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Promoting excellent work ability and preventing poor work ability: the same determinants? Results from the Swedish HAKuL study
  1. P Lindberg1,
  2. M Josephson2,
  3. L Alfredsson3,4,
  4. E Vingård1,2
  1. 1Section for Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2Section of Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Sweden
  3. 3Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Centre of Public Health, Stockholm County Council, Stockholm, Sweden
  1. Correspondence to:
 MrP Lindberg
 Section for Personal Injury Prevention, Karolinska Institutet, Box 12718, SE-112 94 Stockholm, Sweden; per.lindberg{at}


Aim: Health has been described as a continuum between the two poles of excellent health and ill health. Research has so far focused on the negative pole, leaving knowledge about the positive pole vague. With a main focus on working life, the authors aim was to identify determinants promoting excellent work ability and determinants preventing poor work ability.

Methods: 5638 (73% answering rate) employees in the public sector in Sweden answered a questionnaire both at baseline and at follow up 18 months later. The employees were divided into three groups based on sick leave at follow up: excellent work ability (13%), poor work ability (15%), and a middle group (72%). Self reported sociodemographic data, lifestyle data, and working life exposures at baseline were fitted into logistic regression models to determine which factors, if any, promoted excellent work ability or protected against poor work ability.

Results: Some determinants were mutual, but more than half of the determinants in the final model were associated solely with promoting excellent work ability or preventing poor work ability, thus creating different patterns of associations. Promotion of excellent work ability seemed more dependent on physical factors, clear work tasks, and positive feedback, while prevention of poor work ability seemed more dependent on job security and psychosocial factors.

Conclusions: This explorative longitudinal study showed slightly different patterns of determinants promoting excellent work ability and preventing poor work ability. As most of the identified determinants are amenable to influence, our results open up the possibility of interventions for promoting excellent work ability and preventing poor work ability.

  • health promotion
  • work ability
  • sick leave
  • working life
  • follow up

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  • Funding: The HAKuL study was funded by a grant from AFA - labour market insurance. AFA was not involved in designing the study; in collection, analyses, and interpretation of data, nor in the writing of the report and decision to submit the paper for publication.

  • Competing interests: none.

  • Ethics: The HAKuL study was approved, no 99-242, by the Ethical committee at Karolinska Institutet, Stockholm, Sweden.