"so Many Disincentives to Take Care of Ourselves": A Photovoice Study on Graduate Student Workers' Health Care Experience

Background and Purpose: U.S. universities have become increasingly reliant on graduate students to perform tasks that would otherwise be carried out by higher-paid faculty and staff, yet graduate workers are not often afforded the same benefits of employees. In recent years, graduate workers at private universities have utilized their right to unionize and collectively bargain for equality in terms of livable wages, improved working conditions, and access to high-quality, affordable health care. Despite well-documented pressures on graduate workers and recent advocacy efforts by graduate worker unions, there is limited research on graduate workers’ perceived health care needs and access. This study aimed to address this gap by exploring graduate workers’ perceptions of how barriers and facilitators to physical and mental health care affect their lives.

Methods: This study utilized Photovoice, a Community-Based Participatory Research (CBPR) method in which communities depict their strengths and concerns through photography and personal narrative. Influenced by critical consciousness theory, Photovoice empowers community members to take action and advocate for change by sharing the reality of their lives with the public and policymakers. Four female participants aged 25-28 were recruited from a health care working group within the Graduate Workers Union at a large university in New York City. Over a two-week period, participants took photographs of the ways in which barriers and facilitators to health care affect their lives. Participants then critically reflected upon their photographs in an audio-recorded focus group discussion and selected photographs and key themes to share in a Graduate Workers Union newsletter as a part of ongoing advocacy for their first contract with the University. Guided by the socio-ecological model, a thematic analysis of the focus group discussion was conducted using Dedoose qualitative software.

Results: Participants noted numerous barriers to health care, including financial limitations and the time burden and stress associated with accessing services on the individual-level, negative relationships with healthcare providers, faculty members, and peers on the interpersonal-level, opaque health insurance policies and a lack of health insurance coverage on the organizational-level, the pervasive competitive culture in academia on the community-level, and difficulties associated with the larger U.S. health care system (e.g., high cost of services) on the societal-level. Key facilitators to health care included self-care on the individual-level, supportive relationships and financial support on the interpersonal-level, and access to health insurance information and other resources on the organizational-level.

Conclusions and Implications: Unmet health care needs take a significant toll on graduate workers’ lives. Through photography and personal narrative, this study captures the impact of this toll on graduate student workers, and demonstrates the power of CBPR to identify and express community needs and empower community members to advocate for change. Universities must address barriers to health care by expanding access to critical health and mental health services and enhance facilitators to health care by providing graduate student workers with the financial and emotional support needed to thrive in higher education.