. The significance of these joint effects was studied using appropriate crossproduct terms (time pressure multiplied by WTC) with the Wald test for interaction. Analyses of long-term sickness absence are conducted in three steps. Unadjusted effects of WTC and time pressure are presented in the first model. Background (age, gender, marital status and dependent children), work-related (weekly working hours, job tenure, employer sector and occupation) and health-related (long-standing illness) factors are added in the second model. In addition, long-term sickness absence before the survey year was treated as baseline absenteeism and added to the model. In the third, fully adjusted model, either WTC or time pressure is added. The combined effects of WTC and time pressure are presented for the unadjusted and fully adjusted models.

RESULTS Table 1 shows descriptive information of the study participants and the relationships between the control variables, time pressure, WTC and subsequent long-term sickness absences. The majority of the participants were female (53%), under 50 years of age (67%), married or cohabiting (58%) and had no dependent children (60%). Most worked 35–40 h per week (77%), were workers or clerks (56%), had job tenure less than 10 years (53%) and worked in the private sector (62%). The great majority had no long-standing illness (69%) or long-term sickness absences in the previous year (89%). The average score of time pressure was 0.41 and WTC 0.58 on the scale 0 to 1. The accumulated long-term sickness absence days had highly skewed distribution, and 70% of the sample had no medically certified absences during the follow-up. For those who had at least one long-term sickness absence day, the median was 22 days of absence during the follow-up (2004–2006). All background, work and health characteristics except gender, marital status and weekly working hours were associated with the accumulated sickness absence days. Sickness absence was more common for participants aged 50 years and above, employees without dependent children, employees working in the public sector, employees with job tenure longer than 10 years, long-standing illness and previous sickness absence. Gender, work hours, job tenure, time pressure, sector and baseline sickness absence were associated with WTC. Men, those working over 41 h per week, job tenure over 2 years, no 267

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Workplace Table 1 Descriptive information of the study participants and the relations of background variables with time pressure, working time control and accumulated long-term sickness absence days Time pressure

Gender Women Men Age 18–34 35–49 50–64 Married or cohabiting No Yes Dependent children No Yes Occupation Managers Professionals Experts Clerks/workers Weekly working hours 5–15 16–34 35–40 41+ Job tenure (years) 1–2 3–9 10+ Employer sector Private Public Long-standing illness No Yes Long-term sickness absence in previous year No Yes

N

Mean (SD)

1804 1632

0.46 (0.25) 0.44 (0.24)

839 1468 1129

0.44 (0.23) 0.46 (0.25) 0.43 (0.24)

1458 1978

0.44 (0.24) 0.45 (0.24)

2024 1412

0.44 (0.24) 0.46 (0.24)

238 681 600 1917

0.57 0.53 0.48 0.39

(0.23) (0.22) (0.24) (0.24)

59 412 2658 304

0.31 0.39 0.44 0.58

(0.23) (0.24) (0.24) (0.23)

584 1222 1630

0.42 (0.25) 0.46 (0.24) 0.45 (0.24)

2113 1323

0.44 (0.24) 0.46 (0.25)

2355 1080

0.44 (0.24) 0.46 (0.25)

3055 381

0.45 (0.24) 0.45 (0.25)

Long-term sickness absence (2004–2006)

Mean (SD)

Mean (SD)

0.002

F-test (p)

Time pressure, working time control and long-term sickness absence.

Perceived time pressure at work has increased in most European countries during recent decades. Time pressure may be harmful for employees' health and...
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