Nearly half of workers with disabilities hide impact of health condition on work

Workers with a health condition that isn’t visible often face the complex choice of whether to share information about their health and its potential impacts on their job with their workplace. They may share to receive supports to help them do their job. Or they may not share because of personal or work-related reasons—including because their condition currently has little impact on their ability to do their job. Workers may also feel that they have to hide certain information if they think sharing it would negatively impact them. For example, a worker may disclose their condition but hide the full extent of their difficulties due to fear of stigma. 

Most studies examining the complexities of these disclosure decisions do not distinguish between not disclosing and actively hiding information. As a result, it is unclear how often people hide health information at the workplace, who is likely to do so, or what the impacts may be. 

The researchers conducted an online survey of 695 adult workers with physical or mental health/cognitive conditions that limited their ability to meet job demands to some degree. Participants were recruited from a national panel of 90,000 Canadians designed to mirror the Canadian population. 

The study team asked about workers’ conditions and whether they disclosed to their supervisor any related limitations that might affect their work. They also asked if workers had tried to hide from others at work about any difficulties that they were having with their job due to their health. 

Finally, the study asked about factors surrounding that decision-making process, and about their workplace, including:

• job sector, employment conditions like contract work versus permanent employment, and job control;
• perceptions of their workplace’s supportiveness;
• perceptions about decisions to hide or disclose information—whether they felt it was stressful, they had enough information to make such a decision, or they felt pressured to make a decision;
• personal goals that would lead them to share or not share health information;
• whether they received workplace supports; and
• job productivity losses or disruptions.

Based on the responses, the researchers split participants into four groups of those who had disclosed or not, and/or hid information or not. They The team then compared these groups to identify how they were similar or different.

The researchers found the following proportions of the sample fell into each group: Table 1: Proportion of respondents in the sample who disclosed or not, and hid information or not

Those who had disclosed health information to a supervisor (58 per cent of the sample) were more likely to report having workplace supports available to help with their condition than those who did not disclose. However, only about a quarter of those who disclosed, and less than ten percent of those who did not disclose, received supports.

Among those who hid information, whether they disclosed or not (45 per cent of the sample), the following factors were most common:

• having mental health or cognitive conditions,
• experiencing recent changes in symptom severity or unpredictable symptoms,
• holding contract positions,
• having goals that would discourage sharing, like wanting to protect one’s reputation, or maintain the status quo.
• expressing negative perceptions of their workplace’s supportiveness,
• reporting challenges in deciding whether to disclose information, and
• reporting productivity problems at work.

Comparing the four groups, the researchers found some similarities, and a number of differences. For example, the two groups that did not hide information were similar on many demographic and work factors; but between these two groups (who did not hide), those who disclosed had more goals that would encourage sharing and a more positive work culture than those who did not disclose. 

Those who disclosed some information but reported that they were hiding other information were more likely to receive support than those who did not disclose (regardless of whether they hid or not). But they had the highest absenteeism and the greatest number of job disruptions like lost time from arriving late or leaving early and interruptions to their workday. This led the researchers to speculate that the reason they may have disclosed some information was to explain their work behaviours or work absences. 

This group was also most likely to have:

• both a physical and mental health or cognitive condition,
• poorer health, with more severe and unpredictable symptoms,
• lower income levels, and
• experienced changes in their job that made it difficult to work

Of importance for workplaces and employers is that those employees who were hiding information, regardless of whether they disclosed or not, reported more stress in making a decision, felt that they had gaps in information needed to make a decision, and were more likely to be worried about becoming unemployed.

This study has found that not disclosing health information at work is different from actively hiding information. It also shows that those who hide information may be experiencing more severe health challenges and productivity issues. Beyond the availability of supports, the findings indicate that other personal and workplace factors may influence workers’ decisions to hide or disclose information. 

For workplaces, more frequent communication about what supports are available and the processes for accessing support—including discussions about confidentiality—may relieve some of the stress workers experience in making a disclosure decision and can fill information gaps reported by workers, especially those who are hiding information. 

The study also highlights the importance of resources (such as the DCIDE and the JDAPT tools) that are aimed at helping workers make a disclosure decision that is right for them. These tools also identify support and accommodation ideas that can help workers with a health condition manage job demands, including potential strategies that can be used without having to share any health information. 

A strength of this study was that it drew on a large sample of workers with a range of different conditions, and in a broad range of jobs and sectors. This allowed the researchers to explore disclosure and hiding decisions more comprehensively than studies focused on a single health condition or job type.

A limitation of the study was the cross-sectional design, which looks at participants’ responses at a single point in time, rather than at how things may change over time. This means that the study cannot say with certainty that any factor caused someone to not disclose or hide information, only that it was linked to someone not disclosing or hiding information. Further studies that examine how things change over time or that ask participants why they made such decisions are needed to determine a cause and effect.