Workplace health promotion and absence culture are more important than structural factors as determinants of local differences in sickness absence among social care employees in Swedish municipalities

Workplace health promotion and absence culture are more important than structural factors as determinants of local differences in sickness absence among social care employees in Swedish municipals Background In Sweden there are large unexplained differences in sickness absence between regions as well as between employers within the same trade. The aim was to study sickness absence differences between municipalities in their social care staff in relation to internal workplace factors as well as external structural factors in the local society. Method A questionnaire with focus on perceived organizational climate, health, absence culture and workplace health promotion (WHP) was sent out to 15,871 social care employees in a random sample of 60 out of Sweden’s 290 municipalities. The response rate was 58%. A database of the 60 municipalities was constructed with aggregated data from the questionnaire and official registers. Results In a Structural Equation Model analysis, lower sickness absence level was related to internal factors (access to and utilization of a broader repertory of WHP measures, a more restrictive absence culture, and better self-rated health) as well as external structural factors (lower rates of sickness absence in the population). Multivariate analyses indicate that WHP measures was the most important predictor followed by absence culture which, however, was mostly determined by external structural factors such as a more favorable situation concerning prosperity, labour market, and standardized mortality rate in the local society. Better self-rated health was determined by encouraging leadership mediated by better social climate at the workplace. Conclusions Although the staff sickness absence level is related to local structural factors beyond the control of the manager such as the level of sickness absence in the general population and the local absence culture, the managers’ measures concerning WHP, leadership and organizational climate matter irrespective of these external circumstances