Sickness Absence Culture: A Scoping Review


 Background: Several studies show that the absence behavior of co-workers’ influence the absence rates of individual group members so that an employee is more likely to be absent when co-workers are often absent. To our knowledge, there are no systematic scoping reviews or other reviews on the concept of sickness absence culture. The objective of this review is to identify and map existing literature on sickness absence culture. We will also investigate what methods and designs are used.Methods: We will be conducting a systematic scoping review with the aim of getting a broad overview of the preexisting literature. This scoping review will consider any publication on sickness absence culture in the field of human sciences, including also reviews, original research, and opinion pieces. The review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and a populated PRISMA-P checklist (Additional file 1). Two reviewers will independently screen all abstracts for inclusion. We will search the electronic databases: MEDLINE, Embase, PsycINFO, Clarivate Web of Science, BASE and CINAHL. We will use Covidence for data screening and extraction. The final stage will include a narrative synthesis of the data.Discussion: The results of this scoping review will contribute to identifying and mapping the existing literature on sickness absence culture, which could facilitate future research on the topic. Systematic review registration: Not registered in publicly accessible registry.


Introduction
Sickness absence, when in excess, lead to enormous social and economic costs (1). There are several economic factors affecting sickness absence rates. For instance, we know that sickness bene ts have a signi cant effect on sickness absence and that sickness absence declines when nancial costs are shifted to the employer. Therefore, policy changes where the employer is responsible for covering the economic costs of sickness absence is suggested to reduce sickness absence (1). On the other hand, less is known about cultural factors affecting sickness absence.
Seeing as sickness absence occurs in the context of a workplace, our use of the term culture will therefore refer to organizational culture. Organizational culture is de ned by Andrew Brown as: "…the pattern of beliefs, values and learned ways of coping with experience that have developed during the course of an organization's history, and which tend to be manifested in its material arrangements and in the behaviours of its members." (2 p.9).
Absence culture as a phenomenon has been described by Johns and Nicholson as: "the set of shared understandings about absence legitimacy in a given organization and the established 'custom and practice' of employee absence behavior and its control…" (3 p.136). Absence culture is here described as a social phenomenon that employees affect and is affected by. It entails norms and beliefs about the perceived legitimacy of various reasons not to attend work. Sub-groups of an organization may develop differing absence cultures from the organization as a whole (4-6). Since smaller working groups and teams have become a more common way to organize work (7), it is important to consider the possibility of several absence cultures within a single organization. A more recent de nition by Gellatly and Luchak takes this into account by de ning absence culture as: "the set of absence-related beliefs, values, and behavioral patterns that are shared among the members of a work group or organizational unit...shown to account for the different pattern of absences within and between organizational settings…" (8 p.1086).
In this review, we apply Gellatly and Luchak's understanding of absence culture.
According to Stuart Whitaker, sickness absence can be de ned as: "...absence from work that is attributed to sickness by the employee and accepted as such by the employer…" (9 p.420). Drawing on this de nition, sickness absence it not just medically certi ed absence due to sickness, but all absence reported as sickness by the employee. The threshold for reporting in sick from work is thought to be affected by the workgroup. Several studies show that the absence behavior of co-workers' in uence the absence rates of individual group members so that an employee is more likely to be absent when coworkers are often absent (10)(11)(12)(13). This effect can partly be explained by norms and social interactions regarding sickness absence (14). Individual sickness absence seems to be moderated by factors like group cohesion, group absence norms, and task interdependency within a working group (15)(16)(17). These types of effects are not restricted to a certain eld of work as we for instance see similar results when comparing blue-collar workers and white-collar workers. In addition, there have been studies done on employees in countries with different working policies, for instance Finland, USA, and China (15)(16)(17)(18).
When looking at the preexisting literature are several different conceptualizations of sickness absence culture. These include absenteeism, absence culture, unit-and cross-level absence culture, and sick leave culture, to name a few. After a preliminary literature search, we discovered that the term absenteeism is widely used. Absenteeism refers to an employee's failure to report for scheduled work (12). As per this de nition absenteeism does not exclusively refer to an individual being absent from work due to illness.
Absenteeism can refer to an employee being absent due to a family funeral, a dentist appointment, having a sick child, etc. Due to the nature of our review, literature that make a clear distinction between the reasons why employees are absent will be of great interest, considering we are mainly interested in absence due to reported employee sickness. In addition, the designs used to investigate these conceptualizations also varied (e.g., in-depth interviews, eld studies and survey studies, in addition to use of objective measures, self-reports and co-worker reports).
The objective of this review is to identify and map existing literature on sickness absence culture. We will also investigate what methods and designs are used.
A preliminary search of PROSPERO International prospective register of systematic reviews and JBI Evidence Synthesis was conducted and no current or underway systematic reviews or scoping reviews on the topic were identi ed.

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The objective of this review is to identify and map existing literature on sickness absence culture.

Eligibility criteria
Participants Not applicable.

Concept
This review will include studies that focus on the concept of sickness absence culture. We will consider sickness absence culture as a broad concept and will therefore include studies that report on absenteeism, organizational culture and concepts associated with culture such as norms and beliefs.

Context
We will identify the differing contexts and academic disciplines in which sickness absence culture has been investigated. In addition, we will identify which research questions has been asked regarding sickness absence culture, and what their ndings are.

Types of Sources
This scoping review will consider any publication on sickness absence culture in the eld of human sciences, including also reviews, original research, and opinion pieces.

Methods
The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews (19).

Search strategy
Based on the search terms identi ed in the initial search, speci c search strategies will be developed to t the following databases: MEDLINE, Embase, PsycINFO, Clarivate Web of Science, BASE and CINAHL, all studies up to present date.
The search strategy will aim to locate published studies. An initial limited search of MEDLINE and Clarivate Web of Science was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE (see Appendix I). The search strategy, including all identi ed keywords and index terms, will be adapted for each included database and/or information source. The reference list of all included sources of evidence will be screened for additional studies. Studies published in English or any Scandinavian language will be included. There is a strong tradition for sickness absence research in the Scandinavian countries. Therefore, studies in these languages are of interest. Due to the broad aim of this review, all studies up to present date are considered. Relevant MeSH terms and headings will be identi ed and used where required. The language may change slightly depending on the database; however, the main keywords will be used throughout. Only English search terms will be used in the search strategies. The databases to be searched include MEDLINE, Embase, PsycINFO, Clarivate Web of Science, BASE and CINAHL.

Study selection
Following the search, all potentially relevant citations will be collected and uploaded into Covidence and duplicates removed. Titles and abstract will be screened by two independent reviewers for assessment against inclusion criteria for the review. Studies not meeting the inclusion criteria will be excluded. Potentially relevant studies will be retrieved in full and assessed in detail against the inclusion criteria by two independent reviewers. Reasons for excluding sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion. The results of the searches will be reported in full in the nal scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) ow diagram (20).

Data Extraction
A selection of papers included in the scoping review will be extracted and reviewed by two independent reviewers by using a data extraction tool. Any con icts will be solved through discussion. If no con icts appear from this stage, or when a su cient degree of agreement is obtained, the remaining articles will be extracted together as a team. A generic data extraction tool developed by the researchers will be used (see appendix II). The draft data extraction tool will be modi ed and revised as necessary during the process of extracting data from each included study to leave openness for inclusion of additional unforeseen data that may be relevant for our inquiry. Modi cations will be detailed in the scoping review.
Any disagreements that arise between the reviewers will be resolved through discussion. If appropriate, authors of papers will be contacted to request missing or additional data, where required.

Data Presentation
The data will be presented in a diagrammed or tabular form in a manner that aligns with the objective of this scoping review. The charted and/or tabulated results will be accompanied by a descriptive summary that will describe how the results relate to the reviews objective and question.

Declarations
Ethics approval and consent to participate