Sickness presenteeism (SP), defined as working despite being sick, is a complex phenomenon that is influenced by health-related vulnerability and individual decision-making behavior. Traditional survey measures, such as the frequency of SP days, conflate these two factors, which limits their usefulness in research focusing on attendance decision-making behavior. Presenteeism propensity – a ratio of SP days to total sickness days (that is, the sum of SP and sickness absence days) – has been proposed as a less biased and more informative measure. This study validates the use of presenteeism propensity with data from the German BIBB/BAuA Employment Survey 2024 and a vignette study (n = 2,350). We compare the predictive power of SP frequency and presenteeism propensity for explaining attendance decisions under experimentally controlled conditions. Our results show that presenteeism propensity correlates more strongly with vignette-based attendance decisions than SP frequency, particularly when virtual presenteeism is included. Truncating frequency measures (< 60 days) improves the predictive validity of frequency measures, but has negligible effects on propensity. While SP frequency measures are more closely linked to health-related vulnerability, presenteeism propensity captures individual tendencies to opt for SP over sickness absence. These findings highlight the utility of using presenteeism propensity as a measure in research on attendance behavior. This study contributes to the literature by offering a validated framework for distinguishing between health-related and decision-related factors in attendance research. Future research should more thoroughly determine whether frequency or propensity measures are appropriate for answering the research questions.

This article is published in the Journal "Health Services and Outcomes Research Methodology" (2026).