Why are Disclosure Decisions so Difficult? Understanding Factors that Encourage and Discourage Workers with a Chronic Disabling Condition from Disclosing Health Information at Work

Abstract

Purpose: The decision whether to disclose a disability at work is complex. Drawing on communication theories, we examined disclosure decision-making and how workers with disabling health conditions prioritized information that could simultaneously encourage and discourage disclosure.

Methods: An online, cross-sectional survey asked workers with physical and mental health/cognitive conditions creating job limitations (i.e., disability) at work about the health impacts on their employment, their disclosure goals, preferences, support availability, workplace culture, work context, and demographic information. Descriptive, multivariate, and latent profile analyses were used.

Results: Participants were 591 workers (51% men, 48% women, 1% non-binary) with physical (41%), mental health/cognitive (24%), or both groups of conditions (35%). Forty-two percent of participants had not disclosed health information or needs to their supervisor. Six profiles of decision patterns were identified: (1) little health impact, supports available; (2) some health impacts, positive support appraisals; (3) some health impacts, uncertain what to do; (4) some health impacts, considerable personal concerns; (5) little health impact, few concerns, few supports available; and (6) considerable health impacts but perceives many risks to sharing. Disclosure decisions often prioritized personal goals, preferences, and workplace culture over health impacts and support availability. Profiles were differentiated by health condition type and work context.

Conclusion: Understanding how workers prioritize information when considering disclosing a disability at work has implications for organizational support practices and clinical efforts to support workers. It underscores that worker decisions go beyond health impacts and highlights the need for support resources to help workers address decision uncertainty and stress.

Keywords: Accommodations; Chronic disease; Decision-making; Disability; Disclosure; Employment; Mental health.