Abstract
The American Occupational Therapy Association (2008) has identified education as one of the core areas of occupation, thereby placing focus on participation in classes and exploration of interests. As of December 2011, the Iraq war officially ended, and approximately 33,000 troops returned from service to the United States (Torreon, 2012). Many returning troops gain the status of veteran, defined by statute as “a person who served in the active military, naval, or air service, and was discharged or released under conditions other than dishonorable” (Veterans' Benefits, 38 U.S.C. § 101(2); Pensions, Bonuses, and Veterans' Relief, 38 C.F.R. § 3.1(d)). Student veterans commonly engage in higher education (conceptualized as enrollment in baccalaureate-granting institutions) through benefits associated with their veteran status (Rumann & Hamrick, 2009). Many veterans report struggling with occupational performance areas that involve school engagement (Plach & Haertlein Sells, 2013). Needs of veterans transitioning from military to student life are different from those of nonveteran students, and student veterans can face unique challenges while pursuing higher education (Ackerman, DiRamio, & Mitchell, 2009; Herrmann, Hopkins, Wilson, & Allen, 2009; Rumann & Hamrick, 2010).
Student veterans can face challenges such as managing time, financing their education, accessing health care, searching for employment, and establishing or continuing social relationships (Radford, 2009; Sayer et al., 2010), which may hinder their educational progress. Student veterans attending baccalaureate-granting colleges in the United States spend more time working at jobs and caring for dependents than their nonveteran classmates, but they spend equivalent time studying. Freshman and senior veterans have reported that they feel “less engaged with faculty” and perceive “less campus support” than nonveteran students (National Survey of Student Engagement, 2010). Veterans may also experience other physical and mental strains, including alcohol abuse, posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (Hoge et al., 2004; Morissette et al., 2011; Tanielian & Jaycox, 2008).
Despite these challenges, many student veterans attribute their success to their past military experience. Many student veterans who served in the war zone have reported experiencing personal development in areas of self-discipline, time management, and goal establishment (Ackerman et al., 2009; Smith, 2010). Service experience has enabled many veterans to become valuable college students and leaders (Smith, 2010). Through service, veterans may learn to ignore negative cultural stereotypes and establish relationships with people from different cultures, making them potential candidates for the global workforce (Katopes, 2009). Both these positive attributes and the negative consequences of war can influence the educational pursuits of student veterans; however, existing literature provides a scattered understanding of their lived experience. Qualitative research methods assist in collecting subjective data that can facilitate a scientific understanding of the lived experiences of student veterans (Daly, 2007; Plunkett, Leipert, & Ray, 2013).
Photovoice, which is based on the methods of educator and philosopher Paulo Freire (Wang & Burris, 1997), is acknowledged as a participatory action research method (Wang, 1999). In photovoice, members of a community (participants) are given cameras and asked to photograph events, people, or objects from their everyday life with a focus on aspects they wish to see improved (Wang, 1999; Wang, Burris, & Ping, 1996). Participants engage in a group process of critical reflection and write photo narratives using the SHOWED strategy (Wang, 1999), which comprises the following questions:
What do you
What is really
How does this relate to
How could this image
What can we
Engagement in photovoice through critical reflection empowers participants to communicate and advocate for desired changes to policymakers in their community using images and stories (Brake, Schleien, Miller, & Walton, 2012; Wang & Redwood-Jones, 2001). “Photovoice has three main goals: (1) to enable people to record and reflect their community’s strengths and concerns, (2) to promote critical dialogue and knowledge about important issues through group discussions on photographs collected, and (3) to reach policymakers” (Wang & Burris, 1997, p. 369) by creating scientific evidence.
Military experience can influence the future pursuits of young veterans, including engagement in and successful completion of higher education. As the number of student veterans grows, higher education institutions need to learn more about their transition into student life (Rumann & Hamrick, 2009). Occupational therapy practitioners can serve in advisory and leadership roles to assist in this endeavor given their engagement in school systems from early intervention through higher education. However, scientific understanding of student veterans’ lived experience is also required. Thus, the purpose of this exploratory study was to understand the lived experience of student veterans and identify the factors influencing their educational goals using photovoice methodology. Research questions were as follows:
What are the factors and support systems for student veterans that positively influence attainment of their educational goals?
What are the factors that hinder educational goal attainment for student veterans?
Method
Research Design
This study used principles from interpretive phenomenology and participatory action research (Plunkett et al., 2013). We used a qualitative research design using photovoice, a participatory action research method (Wang, 1999) that can assist in phenomenological inquiry (Plunkett et al., 2013), to learn about the lived experience of student veterans and identify the factors they perceived as influencing their educational goals. This study was approved by the University of Wisconsin–Milwaukee Institutional Review Board as the primary author's thesis project, and all participants provided informed consent.
Participant Recruitment and Data Collection
We recruited participants through announcements (flyers and emails) posted on the educational institution’s campus with assistance from the on-campus Military Educational Benefit Office (MEBO). Inclusion criteria consisted of three characteristics: current enrollment in higher education, past or current service in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND), and age between 20 and 29 yr (in 2008, 54% of OEF–OIF veterans were ages 20–29 yr; Student Veterans of America, 2010). We met with interested student veterans and informed them about the study, photovoice methodology, and their role as participants. Participants completed a demographic questionnaire adapted from Plach and Haertlein Sells (2013) to gather information about their past military duty and current living situation. At the end of this session, participants were given a disposable camera for a 3-wk period to take photographs of events, people, and things from their everyday life focusing on aspects of their lived experience and factors influencing their educational pursuits.
We facilitated a six-session photovoice workshop with the participants. Each session (1.5–2.0 hr) was held on campus and included critical reflection on and discussion of photographs and quiet time for narrative writing. Participants used the SHOWED technique to discuss and write about the importance of selected photographs. Data collection spanned 4 mo between March and June 2012.
We audiotaped all sessions and recorded field notes to allow for data triangulation to support validation of findings (Ritchie & Lewis, 2003). Thus, data included photovoice pieces (which included visual data in the form of photographs and accompanying text in the form of narratives) generated by the participants, field notes created by the researchers, and workshop audio recordings.
Data Analysis
We analyzed collected data (including 18 photovoice pieces) using techniques suggested for photovoice analysis by Wang and Burris (1997). These techniques include selection of photographs by the participants that best represent their lived experience, identity, strengths, and struggles; contextualization through narrative writing by the participants that included details on and the meaning of photographs; and coding of data, in which the researchers identified, sorted, categorized, and built themes.
We used descriptive coding and thematic analysis (Braun & Clark, 2006) to convert collected data into themes and subthemes. We performed thematic analysis using stepwise strategies that included data recognition, preliminary descriptive code formation, pattern identification, theme development and review, and theme labeling and definition. To enhance study rigor and validity, we used a member check of preliminary findings with both participants at the end of data analysis (Hoffart, 1991; Ritchie & Lewis, 2003).
Results
Participants
Two student veterans from a midwestern university were recruited as participants. The participants differed in gender, level of study, marital status, and past military duty (Table 1).
Participant Demographics
Participant 1: Jon.
Jon was a 28-yr-old White male student veteran enrolled in an undergraduate program. At the time of data collection, he was single, lived alone, and did not have children. Jon was 22 when he enrolled in military service, worked in the Navy on active duty for 4 yr, and served on reserve for 1 yr. It had been 7 mo since Jon returned from the service and began living in a civilian community. He worked part time for 16 hr per month. As a participant, he created 10 photovoice pieces.
Jon spoke about struggling during initial community integration and identifying resources for student veterans such as housing and community navigation. Some of his photovoice pieces highlighted the importance of camaraderie among service members, an aspect he felt was missing in the traditional community: “It’s kinda like, when I am in military . . . I got a feeling, a sense of community, as if everyone’s gonna help you. . . . And here [civilian life], you don’t feel like that.” He suggested that student veterans seek quiet places to avoid a plethora of stimuli, although he noted that sensitivity to multiple stimuli should not always be considered a symptom of PTSD.
Participant 2: Emily.
During data collection, Emily, a 28-yr-old White female student veteran, was enrolled in a social work graduate program. She was married and lived with her husband, who also served in the military (active duty), and 6-mo-old daughter. Emily enlisted at age 17 and served in the National Guard for 9 yr, during which she was deployed and served in OIF. It had been 2 yr since Emily returned to the civilian community. She was not employed outside her home during the study. Emily generated eight photovoice pieces, many of which emphasized the importance of family, whom she referred to as the “civilian version of battle buddies.” She advocated for better outreach and accessibility of resources catering to student veterans.
Theme 1: Reminiscence of Past Duty and Reflections on Military Life
The participants reminisced about their fellow veterans and past duty, environments, and living situations. A photovoice piece by Emily stated,
I feel disconnected with others. . . . Especially when you are active duty, when you come back from deployment, . . . the people that I have come so close to, they seem to me like they don’t care about me either. But they were also thrown back into their lives where they were trying to figure everything out too. . . . So you keep your head above the waters and try to re-figure things out again.
Jon shared similar views: “It’s just really sad. When I first came back to school here, it just felt like so isolated. . . . Going from base to base, there’s a group of people to help you out.” Feeling disconnected from others (nonveteran students, classmates, and officials on campus) can result in longing for past environments, including the places and people whose lives one shared during military service, especially when no new relationships have yet been established. Jon shared during a group discussion,
I still desire to go [to] sea all the time. I want to be out there with them. It’s kinda like a conflict; I want to continue my schooling, but at the same time I want to go back to the military.
Emily corroborated this feeling:
Everyone expects you to be overjoyed when you are back. . . . You get off the plane, and everybody there is . . . so happy to see you, and you are just, like, “Put me back into the plane and send me back.” I still have those times when I wish I was in Iraq.
Theme 2: Transition From Military Life to Civilian Student Life
The transition from military life to civilian student life was stressful for the participants because of the sudden changes in the immediate environment. Jon shared, “I am not used to high ceilings. It’s weird. . . . I am not used to going to huge lecture halls. It’s kinda bothersome.” Both participants reported struggling with social relationships. They felt like outsiders within the campus community, partly because of a perceived communication gap between them and traditional students. An excerpt from a photovoice by Emily (Figure 1) highlighted this issue: “It’s not the challenges associated with school that turn [student veterans] away. I believe they don’t feel like they belong.”
Excerpt from Emily’s photovoice.
The reluctance of the participants to share their experience with others, because they preferred to keep their veteran identity a secret, might have contributed to communication gaps. Jon shared,
We want to keep it a secret. We like to reveal certain things at certain times. . . . We don’t want everyone to know about [our service], so it’s kinda like, keep it quiet, and don’t discuss, and just go on with your life.
However, the participants shared that they felt like insiders while communicating with fellow student veterans about their insights related to military experience. Jon shared,
In my German class, there are some veterans from the Navy. . . . We talk a lot in class about veteran experiences. . . . So there were [a] wide range of veterans there, and it was kinda nice to talk to them.
Acknowledging anxiety as a shared phenomenon also assisted the participants in making the transition and reducing stress. Emily reflected on this aspect through her experience as a social work graduate student: “Even working with clients, they don’t understand that their symptoms are trauma symptoms, and once they realize [this], it takes a whole weight [off] of their shoulders. . . . This is common for people [student veterans] transitioning.”
Hypervigilance was also a concern for the participants. The ability to address numerous stimuli in a short span of time is a positive skill to protect self and others; however, this skill can jeopardize long-term focus, a skill required of students. The participants reported being hypervigilant of their surroundings on initial reintegration. Jon shared the following through a photovoice piece (Figure 2):
On submarines, we had to know our space and where the fire extinguishers were and how to use them. I brought this back to the civilian life by constantly noticing all this and expecting the worst to happen. I see first aid kits in malls and remember where they are, just in case.
Excerpt from Jon’s photovoice.
The participants also experienced a shift in identity as they transitioned into the role of student. They had learned various skills during their military training that later became part of their identity. Many of those skills, however, they seldom used during student life, an experience that resulted in a perceived loss of identity. Jon expressed through a photovoice piece (see Figure 2),
The submarine training takes so much of your life that turning it off when you do not need it almost seems like giving up a part of yourself. As I move on in my civilian life I feel a loss and also emptiness without it.
Theme 3: Entry to a New Stage of Life
Over time, participants learned to successfully reintegrate into civilian life and assume the student role. Being a service member is part of their identity for many veterans. As the participants entered higher education institutions, it was advantageous for them to adapt student roles to successfully achieve their goals in higher education. Jon shared,
Moving from [the] military to [the] civilian world was a great change of everything in my life. Now, after a year, I have less and less of a problem adapting to the change and can function in a civilian life without nervousness.
The participants also returned to their family member roles of spouse, parent, and/or adult child. These roles were initially challenging; however, the participants learned to adapt roles and renew their relationships. Emily emphasized the importance of family through a photovoice piece:
People, specifically my family, are my number-one priority. Being at class is important, participating in student organizations and research is important, but family is paramount. I would drop everything else without question for my family.
A war zone can be characterized by turbulent, disquieting, and life-threatening environments, unlike traditional community living. The participants observed that they seemed to appreciate aspects of community environments more than traditional students. As Jon shared through a photovoice piece, “It’s kinda like [I have] appreciation for the environment and everything around [me]. . . . It’s kinda like [I] can be around and enjoy everyday smells and everyday experiences.” The participants also perceived experiencing less education-related stress than traditional students. Jon expressed,
Here [the school environment], it’s like everyone’s freaking about finals. But from my point of view, it’s not that stressful as I’m used to. There’s, like, less stress . . . here [than] there was in the military ’cause qualifying for submarines is [a] lot harder than studying for the school here.
Over time, both participants were able to adjust to their student role. However, they suggested that university and community environments and resources substantially shaped their reintegration.
Theme 4: Influence of the University and Community Environment
Social Attitudes on Campus.
The participants suggested that attitudes of nonveteran people (including students and teaching staff) influenced their educational experience. Misconceptions and perceived prejudiced opinions led to challenges in the maintenance of social relationships between participants and nonveterans. The participants perceived some people, however, as welcoming and sensitive. Emily shared,
I had somebody in one of my classes talk about how they are lowering the scores for people to get into the military, and he’s, like, “Now our military is gonna be stupider than they are,” and I was, like, “I am a master’s student in the same program as you. Don’t call our military stupid.” So the ignorance of people has been part of my experience. But also, on the flip side, people . . . admire my service, and people ask for my perspective. So, you know, there are people who are sensitive and some not so sensitive.
The participants identified teaching staff as a potential audience for their photovoice pieces. Jon shared, “Professors and teachers need to become more understanding of veterans’ culture and their past experiences. . . . There is . . . need for a community [and] understanding out there.”
Available Resources.
Access to campus resources such as student veteran organizations, recreational classes, MEBO, and educational assistance classes was useful for the participants’ community reintegration and campus navigation. Jon shared his experience: “In my first semester, I didn’t know about the tutoring sessions or [that] the writing center existed. I actually thought about [these resources], and [they are] a great asset for students like us.” Along with the resources Jon mentioned, the participants also expressed the need for organizations that can assist student veterans in connecting with and assisting one another in educational pursuits and social relationship building. Emily stated, “I think student veteran organizations are severely needed on every campus because . . . they will understand [veterans’] losses.” Jon further corroborated, “It is good to know that there’s a [veterans’ organization] group. . . . Just going from day to day, and not knowing that anyone has your experience, it’s hard.”
Recommendations to Strengthen Existing Resources and Build New Ones.
The participants shared their concerns regarding the importance of accessibility, marketing, and outreach of relevant resources within higher education institutions. They also advocated for developing resources, such as family care and early integration services, to facilitate community reintegration. Jon noted,
I came after 2 weeks out from [the] military, and I needed a car and a place to live and all other stuff. . . . And trying to figure stuff out . . . there was no one helping me. . . . In the first semester, I was stumbling through everything.
Emily advocated for family care and child support services through a photovoice piece:
We focus a lot on vets, but a space should be created for their family members, too. Perhaps that means reduced child care costs when a soldier is deployed, inviting family members to the center for military and student veterans, or finding a way to help out families of deployed soldiers. . . . Family members are the main support for our vets; we should welcome them with open arms.
The participants conveyed that student veterans, as a group, do not want to be identified as “needy.” Jon observed, “We [student veterans] don’t wanna be recognized, but at the same time you need a little help, but you don’t wanna, like, stand out.” Emily noted a similar concern: “Also with veterans, too, they are not gonna ask for help.”
The participants noted that university officials took steps to assist with the transition and reintegration of student veterans. University personnel, however, can face challenges in acknowledging student veteran needs.
Discussion
A preliminary model emerged (Figure 3) through the findings representing the transitional nature of the lived experience of the participants. It places the first three themes along the continuum of time as each theme or phase transitions into another. The measure of time is, however, not similar for the participants because each had a unique reintegration pace. This model places university and community environmental factors on an axis running through each theme, highlighting the influence of such factors throughout their reintegration.
Preliminary model representing the transitional nature of the experience of the participants.
The lived experience of student veterans can be a dynamic process (DiRamio, Ackerman, & Mitchell, 2008) in which the phases can coexist. As an example, both participants reminisced about their fellow service members, even during the latter phases of transition. Another way to examine this transitional model is to consider the phases as representative of key perceptions held by participants as they moved through the transition process. As they transitioned, they chose strategies and relationships that allowed them to move toward civilian life as a student.
Education is a primary aspect affecting quality of life for returning veterans and is a challenging occupation for student veterans (Plach & Haertlein Sells, 2013; Sutherland, 2013). Both participants struggled with social relationships, a finding reflecting existing literature (Plach & Haertlein Sells, 2013). Student veterans can experience emotional turmoil while transitioning into student life, requiring time to adjust to this complex process and new roles (DiRamio et al., 2008). Analysis revealed the following factors as hindering the participants’ educational pursuits:
Perceived negative attitudes and ill-informed judgments of nonveteran students and staff,
Lack of existing community resources and university outreach and marketing, and
Perceived lack of connection and social interaction with the nonveteran population.
Access to and efficient outreach of resources such as tutoring, recreational classes, and MEBO assisted the participants in making a smoother transition, a finding echoing existing literature (DiRamio et al., 2008; Matus-Grossman, Gooden, Wavelet, Diaz, & Seupersad, 2002). Along with such resources, the participants identified the following factors as helpful for education attainment:
Increased social connection and interaction among student veterans,
Assistance during early transition with needs such as housing and community and university navigation,
Increased awareness of military culture on campus,
Availability of family care services on campus, and
Employment assistance resources and services.
One challenging task for returning veterans is to seek and accept help. Because of high self-expectations and a war hero culture of hypermasculinity, veterans may resist seeking required assistance (Caffrey, 2009; Vacchi, 2012). Teaching staff and university officials can learn to approach student veterans and be sensitive to their experience (Rumann & Hamrick, 2009; Washton, 1945). Higher education institutions should make efforts to inform teaching staff about the military life experience and its consequences to promote an understanding of the individual educational and health care needs of student veterans.
The attitudes of nonveteran students also influence the transition and lived experience of student veterans. Strategies to reduce communication gaps can help student veterans feel welcomed on campus and assist them in their transition phases. Veterans bring unique perspectives and skills to campus that can benefit not only their own transition (Normandin, 2010) but the university community. Understanding factors influencing their education, through an occupational lens, can help universities develop strategies to assist student veterans (DiRamio et al., 2008).
Limitations
A major limitation was the small sample size; the time commitment required for participation was a consideration for many student veterans. Data provided by the participants, however, were rich in context and details. Both participants were White and 20–29 yr old; therefore, issues that particularly affect student veterans from other ethnic backgrounds and age groups were not acknowledged and require further research. Another limitation was participants’ attendance in discussion sessions; in two sessions, only 1 participant and the researchers were present. During these sessions, peer-to-peer discussion did not occur, which may have limited idea sharing. The researchers, however, asked questions and provided general feedback to gain a deeper understanding of the issue being discussed by the participant present.
Implications for Occupational Therapy Practice
Pursuit of higher education is a significant occupation for student veterans, defining their identity and life role as students. The Centennial Vision of the American Occupational Therapy Association (2007) includes supporting the occupational needs of society and helping people overcome obstacles to participation in their valued activities as significant roles of this evolving profession. This study has the following implications for occupational therapy practice that support the Centennial Vision:
Occupational therapy scholars can use photography-driven narratives as an influential advocacy tool.
Occupational therapy faculty, staff, and students can serve their campus communities by actively leading efforts to better meet the transitional needs of the student veteran population.
Use of occupation-centered interventions guided by occupational therapy practitioners can strengthen educational outcomes for student veterans experiencing health care issues.
Conclusion
Participation in meaningful occupations, including education, is a core concept in occupational therapy intervention. Existing literature and this study suggest that returning veterans struggle while transitioning into the student role and engaging in the occupational context of a university setting. The findings can help occupational therapy practitioners facilitate successful occupational engagement for student veterans and gain an understanding of their lived experience and factors influencing their educational pursuits. We have presented our findings at campus, community, and professional forums to raise awareness of the struggles of student veterans and elicit ways to alleviate their struggles and support their success.
Photovoice proved to be an effective methodology to reveal participants’ lived experience. The participants enjoyed their role as data collectors and shared a sense of empowerment as they contributed their expertise to the photovoice experience.
Acknowledgments
The authors thank Carol Haertlein Sells, Heidi L. Plach, and Mary Radomski for their intellectual support. The authors are also thankful to the University of Wisconsin–Milwaukee for providing financial support to this research project.