Background: Presenteeism is the act of attending work whilst ill, often resulting in a productivity loss (Aronsson, 2000; Ruhle et al., 2020). According to Hobfoll's (1989) Conservation of Resources (CoR) theory individuals work to conserve and acquire resources, being approach or avoidance motivated, wherein, respectively one is motivated to obtain something (e.g., prove their worth) or actively negate something (e.g. avoid using sick leave) (Henderson & Smith, 2021). Both motives and the CoR theory imply that presenteeism reduces work productivity, however this has not been directly observed in terms of audiologists internationally, and not divided between public and private sector audiologists who presumably have very different pressures. The comparison of mental health and physical health induced presenteeism in audiology is also absent in the literature, which could provide insight to improve audiologists’ wellbeing and client care.

Aims: This study aims to measure the potential effect of approach-avoidance motivations on presenteeism in the field of audiology and determine if the rates of presenteeism and absenteeism due to mental or physical health are significantly different in the public and private sectors.

Methods: An international cohort of audiologists was recruited to complete the crosssectionally designed online survey, with a minimum of 84 participants working mostly in the private sector and 84 working mostly in the public sector. This allowed the study to have sufficient power to answer the research questions. The anonymous survey used measures of the World Health Organisation Mental Health Composite International Diagnostic Interview (WHO, 2017), demographic items, WHO’s 2010 Health and Work Performance Questionnaire presenteeism question, the Stanford Presenteeism Scale (Koopman et al., 2002), a 9-item scale developed by Lu et al. (2013), and a question from Whysall et al. (2018) regarding the pressures of presenteeism.

Results: No significant differences were found between public and private sector absenteeism and presenteeism rates, nor in productivity loss following presenteeism. No significant differences were found in mental health or physical health yearly absenteeism rates, yearly and monthly presenteeism rates, nor productivity loss. However, there was significantly more physical health related absenteeism noted in the monthly count than mental health related absenteeism. The public and private sectors showed no significant difference in both approach and avoidance motives in the different sectors (public and private). However, there was significantly more approach-motivated presenteeism resulting from mental health issues than physical health issues. The same was true for avoidance-motivated presenteeism, having significantly more mental health induced cases than physical health induced. Discussion: The literature extensively shows mental health to cause significantly more days of absence than physical health, but this study found the opposite in monthly counts (Bubonya et al., 2017; de Graaf et al., 2012; Milner et al., 2020). This could be the result of mental health stigma or type 1 errors as the study also found no significant difference in the rate of clinician absenteeism, presenteeism, or productivity loss in the public sector versus the private sector, despite the literature heavily indicating public sector work to be more stressful, time pressured, and mentally challenging (Barmby et al., 2002; Bryan et al., 2021; Dew et al., 2005; Jensen et al., 2019; Mastekaasa, 2020; Pfeifer, 2013; Yang et al., 2020). Clinician productivity loss could cause increased wait times, diminished patient trust following reduced continuity of care, or even deter patients from seeking healthcare in the future (Tumlinson et al., 2019). Similarly, the nonsignificant difference in presenteeism rates due to mental health versus physical health contests Bubonya et al.'s (2017) study which noted mental health to be one of the strongest correlates of presenteeism, often accounting for more total productivity loss than absenteeism (Johns, 2010). The nonsignificant difference between public and private clinician’s approach or avoidance motivates was expected, as were the greater motive scored for mental health than physical health. Via the CoR theory, audiologists in the public sector were expected to have greater resource loss and experience the first corollary (Hobfoll et al., 2018).

Conclusion: This study was the first of its kind, examining audiological absenteeism, presenteeism, productivity loss, and approach-avoidance motives. The findings demonstrate that audiology appears to buck the trends of the literature, hence further research is needed to limit the economic, social, and health impacts of these behaviours to improve clinician and patient wellbeing. As the sample only represented 6% of the world’s population it could be prudent to perform a similar study involving more countries (Worldometer - Real Time World Statistics, n.d.). The use of matched control groups and daily units to measure absenteeism and presenteeism would enable comparison of audiology rates to other professions.