Contextually adapted functional and dysfunctional presenteeism during protracted conflict

Healthcare professionals working during protracted conflict are exposed to persistent stressors that challenge both psychological well-being and occupational functioning. Understanding the mechanisms that support adaptive functioning under prolonged adversity is essential for maintaining workforce capacity and continuity of care. Drawing on Conservation of Resources (COR) theory, this study examined how stress, resilience, organizational trust, and strain symptoms relate to functional and dysfunctional presenteeism.

To examine whether strain symptoms mediate the relationships between perceived stress with dysfunctional presenteeism and the relationships of personal resilience and organizational trust with functional presenteeism among healthcare professionals during protracted conflict.

A cross-sectional study was conducted among 227 healthcare professionals. Participants completed self-report measures of perceived stress, personal resilience, organizational trust, strain symptoms, and work functioning. The Stanford Presenteeism Scale (SPS-6) was contextually adapted to assess work functioning during protracted armed conflict. Path analysis with bootstrapping (5,000 resamples) was used to test the hypothesized relationships.

Participants reported relatively high functional presenteeism (M = 3.85, SD = 0.77) and lower dysfunctional presenteeism (M = 2.79, SD = 0.98). The final model demonstrated acceptable-to-good fit [χ²(9) = 12.48, p = 0.188, CFI = 0.978, TLI = 0.949, RMSEA = 0.042]. Resilience and organizational trust were associated with higher functional presenteeism through lower strain symptoms. In contrast, perceived stress showed a significant direct association with dysfunctional presenteeism (β = 0.17, p = 0.005), while its indirect effect through strain symptoms was not significant.

Findings provide partial support for the proposed model and suggest distinct patterns of functional and dysfunctional presenteeism during protracted conflict, as captured by the contextually adapted framework. Perceived stress was primarily associated with maladaptive work functioning, whereas personal resilience and organizational trust were associated with adaptive functioning through lower strain symptoms. Strengthening individual and organizational resources may help nurses and dietitians, and potentially other healthcare professionals, maintain effective functioning under prolonged adversity.