This paper explores the role of self-management of chronic illness at work, as a predictor for self-disclosure. The study reports findings from a survey sent to all staff at a UK university, of which 610 employees reported managing a chronic illness: arthritis, musculoskeletal pain, diabetes, asthma, migraine, heart disease, irritable bowel syndrome and depression. The study found that discrete self-management factors predicted different levels of disclosure: partial self-disclosure (employees informing line managers about the presence of a chronic illness) and full self-disclosure (employees informing line managers how that chronic illness affected them at work). For partial disclosure, a greater reported experience of chronic illness by employees was positively associated with self-disclosure. For full-disclosure, employees were more likely to report disclosure to line managers if they had already disclosed to colleagues, and if they perceived receiving support from their line managers in relation to their chronic illness as important. Except for academics who were least likely to disclose, occupational groups did not emerge as significant predictors for either partial or full disclosure. Except for diabetes, chronic illness itself was not a significant predictor or barrier to self-disclosure. Our findings suggest that chronically ill employees adopt a disclosure strategy specifically related to different self-management needs of chronic illness at work.
The impact of chronic illnesses on labour force participation has received much attention in recent years. Part of this can be attributed to the 1992 World Health Organization report in which chronic illnesses are recognised as one of the most expensive health problems in modern industrialised countries (WHO, 1992). At least a third of the workforce by the age of 50, is likely to be managing a chronic illness, usually a cardiovascular or musculoskeletal disorder (Ilmarinen, 1994). In this respect, much of the attention has been given to the work-related causes of chronic illness (e.g. back pain), the impact of chronic illness on work productivity or to work adjustments provided (Baanders, Andries, Rijken, & Dekker, 2001; Burton, Conti, Chen, Schultz, & Edington, 1999; Gulick, Yam, & Touw, 1989; Gulick, 1992; Kessler, Greenberg, Mickelson, & Wang, 2001; Lerner et al., 2003; Lerner, Amick, Malspeis, & Rogers, 2000; Roessler & Rumrill, 1998). Less attention has been paid to the management of chronic illness from the employees’ perspective. Self-management includes recognising and responding to symptoms, managing acute episodes, use of medication, managing relations and obtaining support from significant others, and is influenced by contextual factors such as social networks, family support, health care providers, and the physical environment (Clark, Becker, Janz, Lorig, Rakowski, & Anderson, 1991; Gallant, 2003). Whilst a significant minority of those managing a chronic illness are likely to be working, there is little evidence as to how work impacts on self-management.
It is suggested that the work context may have received limited attention from researchers, due to issues associated with disclosure. Self-disclosure was defined by Collins and Miller (1994) as the ‘act of revealing personal information about oneself to another’ (p. 457). As a large number of chronic illnesses are hidden and not perceptible to others, receiving appropriate support from line managers and colleagues requires their knowledge and understanding of an employee's illness. Unless employees choose to inform significant others at work as to the nature of their illness, such support may be lacking. However, the choice to disclose a chronic illness is complex, and influenced by a host of factors such as stigma, type and severity of illness, and access to support (Greene, 2000; Vickers, 1997). There are perceived risks to the employee in disclosing a chronic illness. These include potential rejection, discrimination, loss of social support and loss of employment. Conversely, the benefits to disclosure may include access to practical and social support, social integration (e.g. Dilorio, Hennessy, & Manteuffel, 1996), ensuring as far as possible that the illness does not affect task effectiveness or performance, and re-affirming professional and work identity (Adams, Pill, & Jones, 1997; Beatty, 2001). There is currently a lack of research on self-disclosure of chronic illness at work. The purpose of the present study was to explore the self-management of chronic illness as predictors for self-disclosure of illness to line managers.
A total of 2172 completed questionnaires were received, representing a response rate of 44%. Of these, 734 (34%) employees reported managing a chronic illness. Table 1 shows the demographic details for participants reporting a particular chronic illness. This was compared with data obtained from the organisation's Human Resources department and indicated that the sample was representative of the population of the organisation in terms of occupational groups, age, gender and tenure.
Across the sample included in the analyses (n=610n=610), depression and anxiety were the most reported chronic illness (16.9%), followed by asthma (13.1%) and musculoskeletal pain (12.9%). Across the eight chronic illness groups, 89.6% reported their illness had been diagnosed by a medical practitioner, 26.0% reported partially disclosing their chronic illness to their line manager (informing line manager about the presence of a chronic illness), and 24.2% reported making a full disclosure to their line manager (informing line manager how that chronic illness affected them at work).
