# Understanding School Presenteeism and Absence in Adolescents Affected by Chronic Musculoskeletal Pain: A Qualitative Study

## TL;DR

This study explores how chronic musculoskeletal pain affects school attendance and participation in adolescents, highlighting the role of support and understanding from peers and teachers.

## Contribution

This is the first qualitative study to explore factors influencing both presenteeism and absence in adolescents with chronic pain, focusing on adolescent and parent perspectives.

## Key findings

- Supportive school environments and understanding from peers and teachers increase school attendance in adolescents with chronic pain.
- Designating a trusted adult in school and adjusting healthcare appointments can help reduce absenteeism.
- Walking aids prescribed to adolescents may unintentionally cause stigma and social isolation.

## Abstract

Absenteeism among adolescents experiencing chronic pain is a critical issue, and factors influencing absence have been identified as an evidence gap. Existing research overlooks aspects beyond attendance, such as presenteeism, reflecting adolescents' school functioning before becoming absent. This novel qualitative study sought to identify the influencing factors on presenteeism and absence from school in adolescents (11–18 years) experiencing chronic pain, through exploration of adolescent and parent perspectives.

This study conducted a secondary analysis of qualitative data using semi‐structured interviews and a timeline drawing from 21 adolescents treated for chronic musculoskeletal pain and 21 parents. Data regarding school experiences were extracted and analysed using the six stages of thematic analysis, identified by Braun and Clarke. Initial codes were identified manually, discussed and validated by all authors in a face‐to‐face meeting.

Thematic analysis of the data identified three themes: (1) understanding the unseen struggle, (2) the feeling of belonging and (3) navigating transitions.

A key finding was the importance of adolescents feeling understood and supported by their peers and teachers throughout their education. Receiving validation of their symptoms, despite the invisible nature of chronic pain, affirmed a sense of security at school, contributed to a more positive school experience and improved adolescents' reported attendance. This has important practice implications in healthcare and education, in validating the adolescents' struggle, fostering a sense of belonging through shared goal setting and advocating for their voices to be heard.

When adolescents experiencing chronic pain perceive school staff and peers as supportive, they report being more likely to attend school.Having a designated trusted adult within the school environment was key to supporting adolescents experiencing chronic musculoskeletal pain to function in school.Healthcare professionals should carefully consider the prescriptions of walking aids because they can inadvertently contribute to stigma and social isolation.There is a need to increase health professional awareness of the importance of school transitions, as these pivotal periods may trigger student absenteeism whilst also providing unique opportunities for re‐engagement in education.Healthcare professionals should prioritise school attendance by setting school‐related goals, providing additional support around transition points and adjusting appointment schedules to avoid adolescents missing school.

When adolescents experiencing chronic pain perceive school staff and peers as supportive, they report being more likely to attend school.

Having a designated trusted adult within the school environment was key to supporting adolescents experiencing chronic musculoskeletal pain to function in school.

Healthcare professionals should carefully consider the prescriptions of walking aids because they can inadvertently contribute to stigma and social isolation.

There is a need to increase health professional awareness of the importance of school transitions, as these pivotal periods may trigger student absenteeism whilst also providing unique opportunities for re‐engagement in education.

Healthcare professionals should prioritise school attendance by setting school‐related goals, providing additional support around transition points and adjusting appointment schedules to avoid adolescents missing school.