Using Photovoice to Conduct an Educator Health Needs Assessment: An Accessible Tool to Inform Participatory Organizational Interventions

Using Photovoice to Conduct an Educator Health Needs Assessment: An Accessible Tool to Inform Participatory Organizational Interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Using Photovoice to Conduct an Educator Health Needs Assessment: An Accessible Tool to Inform Participatory Organizational Interventions Alicia G. Dugan, Laila B. McGeorge, Megan N. Miskovsky, Sierra M. Trudel, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8961242/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Educators are an at-risk occupational group with high demands and limited resources that drive strain, resulting in mental well-being challenges and high turnover. The Total Teacher Health project develops participatory workplace initiatives to support well-being, emphasizing organizational responsibility for worker health. This study evaluated Photovoice as a feasible and rapid workforce needs assessment method to inform health initiatives. We compared findings with those from a traditional survey. Methods In 2023, we recruited educators and staff from four public elementary schools in the northeastern U.S. Over two weeks, participants responded to weekly prompts using smartphone photographs and captions. Prompts asked participants ( 1 ) how work affected well-being and happiness and ( 2 ) how work could be changed to better support well-being. Participants submitted five photos with captions each week. Qualitative data were analyzed using inductive thematic analysis. A cross-sectional survey was administered in the same schools using standardized measures of psychosocial risk factors and well-being outcomes; responses were dichotomized to identify high-concern priorities. Results Participants (N = 20) were female and White, with a mean age of 39 years. Eighteen participants submitted 100 photos in Week 1 and 85 in Week 2; inter-coder agreement was substantial. Week 1 themes reflected job demands and resources, the need for personal self-care, and well-being impacts. Week 2 emphasized organizational change solutions (improving psychosocial climate and recognition, addressing time pressures, reducing workloads, strengthening student support, providing work breaks) over individual solutions. Survey respondents (N = 167) reported similar concerns with job demands such as work overload, lacking resources (time, breaks, autonomy, recognition), and psychological well-being impacts. This suggested convergence between Photovoice and survey methods. Conclusions Photovoice was feasible and time-efficient as a workforce health needs assessment, producing actionable priorities more rapidly than conventional approaches. Findings reinforce that psychological well-being is a concern primarily shaped by imbalances between high demands and limited resources. Most solutions targeted organizational change, though individual self-care practices (leisure coping, positive mindset) were helpful and may have been viewed as necessary to offset unhealthy, intractable system-level conditions. Overall, results support Photovoice as a practical assessment method to inform organizational interventions aimed at improving educator well-being and retention. educators schools health needs assessment Photovoice qualitative methods participatory research methods Total Worker Health® Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Teachers are an at-risk occupational group coping with unique stressors and well-being challenges. Educators in the United States (U.S.) commonly experience stress, burnout, and job-related depression (1). They report high stress and clinically significant anxiety and depression, which are associated with higher turnover intentions (2). Beyond adverse mental health outcomes, teachers also experience physical health consequences associated with chronic occupational stress. Chronic stress among teachers is linked to fatigue and adverse changes in biological indicators of stress, such as atypical cortisol levels (3,4). Similarly, there is a consistent association between teacher burnout and a range of physical health outcomes, including biomarkers indicating hypothalamic-pituitary-adrenal (HPA) axis dysregulation and inflammation (cytokines), as well as somatic complaints (e.g., headaches), illnesses (e.g., gastroenteritis), and voice disorders (5) Stress has been shown to adversely affect teacher-student relationships, which may give way to academic, social, and behavioral challenges among students with consequences that extend beyond the classroom (6). Different and intersecting identities (e.g., sex, race, age, socioeconomic status) can contribute to the sources, experiences, and consequences of teacher stress, shaping both exposure to stressors and vulnerability to their effects, with impacts including adverse mental health outcomes and greater exhaustion (7). Stress has long impacted educators’ ability to provide high-quality learning environments, a pattern that was significantly exacerbated during the COVID-19 pandemic (8). Teacher turnover rates are approximately 16% annually, comprising about 8% who leave the profession and another 8% who move to different schools (9). The majority leave voluntarily (10), and of those who exit the profession, two-thirds do so for reasons other than retirement, indicating that most teachers leave in the early- or mid-stages of their careers (11). Turnover data indicate that approximately 10% of teachers leave after their first year, and about 17% leave after five years (12,13). Teacher departure is attributed to various factors including inadequate financial compensation, limited opportunities for career advancement, and notably, stress (14,15). The onset of the COVID-19 pandemic in the U.S. prompted additional and compounding reasons for turnover and worsened the existing teacher shortage, drawing attention to longstanding issues of stress, burnout, and retention within the profession (8,9,14). One study found that the desire to exit the teaching profession increased significantly during the 2020–2021 academic year coinciding with the early COVID-19 pandemic years, with one in four teachers expressing intent to leave, compared to one in six before the pandemic (1). During the pandemic, researchers observed deteriorating teaching conditions, finding associations between teacher distress and insufficient administrative support, student behavioral problems, increasing job demands, technical challenges due to remote teaching, and mismatches between actual and preferred instructional modalities (1,10,16). Collectively, these findings underscore an urgent need for effective, scalable interventions to address persistent stress, burnout, and adverse mental and physical health outcomes among educators. The job demands-resources (JD-R) model is a useful framework for understanding work-related stress and provides valuable insights into the burnout and mental health difficulties experienced by educators. Job demands may be physical, cognitive, emotional, social, or organizational in nature, requiring sustained effort in one’s work role and incurring physiological and psychological costs (17). Similarly, job resources may be physical, psychological, social, or organizational elements that are instrumental in achieving work objectives, reduce job demands and associated strain, and encourage personal growth, learning, and advancement (17). Personal resources may be beneficial aspects of oneself (e.g., optimism, self-efficacy) that people draw from to conduct work and life activities (18). The JD-R model posits that when job demands outweigh available resources, it results in burnout and strain (17,18). Conversely, having adequate job and personal resources can mitigate the strain caused by excessive job demands and directly contribute to worker engagement and overall well-being (17,18). In educators, stress arises from an imbalance between demands and resources operating at multiple levels, including institutional (e.g., class size, administrative expectations), classroom (e.g., student behavior), and personal (e.g., self-efficacy, coping skills) levels (19). Research consistently shows that excessive institutional and classroom demands, such as administrative workload related to testing and paperwork and challenging student behaviors, are among the most stressful aspects of teaching and are associated with emotional exhaustion, reduced professional accomplishment, as well as disengaged students (20). Teachers who experience persistent mismatches between demands and available resources are at higher risk for stress and burnout, and report lower job satisfaction and occupational commitment, whereas teachers with access to greater resources report less stress and more job satisfaction (21). Notably, a recent meta-analysis identified better resources at school, more job autonomy, and higher salaries as key factors associated with teacher retention (22). Together, these findings underscore the central role of demands-resources balance as a determinant of teacher well-being and reinforce the need for interventions that reduce excessive demands while strengthening organizational and personal resources. Several recent systematic reviews of stress and burnout interventions have been conducted, collectively covering over 30 years of research from 1987-2022 (23,24,25) The most recent review found that nearly half of interventions focused on mindfulness-based approaches, including yoga, and just over one-third involved cognitive behavioral therapy (CBT) or rational emotive behavior therapy (REBT). The remaining interventions included sports-based physical activity programs, stress reduction training, social and emotional development, and prayer (23). This pattern illustrates a predominant emphasis on individual-level solutions, such as improving self-care and coping skills, rather than organizational change interventions that address systemic, workplace-level contributors to poor teacher well-being. The limited attention paid to organizational change interventions in both research and practice has been notable (26,27). However, the U.S. National Institute for Occupational Safety and Health promotes a Total Worker Health® approach, emphasizing organizational change rather than relying solely on individual workers to achieve well-being amid persistent structural stressors (28). While teachers may possess effective coping skills, the impact of these skills is constrained when workplace conditions continue to cause harm. Accordingly, employer accountability and the prioritization of worker well-being as an organizational objective are essential for effective interventions (28). A Participatory Intervention Method to Improve Worker Well-Being The Total Teacher Health (TTH) research project is a multi-phase intervention study conducted in public schools aimed at protecting and promoting educator health and well-being ( 29 ). The project uses an adapted version of the Center for Promotion of Health in the New England Workplace’s Healthy Workplace Participatory Program toolkit, a structured process designed to identify, prioritize, and remediate root causes of health, safety, and well-being concerns across worker populations ( 30 , 31 ). The toolkit is an intervention designed to systematically generate and implement context-specific workplace health initiatives at both the organizational- and individual-levels. This evidence-based process engages a design team of frontline workers (subject matter experts of their job and work conditions) to assess workforce health needs and develop tailored interventions, with support from a steering committee of organizational leaders who oversee activities and facilitate implementation. The adapted version of the Healthy Workplace Participatory Program that the TTH project uses, entitled the Educator Well-being Program , was tailored for educators and previously pilot-tested by Sanetti and colleagues ( 25 , 32 ). The first task of the design team is to conduct a workforce health needs assessment to identify priority concerns and inform subsequent intervention development, implementation, and evaluation. While engaging workers in identifying workplace hazards and health concerns enhances intervention relevance and effectiveness ( 28 ), traditional needs assessment methods such as surveys and focus groups can require substantial time, resources, and expertise that may not be available, posing a barrier to the independent functioning and long-term sustainability of the program. For example, implementing the Healthy Workplace Participatory Program within the corrections workforce required several months for survey development and analysis, as well as specialized assistance from subject matter experts in research to develop data collection methods and analyze findings ( 33 , 34 ). To address these feasibility challenges, the TTH research team piloted Photovoice as an alternative needs assessment approach with the potential to rapidly identify educator health priorities. Photovoice is a participatory action research method in which community members, defined as individuals connected by shared experiences and a collective interest in health and well-being ( 35 ), use photographs and narratives to document lived experiences, promote dialogue, and advocate for improvements in health and well-being ( 36 ). Although Photovoice has been used successfully in some workplace contexts, its application remains limited ( 37 , 38 ). In addition to its feasibility, the TTH project selected Photovoice because its use of visual imagery may more effectively facilitate shared learning about health and safety concerns and engage decision-makers in initiating organizational change as compared to conventional methods used with the Healthy Workplace Participatory Program. This paper describes the process and findings from the implementation of Photovoice across four public schools in the northeastern U.S., demonstrating the feasibility and utility of Photovoice as a workforce health needs assessment tool among a novel worker population: elementary school educators and staff. The Photovoice needs assessment is guided by two research questions: ( 1 ) How do elementary public school educators and staff perceive the impact of their work on their well-being? and ( 2 ) What individual- and organizational-level factors do educators perceive as modifiable to improve well-being? In addition, we compare findings generated through Photovoice with those obtained from a traditional needs assessment method, a survey, to examine the degree of convergence in health priorities identified across the two approaches. Methods For both the Photovoice and survey data collections described below, participants were recruited from four elementary schools across two suburban school districts in the northeastern U.S. (two schools per district). These schools were recruited as sites for participation in the TTH research study ( 2 ). Participants were educators and staff working in jobs including: regular classroom teacher, unified arts teacher (art, music, physical education), instructional aide (paraeducators, tutors), substitute teacher, secretary (or other clerical support staff), or student support services (e.g., school counselor, school psychologist, social worker, school nurse, etc.). All research protocols were approved by the UConn Health Institutional Review Board. Photovoice Procedure Photovoice was conducted at three schools in October 2023 and one school in January 2024. The Photovoice activity required a six-week implementation timeline that included recruitment (3 weeks), the Photovoice activity (2 weeks), and qualitative data analysis (1 week). To recruit participants, TTH team members distributed study flyers at school staff meetings, and school principals emailed flyers to staff. Flyers included study information and enrollment instructions and indicated that participants were required to have a smartphone to participate. Participants were compensated with a $ 50 e-gift card to an online retailer for the successful completion of the two-week Photovoice activity. Upon enrollment, participants first completed a voluntary, brief demographic survey and then received an email containing written and video instructions explaining the study purpose and Photovoice process. A designated Photovoice Coordinator (AH) served as the primary point of contact for participants throughout the study, with all communication conducted through a dedicated TTH Project smartphone. The Photovoice Coordinator documented all text-based communications with participants. Photovoice data collection occurred over two weeks. At the beginning of each week, the Photovoice Coordinator texted participants a specific question (“prompt”), which participants were instructed to answer by taking photographs using their smartphones. The Week 1 prompt was intentionally broad to capture both work conditions and their effects, asking: “ How does your current work situation affect your mental well-being and happiness?” The Week 2 prompt focused on potential solutions, asking: “ If you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now? ” Per the Photovoice instructions, participants were encouraged to take one to two photographs per day that reflected their response to the weekly prompt. At the end of each week, participants were instructed to review all photographs taken, select five images that best represented their response to the prompt, write a brief caption for each image, and submit the five photographs with captions to the Photovoice Coordinator via text message. To support participation and adherence, the Photovoice Coordinator sent standardized text communications each week, including: ( 1 ) the weekly prompt on Monday morning (7:00 AM), ( 2 ) a reminder on Thursday morning (7:00 AM) to continue taking photographs, and ( 3 ) a reminder on Saturday morning (10:00 AM) to submit five photographs with captions by Sunday evening. After receiving submissions each Sunday, the Photovoice Coordinator confirmed receipt via text message. Following completion of Week 2, participants were invited via text message to complete a brief survey evaluating their experience with the Photovoice process. Photovoice Data Analysis We calculated descriptive statistics, including means, standard deviations, and frequencies for all information collected from the brief demographic survey. Submitted photographs and accompanying captions were compiled by the Photovoice Coordinator into a centralized Word document for analysis. Prior to coding, the research team reviewed all photographs and captions to ensure that no confidential information or inappropriate content was included. A thematic analysis approach was used to identify patterns and themes across the Photovoice data. The academic researcher leading the Photovoice project (AD) reviewed all qualitative data (photographs and captions) to develop an initial coding scheme (codebook) for each Photovoice question, identifying major themes and subthemes. An inductive analytic approach was used, whereby themes emerged from the data rather than being predetermined ( 39 , 40 ). Separate codebooks were developed for Week 1 (educator well-being concerns) and Week 2 (perceived solutions). Two coders (ST, MM, NC, LM) were assigned to each of the two participating schools and followed a multi-step coding process. First, Coder 1 applied the initial coding scheme to all data and, if needed, made edits to the coding scheme in consultation with the project lead. Next, Coder 2 independently coded all data using the (revised) coding scheme and if necessary, proposed additional refinements. Initial interrater agreement was calculated, and coding discrepancies were discussed until consensus was reached. When disagreements could not be resolved by the coders, the full Photovoice research team decided on final code assignments. Once 100% agreement was achieved, the dataset was finalized to only include mutually agreed-upon codes. Tables 1 and 2 present the final codebooks for Week 1 and Week 2, respectively. Insert Tables 1 & 2 here Survey Procedure A cross-sectional survey developed for the TTH research project to assess workforce health needs was administered across four schools between October 2023 and May 2024, with data collection occurring at three schools in October 2023 and at one school in May 2024 ( 2 ). Working with school administrators, research staff visited each school during staff meetings and professional development days to introduce the study and provide the opportunity to ask questions before taking the survey. Participants received an information sheet and were provided a link to the online survey. For survey completion, they were offered the incentive of being entered into a drawing for a $ 50 gift card. The online survey consisted of standardized measures of worker well-being outcomes and psychosocial risk factors; it required a mean time of 45 minutes for completion ( 2 ). Survey data enabled us to identify variables of the greatest health-related concern, due to their especially low or high values. Survey measures used to assess these variables are summarized in Table 3 . Insert Table 3 Survey Data Analysis Descriptive statistics including frequencies, means, and standard deviations were calculated for sociodemographic variables. Missing data were minimal and handled using listwise deletion. Dichotomization was used for all study variables that assessed workplace psychosocial risks and well-being outcomes. This approach offered a clearer interpretation and comparison of the data for stakeholders, as well as for decision-making and intervention planning purposes. Thus, survey response options were recoded to create dichotomous high versus low variables. For example, a one-item measure of mental health status was originally rated on a continuous scale from 1 ( poor ) to 5 ( excellent ). We collapsed responses of 3 ( good ) through 5 ( excellent ) into a single “good to excellent” group to categorize individuals with higher mental health status and collapsed responses 1 ( poor ) and 2 ( fair ) into a single “poor to fair” group to categorize individuals with lower mental health status. Other variables were dichotomized using predetermined cut points to indicate high versus low values. For instance, a 10-item perceived stress measure with response options ranging from 0 ( never ) to 4 ( very often ) was scored using a predefined cut point of 14, such that summative scores ≥ 14 indicated higher stress, while scores < 14 indicated lower stress. For each variable, we calculated frequencies and percentages of participants reporting “high” responses. Based on these percentages, we further assigned a level of concern to each variable in order to facilitate easy identification of priority areas for intervention development. Levels of concern related to each variable were assigned as follows: very high concern if ≥ 75% participants were adversely affected, high concern if 50–74% were adversely affected, and moderate concern if 25–49% were adversely affected. Adverse responses were defined as a low percentage of responses on health-promoting indicators (e.g., mental health status) and a high percentage of responses on health-compromising indicators (e.g., perceived stress). Results Photovoice Results A total of 20 school staff from four elementary schools completed the Photovoice activity, with all four TTH schools represented. One school made up the majority of the sample (65%, n = 13) due to high participation rates. Participants primarily identified as cisgender female (100%), White (94%), and non-Hispanic (83%). The mean age of participants was 39.2 years (ranging from 26–60 years) and the mean job tenure was 10.0 years (ranging from 0–20 years). Participants included 30% instructional aides (paraeducators, tutors), 20% regular classroom teachers, 15% unified arts teachers (art, music, physical education), 15% student instructional services (e.g., special education teachers, interventionists, English as a Second Language teachers, instructional coaches), 15% student support services (e.g., school counselors, school psychologists, social workers, school nurses), and 5% substitute teachers. Only 15 participants submitted photos and captions in both weeks; 6 people submitted photos in either Week 1 or Week 2, but not both. During Week 1, 18 school staff members submitted 100 photos; during Week 2, 17 school staff members submitted 85 photos. Initial inter-coder agreement was good (Week 1 was 0.69; Week 2 was 0.66) per established guidelines advising that .61 to .80 indicates substantial agreement ( 58 ). All coding discrepancies were discussed until complete agreement on the final code was reached. We have summarized the frequency of themes and sub-themes for both Week 1 and Week 2 in Tables 4 and 5 . Each theme and sub-theme is described with photo and caption examples provided in Figs. 1 –7. Insert Tables 4 & 5 here Week 1: Work Effects on Well-being In Week 1 participants answered the question: “How does your current work situation affect your mental well-being and happiness?” with some respondents commenting on aspects of work while others commented on impacts on well-being. We coded 100 responses and three main themes emerged: High Job Demands and Low Job Resources Decrease Well-being (38%), Personal Self-care Needed for Well-being (45%), and Well-being Impacts (17%). Each theme was further broken down into sub-themes. Theme 1: High Job Demands and Low Job Resources Decrease Well-being. Under the job demands and resources theme, work overload was the most common subtheme (n = 18), with participants describing feeling “stretched thin” and “all over the place” as tasks increased, work piled up, and demands pulled them in multiple directions. Many reported dissatisfaction with their job performance due to disorganization, falling behind, and being unable to complete assigned work. Lack of time resources was the second most common subtheme (n = 10); participants described “never having enough time” for required tasks, bringing work home, working longer hours, and having no time for breaks. The emotional demands subtheme (n = 8) reflected participants’ deep care for students, alongside the strain of managing their significant mental health needs and challenging behaviors that affected staff physical and psychological well-being. Finally, the other lacking resources subtheme (n = 2) included a lack of effective communication and workplace support. Insert Fig. 1 here Theme 2: Personal Self-care Needed for Well-being. Under the personal self-care theme, participants emphasized that their challenging work situation required the need to nurture their well-being through two key approaches. Maintaining a positive outlook in life and at work was the most common subtheme (n = 28) and included cultivating positive feelings such as gratitude, having a sense of accomplishment, seeing the job as meaningful and rewarding (i.e., students are safe, confident, and happy while learning and growing into good people), enjoyment of workplace relationships (with colleagues, students and parents), and positive self-talk (e.g., “I can do this”). Leisure coping (using leisure activities to manage stress) was the second most common subtheme (n = 17). Participants reported that to reduce or prevent work stress, they used leisure activities that enabled them to detach from work, restore energy, and improve mood, including relaxation practices, time in nature, recreational activities with other educators, and social connection with friends and family. Insert Fig. 2 here Theme 3: Well-being Impacts. Under the well-being impacts theme, participants most frequently reported physical impacts (n = 9), including tension headaches, physical exhaustion, and changes in health behaviors such as increased caffeine or alcohol use. Psychological impacts (n = 5) included emotional exhaustion and feeling overwhelmed. Participants also described work–life conflict (n = 3), with work demands spilling into nonwork time, interfering with personal needs and home responsibilities. Insert Fig. 3 here Week 2: Changes to Improve Well-being In Week 2, participants answered the question: “ If you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now ?” We coded a total of 85 responses and two main themes emerged: Organizational Change Solutions to Improve Well-being (71%) and Individual Change Solutions to Improve Well-being (29%). Each theme was further broken down into sub-themes. Theme 1: Organizational Change Solutions to Improve Well-being. Under the organizational change theme, the most common subtheme was improving the psychosocial work environment (n = 16), including promoting peace, reducing chaos, fostering supportive coworker relationships, receiving recognition and appreciation from administrators, fairer and higher pay, wellness initiatives, flexible work arrangements, and support for taking personal days. Addressing time-related concerns was the second most common subtheme (n = 13) and included needing sufficient time during the workday for task completion, organizing, collaboration, communication, and preparation, as well as reports of chronic time pressure and extended work hours that affected evenings and weekend free time. The reducing or sharing workload subtheme (n = 10) involved desires to lighten demands on teachers and students, limit curriculum changes and new initiatives, hire additional and experienced staff, and use team-teaching models. The better support for student behaviors subtheme (n = 10) included providing staff with effective tools for managing students’ mental health and behavioral needs, consistently implementing student discipline practices, and receiving greater support from student families. The support for work breaks theme (n = 8) reflected staff’s need for time for restroom use, eating or drinking something, movement, mental health breaks, and connection with coworkers. The least common subtheme was improving the physical work environment (n = 3), and included better temperature control and having larger or permanent workspaces. Insert Fig. 4 here Theme 2: Individual Change Solutions to Improve Well-being. Under this theme, more opportunities for leisure coping was the most frequently mentioned subtheme (n = 17) and involved using activities to detach from work, restore energy, and improve mood, including hobbies, relaxation, time in nature, recreation with other educators, and socializing with family and friends. The practicing a positive outlook subtheme (n = 8) reflected the deliberate cultivation of positive emotions, a sense of job-related accomplishment and meaning, enjoyment of workplace relationships, and the use of positive self-talk related to work. Insert Fig. 5 here Survey Results A total of 167 school staff from all four elementary schools completed the workforce health needs assessment survey. Participants primarily identified as cisgender female (91%), White (74%), and non-Hispanic (85%). The mean age of participants was 40.3 years (ranging from 23–64 years), the mean job tenure was 7.4 years (ranging from 0–28 years), and the mean tenure in education was 13.6 years (ranging from 0–36 years). Participants included 39% regular classroom teachers, followed by 19% student instructional services (e.g., special education teachers, interventionists, English as a Second Language (ESL) teachers, instructional coaches), 16% instructional aides/paraeducators, 13% student support services (e.g., school counselors, school psychologists, social workers, school nurses, etc.), 8% unified arts teachers (art, music, physical education), 1% substitute teachers, and 4% other staff (administrator, librarian or media specialist, secretary or other clerical support, coordinator/supervisor) Results indicated some workplace well-being challenges and psychological risks among staff in the four schools (see Table 6 ). Participants’ perceived stress was the highest concern identified (78% rated stress as being high), with other mental well-being concerns including emotional exhaustion (59%), coping overload (56%), work-life conflict (53%), low work engagement (59%), job performance impact (37%), mental health status (60%), depression symptoms (39%), and anxiety symptoms (33%). Regarding psychosocial risk factors, aside from one overarching job demand, work overload (69%), all other identified concerns related to job resources. These included time scarcity (66%), as well as a lack of: proactive communication (23%), job-related communication (39%), work breaks (39%), mental health days (52%), work recognition (56%), and work autonomy (65%). Insert Table 6 Discussion In this study, we used Photovoice, a participatory action research method based on daily photo-journaling, to assess educator health in public schools. Photovoice offers a quicker, user-friendly alternative to traditional assessment methods, particularly for workplaces or practitioners seeking to implement the Educator Well-being Program independently, without specialized technical support from research experts. Results showed that work affects educators’ psychological and physical well-being in various ways, largely through high job demands and limited resources; findings overlapped substantially with results from a workforce needs assessment survey. Photovoice respondents shared that they use personal self-care practices to counteract the effects of work, particularly through leisure coping and a positive outlook. Organizational and individual change solutions were identified to improve well-being, with most responses emphasizing the strong need for organizational change. Teaching and Well-being Effects Our first research question examined how elementary public-school educators perceive the impact of work on their well-being, an important topic given that occupational effects on worker health are often overlooked ( 28 ). In addition to describing well-being impacts, participants identified the work conditions that most strongly influenced their well-being and the personal resources needed to remain resilient. We identified adverse work impacts on well-being (17% of responses), including physical and psychological symptoms and work-life conflict, consistent with prior research ( 13 , 59 , 60 ). A novel finding was the perceived effect of work on health behaviors (e.g., caffeine use and physical activity), an area that has received limited attention, though recent qualitative work similarly identified teacher job stress as linked to unhealthy behaviors such as insufficient sleep, reduced physical activity, and poor diet ( 8 ). Participants (38%) attributed diminished well-being to two key job demands, work overload and emotional demands related to student behavior, as well as to insufficient job resources, particularly lack of time, communication, and breaks from work. These findings align with research identifying workload, student behavior, time constraints, resource limitations, and administrative factors as major sources of teacher distress ( 61 ). Work role overload and intensification, widely documented among teachers internationally, occur when excessive demands hinder individuals’ ability to complete their work effectively, leading to stress, burnout, and reduced performance ( 62 – 67 ). High emotional exhaustion, a central component of burnout, has prompted growing research on teachers’ emotional job demands, such as frequent exposure to emotionally challenging situations, the requirement for performing emotional labor, and expectations to sustain positive interpersonal relationships ( 68 ). Lack of time (time scarcity) has been widely associated with teachers completing work outside of scheduled work hours ( 69 – 71 ). In this study, time was conceptualized as a lacking job resource, but one that enables task completion, breaks, and personal life, drivers of engagement and positive outcomes, consistent with the JD-R model ( 17 ). Other studies alternatively conceptualize time as a demand (time pressure) which, along with workload and difficult student behavior, have been shown to have associations with teachers’ stress, poor well-being, and withdrawal ( 72 , 73 ). Although fewer responses in our study mentioned other resource shortages (apart from time), recent work shows that limited time and social resources can negatively affect teachers’ cognitive-behavioral functioning ( 74 ), suggesting a need for further research on resources, particularly in socioeconomically disadvantaged schools. A substantial portion of responses (45%) emphasized the need for self-care practices, particularly leisure coping and maintaining a positive outlook. Within the JD-R model, optimism is considered a personal resource linked to work engagement and well-being ( 75 – 77 ), but other dimensions of a positive outlook have received limited attention within the JD-R framework. Specifically, additional positive factors identified in our findings (e.g., relationships, accomplishment, meaning) may be more fully understood through the PERMA model of positive psychology, which posits that five core elements contribute to human flourishing: positive emotions, engagement, relationships, meaning, and accomplishments ( 78 ). Although these constructs have been less frequently studied than optimism among teachers, they have been associated with higher teacher quality of life( 79 ) and remain underexamined as personal resources within the JD-R model. Teachers described leisure coping as essential for managing stress and restoring personal resources through detachment, relaxation, and rest ( 80 – 82 ). Prior research with teachers similarly shows that leisure predicts work engagement and reduced fatigue ( 83 ), that restorative non-work experiences (especially detachment, relaxation, control, mastery, meaning, and affiliation) enhance well-being ( 84 ), and that work-to-leisure conflict relates to poorer satisfaction and higher turnover intentions ( 85 ). Leisure coping has rarely been examined as a personal resource within the JD-R model ( 86 ), but has often been conceptualized through the effort-recovery model, which explains how regular recovery from work-related effort can prevent stress, and that insufficient recovery results in sustained biopsychosocial activation and chronic strain ( 82 ). Studies with teachers indicate that leisure supports recovery when it enables relaxation and psychological detachment from work, whereas engaging in work-related activities during nonwork time impedes recovery ( 87 ). By highlighting personal resources that support motivation, engagement, and well-being, our findings align with the health-facilitation pathway of the JD-R model, contrasting with much of the JD-R literature, which emphasizes the health-impairment pathway whereby heavy job demands lead to burnout ( 88 , 89 ). Our study contributes to emerging research on social and emotional self-care practices among workers facing overload and time pressure in both their work and family roles ( 90 ), and advances understanding of the work-life interface by showing work’s effect on other life roles that promote good health and functioning, such as the leisure role and health role ( 85 , 91 – 94 ). Our findings on self-care practices also demonstrate the value of qualitative methods in capturing detailed insights into teachers’ lived experiences that were not accessible through our survey. Individual and Organizational Solutions Our second research question asked teachers which individual and organizational factors could be modified to improve well-being. Although leisure coping to manage work-related stress was among the most frequently suggested changes, individual-level strategies appeared in only 29% of responses and largely mirrored psychological self-care themes revealed in earlier Week 1 findings, including maintaining a positive mindset and leisure coping. This pattern suggests that individual strategies may function as compensatory responses when adequate structural supports are lacking and unhealthy work conditions feel intractable. Notably, more educators emphasized the need for leisure coping (20%) than for maintaining a positive mindset (9%), indicating a potential unmet need for recovery and insufficient opportunities to mentally detach from work. Further, while adopting a positive outlook is a cognitive shift that requires little additional time, engaging in preferred leisure activities such as reading, spending time outdoors, connecting with loved ones, and engaging in enjoyable pursuits, depend on time resources that participants described as scarce, due to excessive work hours other free time constraints. Interventions informed by leisure science may be considered to improve the feasibility and effectiveness of leisure coping ( 95 ), alongside positive psychology approaches that promote optimism and other facilitators of well-being ( 96 , 97 ). Most proposed solutions (71%) involved organizational changes. Teachers frequently emphasized improving the psychosocial work environment through school policies and practices that promote a calm, well-organized setting, strengthen administrator and coworker support, provide recognition, offer wellness initiatives, support the use of work breaks and personal days, and improve employment conditions (e.g., higher salaries, flexible work arrangements). Although school climate initiatives have been widely used to improve student academic and behavioral outcomes ( 98 ), few interventions have targeted the psychosocial climate to improve educator well-being ( 99 ). We were not able to find any intervention study that enhances teacher well-being by improving their conditions of employment (e.g., via higher wages, expanded leave, reduced class sizes, and protected planning time), which are more commonly addressed through union bargaining and policy advocacy. Our findings showed that some proposed solutions emphasized better support for students’ psychological and behavioral needs (e.g., addressing aggressive, destructive, or antisocial behaviors via mental health services, effective discipline, family support), which are well-established for improving student outcomes ( 100 ), but have received limited attention regarding teacher well-being. Most proposed solutions in our study aligned with well-being concerns previously identified with the Week 1 prompt, particularly excessive workload and time scarcity. Teachers suggested reducing or redistributing workloads and providing dedicated time for preparation, organization, and communication. Despite strong evidence linking educator workloads and time scarcity as the primary drivers of burnout and turnover, few evidence-based interventions directly address these concerns; only limited research on an individual-level mindfulness and motivation intervention, has shown a reduction in perceived time urgency (task-related hurry and general hurry) ( 101 ). Overall, our finding regarding teachers’ preferences for organizational solutions reflects the contemporary approach for protecting and promoting worker health that emphasizes organizational change ( 28 ). This contrasts with most existing teacher interventions that focus on individual-level strategies such as stress-reduction, though systematic review evidence ( 102 ) indicates that organizational initiatives such as fostering collaboration and trust, are among the most effective methods to improve educator well-being ( 103 ). Practical Significance Although our results align with much of the existing research on experiences and determinants of teacher well-being, this study is novel in using Photovoice to conduct a workforce health needs assessment. The first phase of the Educator Well-being Program involves assessing workforce health and identifying priority concerns to guide later intervention development, implementation, and evaluation. Needs assessments are typically conducted through surveys or focus groups, which can require significant expertise, time, and resources, posing obstacles to implementation. The TTH research team piloted Photovoice as an alternative because of its potential feasibility and rapid turnaround, and these expectations were largely met. Moreover, post-project evaluations showed that over 90% of participants rated the process positively, describing the process as simple, appropriate, acceptable, and engaging, as well as fun, creative, and meaningful for self-reflection. Where prior Healthy Workplace Participatory Program studies have taken up to nine months to design and administer workforce health assessment surveys and analyze results ( 33 , 34 ), the Photovoice process was completed in six weeks, with half that time spent recruiting participants. Instead of months spent developing a survey, this health needs assessment method required only one hour for the research team to consider and select two Photovoice prompts, which participants addressed through smartphone photographs and captions. These responses allowed us to identify themes that captured key contributors to educator well-being and potential solutions. This approach may be especially useful for organizations without access to dedicated researchers or survey designers, as the qualitative analysis of photos and captions is relatively simple and easy, can be completed in a few hours, and requires minimal training. Beyond efficiency, Photovoice also served as a reflective and motivating process that helped participants better understand their shared workplace challenges and consider mobilization for change. Photovoice findings substantially overlapped with results from the health needs assessment survey conducted in the same four schools, supporting content validity. Both methods identified concerns related to psychological well-being, emotional demands, work–life conflict, recovery time, recognition, workload, and time scarcity. Lack of communication emerged as a priority in the survey but appeared only minimally in Photovoice, possibly because most Photovoice participants came from one school with strong communication practices. Photovoice revealed perspectives not captured by the survey, particularly regarding the psychosocial environment, conditions of employment, and self-care behaviors, likely because the survey did not include items addressing these constructs. This highlights the value of qualitative approaches for uncovering unanticipated insights. Following the Photovoice data analysis, study findings were shared with participants, design teams, administrators, and school staff through a handout and video summarizing themes and displaying examples of images and captions. Dissemination of results aimed to promote dialogue about strengths and concerns, build enthusiasm for well-being solutions, and inform leaders who have the power to influence working conditions ( 20 , 36 , 38 , 104 ). The emphasis on sharing findings with administrators and school staff reflects the importance of communication and collaboration within participatory action research, which requires cooperation across various levels of influence to effectively address complex health issues ( 105 ). Using visual images and direct quotes powerfully amplifies participants’ voices, generating a vivid and persuasive account of lived experience that can drive organizational change and mobilize resources for targeted, timely well-being interventions. Strengths and Limitations Similar to a daily diary approach, using daily photographs over a two-week period was a strength that may have reduced recall bias, though photos may still reflect social desirability bias. However, the short data-collection window also captured only a specific point in the school year, which may not represent experiences across the full academic school year. For example, data collection occurred around Halloween, when participants reported increased student behavioral challenges due to schedule disruptions, heightened excitement, and sugar consumption. Future Photovoice studies should carefully consider timing and concurrent events that may coincide with the data collection period, such as testing schedules, holiday or seasonal disruptions, and different periods in the school year (i.e., beginning, end) that can affect classroom dynamics. The sample included 20 participants (roughly 12% the 167 workers who participated in the survey), so findings should be interpreted cautiously and may not represent the broader population. Future research should examine optimal sample sizes for Photovoice research, although the volume of photos in our study generated suggests that manual coding may remain feasible even with larger samples. This is particularly relevant for workplaces and practitioners seeking to implement workforce health needs assessments independently, without support from subject-matter experts in research. We were able to feasibly code data by organizing photos and captions within a Word document, though similar low-tech sorting could also be done by printing materials for manual review. Future research should also explore the use of qualitative data analysis software (e.g., NVivo, ATLAS.ti) to support more efficient organization and coding of Photovoice data. Regardless of whether it is used in research or practice, or the technology used for analysis, Photovoice offers a relatively simple and timely method for gathering actionable insights in real-world settings compared with traditional assessment methods such as surveys or focus groups. Because the study used convenience sampling, caution is warranted when generalizing findings from the self-selected participants to the broader population of educators. The sample primarily consisted of white women from a wealthy northeastern U.S. state, which does not reflect educators working in more resource-limited or emotionally-demanding contexts. Future work should recruit more diverse and representative samples, including teachers of color and intersecting identities, and apply a social ecological lens to examine occupational health disparities across school districts and geographic regions (e.g., urban vs. rural). Participation also required smartphone access, which may have excluded some individuals, although 91% of U.S. adults own a smartphone ( 106 ). Finally, the Photovoice process was less participatory than intended due to time constraints, and several common Photovoice practices were not implemented. For example, educators, who are subject-matter experts in their work conditions, were not involved in developing the two prompts used to assess their well-being experiences and impacts, nor were they engaged in theme development, coding, or analysis, which may have limited interpretation and strength of findings. Participants also did not have opportunities to discuss their photos collectively or present their shared results at a report-out session with management and coworkers ( 38 ). In addition, we did not co-develop with teachers an explicit dissemination plan to share their findings broadly with relevant stakeholders ( 107 , 108 ). Future Photovoice projects should fully incorporate participatory research practices, including the collaborative development of assessment questions, analysis, and strategies for disseminating results to stakeholders. Conclusion We used Photovoice, a qualitative photo-journaling method, to conduct a workforce health needs assessment, gathering public school educators’ perspectives on their well-being and their ideas for improving it, to inform future workplace interventions. The method proved feasible and time-efficient for the research team and was perceived by participants as simple, acceptable, and appropriate. It effectively identified health and well-being needs, aligning with findings from existing research on educators and with results from a concurrent survey conducted in the same schools. The study affirmed that educators face substantial challenges, including excessive workloads, high emotional demands, and limited resources, that undermine well-being and interfere with personal life. At the same time, our findings offered new insights, highlighting the importance of maintaining a positive outlook and having sufficient leisure time to help educators prevent and recover from work-related stress. Participants also emphasized the need for their organizations to improve the psychosocial work environment and conditions of employment. Although individual self-care was acknowledged as necessary, participants strongly prioritized organizational-level solutions. Overall, our use of Photovoice demonstrates the value of participatory approaches to identify workforce health needs and inform targeted interventions that improve working conditions. Given the unique stressors facing educators and the growing public concern over teacher turnover, such approaches offer a timely, practical way to strengthen educator well-being and retention. Table 1 Coding themes for Week 1 Question: “How does your current work situation affect your mental well-being and happiness?” Major Theme Sub-Theme Codebook Description of Type of Support ( 1 ) High Demands and Low Resources at Work ( 1 ) Work Overload Any indication that participants feel job tasks are increasing, work is piling up, they are pulled in too many directions at once, work performance is not the best/they are not accomplishing enough, feel disorganized or out of control. ( 2 ) Lack of Time Any indication that participants do not have enough time for job tasks, have to bring work home to finish it, go into work early, work late at home, have no time for breaks. ( 3 ) Emotional Demands Related to Student Behavior Any indication that participants care deeply about children, that children are emotionally needy, and that children’s behaviors are challenging generally. Behavioral challenges were exacerbated by changes to routine because of holiday (Halloween, hyper due to sugar intake) and seasonal change to cold temperature/snow (lack of recess, excitement/distraction). ( 4 ) Other Lacking Resources Lack of clear communication at work, lack of work support in general, not having a routine work role. ( 2 ) Personal Self-Care Needed for Well-Being ( 1 ) Leisure Coping Any indication that participants feel that their work requires the use of nonwork activities to mentally detach from work, recharge, uplift mood, or prevent/reduce stress including leisure (listening to music, journaling, using humor), relaxation/decompression (calming meditation, nature sounds, exercise, being alone), connecting with nature/getting outside (fresh air, sunshine), recreation with the larger community of teachers (going to happy hour, seeing a show), social support from friends/family. ( 2 ) Positive Outlook Any indication that the person feels their work requires the need to nurture their own positive outlook related to work and life, including positive feelings (joy, gratitude, contentment), a sense of accomplishment, feeling that job is meaningful/rewarding (children are safe, happy, learning, developing into good people, gaining self-esteem), enjoying relationships (with colleagues, students, parents), and using positive self-talk about work (I can do this, I love my job, some days are hard). ( 3 ) Well-Being Impacts ( 1 ) Physical Well-Being and Health Behaviors Any indication that participants feel physical symptoms such as tension headaches or exhaustion (tired, fatigued, no energy) or feel their health behaviors are affected, including caffeine use, alcohol use, and physical exercise. ( 2 ) Psychological Well-Being Any indication that participants feel psychological symptoms such feeling stress, emotional exhaustion/overwhelmed, dreading work, or feeling anxious. ( 3 ) Work-Life Conflict Work demands spillover into non-work time and interfere with personal needs and home responsibilities. Table 2 Coding themes for Week 2 Question: “If you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now?” Major Theme Sub-Theme Codebook Description of Type of Support ( 1 ) Organizational Change Solutions to Improve Well-Being ( 1 ) Reduce or Share Workload Any indication that participants want less of a workload for teachers (and students), feel curriculum changes and other things are increasing their workload, feel they are continually falling behind as workload increases, want to feel more productive, are working harder due to inexperienced (or lack of) staff, want to share their workload (by team teaching with other adults), and do not want to feel depleted by work. ( 2 ) Address Time-Related Concerns Any indication that participants feel problems are time-related, including that the number of job tasks assigned is not achievable in the time allotted (the school day), there is no time to plan/organize, communicate/collaborate, or do class preparation, the workday is too long (starts too early when it is still dark out, ends late because they are pressured to take work home), workweek is too long (have to work weekends to get work done), and often feel rushed/have to race to get things done. ( 3 ) Provide and Support Work Breaks Any indication that participants need more work breaks to be able to: use bathroom when needed, take a mental health break, sit down, have a drink (stay hydrated), eat a snack, have lunch or a walk with coworker-friends, go out for fresh air, or interact with other adults. ( 4 ) Better Support for Student Needs Any indication that student behaviors are challenging or exhausting, including students having mental health needs, being aggressive/destructive, needing discipline when they break rules. It was also indicated that teachers need good tools to support students and more support from students’ families. ( 5 ) Improve Physical Environment at Work Any indication that participants feel the physical environment needs to be improved, such as having control over classroom temperature (i.e., functioning heaters/thermostats) or having a bigger space or permanent space to work in. ( 6 ) Improve Psychosocial Environment at Work (In and Outside of Work) Any indication that participants feel the psychosocial environment needs to be improved, such as creating peace/lessening chaos, uplifting the spirits of coworker-friends (giving a card or gift), getting feedback or recognition from principal about work performance, paying teachers a better/fairer salary, or offering workplace wellness initiatives (dog therapy). To support work-life balance, offering flexible arrangements (e.g., working from home) and admin/coworkers being supportive of staff taking their personal days. ( 2 ) Individual Change Solutions to Improve Well-Being ( 1 ) Do More Leisure Coping Activities Any indication that participants feel it would be helpful to have more opportunity for non-work activities to mentally detach from work, recharge, uplift mood, or prevent/reduce stress including leisure (listening to music, journaling, using humor), relaxation/decompression (calming meditation, nature sounds, exercise, being alone,), connecting with nature/getting outside (fresh air, sunshine), recreation with the larger community of teachers (happy hour, seeing a show), social support from friends/family. ( 2 ) Practice Having a Positive Outlook Any indication that the person is feels it is beneficial to practice having a positive outlook related to work and life, including positive feelings (joy, gratitude, contentment), a sense of accomplishment, feeling that job is meaningful/rewarding (children are safe, happy, learning, developing into good people, gaining self-esteem), enjoying relationships (with colleagues, students, parents), using self-compassion/affirmations and positive self-talk about work (I can do this, I love my job, some days are hard). Table 3 Measures in 2023 Educator Workforce Health Needs Assessment Survey Construct and Measure’s Source What Measure Assesses # of items Measure’s Likert Scale How High Score Was Calculated Psychosocial Risk Factors at Work : Work Overload * ( 41 ) Asked to do excessive amount of work 1 1 ( strongly agree ) to 4 ( strongly disagree ) scale was used to rate the item: “I am not asked to do an excessive amount of work”. Higher scores indicate greater work overload. Ratings of 3 ( somewhat disagree ) and 4 ( strongly disagree ) collapsed into one "somewhat to strongly disagree" category. Time Scarcity * ( 41 ) Do not have enough time to get job done 1 1 ( strongly agree ) to 4 ( strongly disagree ) scale was used to rate the item: “I have enough time to get my job done.” Higher scores indicate greater time scarcity. Ratings of 3 ( somewhat disagree ) and 4 ( strongly disagree ) collapsed into one "somewhat to strongly disagree" category. Proactive Communication ( 42 ) Receive advanced information of decisions, plans, changes 1 0 ( to a very small extent ) to 4 ( to a very large extent ) Ratings of 3 ( to a large extent ) and 4 ( to a very large extent ) collapsed into one "large or very large extent" category. Job-related Communication ( 42 ) Receive needed information to do their job well 1 0 ( to a very small extent ) to 4 ( to a very large extent ) Ratings of 3 ( to a large extent ) and 4 ( to a very large extent ) collapsed into one "large or very large extent" category. Work Breaks (original TTH-created item) Able to use restroom when needed 1 1 ( never ) to 5 ( always ) Ratings of 4 ( often ) and 5 ( always ) collapsed into one "often or always" category. Mental Health Days ( 43 ) Feel supported to use sick days for mental health 1 1 ( strongly disagree ) to 4 ( strongly agree ) Ratings of 3 ( agree ) and 4 ( strongly agree) collapsed into one "agree or strongly agree" category. Work Autonomy * ( 41 ) Have input about what happens related to their job 1 1 ( strongly disagree ) to 4 ( strongly agree ) Ratings of 3 ( somewhat agree ) and 4 ( strongly agree ) collapsed into one "somewhat to strongly agree" category. Work Recognition ( 44 ) Receive recognition for doing a good job at work 1 1 ( strongly disagree ) to 5 ( strongly agree ) Ratings of 4 ( agree ) and 5 ( strongly agree) collapsed into one "agree or strongly agree" category. Psychological Well-being Outcomes : Perceived Stress ( 45 ) Appraise life events as unpredictable, uncontrollable, overwhelming 10 0 ( never ) to 4 ( very often ) Cut score of 14 used; summative scores ≥ 14 indicate moderate to high stress. Mental Health Status ( 46 ) Rate their overall mental health as high 1 1 ( poor ) to 5 ( excellent ) Ratings of 3 ( good ) to 5 ( excellent ) collapsed into one "good to excellent" category. Depression Symptoms ( 47 , 48 ) Report high clinical symptoms of depression 10 0 ( rarely or none of the time ) to 3 ( all of the time ) Cut score of 10 used; summative scores ≥ 10 indicate high depression symptoms. Anxiety Symptoms ( 49 , 50 ) Report high clinical symptoms of anxiety 7 0 ( not at all ) to 3 ( nearly every day) and 1 ( not difficult at all ) to 4 ( extremely difficult ) Cut score of 8 used; summative scores ≥ 10 indicate high anxiety symptoms. Work-related Well-being Outcomes : Emotional Exhaustion ( 51 ) Feel depleted emotionally from work, related to burnout 9 0 ( never ) to 6 ( every day ) Cut score of 27 used; summative scores ≥ 27 indicate high exhaustion. Work Engagement ( 52 ) Feel like going to work 1 0 ( never ) to 6 ( always ) Ratings of 4 ( often ) to 6 ( always ) collapsed into one "often to always" category. Coping Overload ( 53 , 54 ) Experience work stress exceeding coping ability 2 Stress item: 0 ( not stressful ) to 10 ( very stressful ). Coping item: 0 ( not well ) to 10 ( very well ). Difference scores calculated by subtracting stress score from coping score. Negative values indicate stress exceeding coping ability and were used to classify high coping overload. Performance Impact ( 55 , 56 ) Feel workload interferes with work quality 1 1 ( never ) to 5 ( always ) Ratings of 4 ( usually ) and 5 ( always ) collapsed into one "usually or always" category. Work-Life Conflict ( 57 ) Leave home responsibilities undone due to job 1 1 ( strongly disagree ) to 5 ( strongly agree ) Ratings of 4 ( agree ) and 5 ( strongly agree ) collapsed into one "agree or strongly agree" category. * Adapted from Original Measure Table 4 Distribution of Themes and Subthemes from Responses to Week 1 Question Across 100 Photos with Captions Major Theme: Sub-Theme Freq % Personal Self-care: Positive outlook 28 28% High Demands & Low Resources: Work overload 18 18% Personal Self-care: Leisure coping 17 17% High Demands & Low Resources: Lack of time 10 10% Well-being Impacts: Physical well-being & health behaviors 9 9% High Demands & Low Resources: Emotional demands 8 8% Well-being Impacts: Psychological well-being 5 5% Well-being Impacts: Work-life conflict 3 3% High Demands & Low Resources: Other lacking resources 2 2% Table 5 Distribution of Themes and Subthemes from Responses to Week 2 Question Across 85 Photos with Captions Major Theme: Sub-Theme Freq % Individual Change: Do more leisure coping activities 17 20% Organizational Change: Improve psychosocial environment 16 19% Organizational Change: Address time-related concerns 13 15% Organizational Change: Reduce or share workload 10 12% Organizational Change: Better support for student needs 10 12% Organizational Change: Provide and support work breaks 8 9% Individual Change: Practice having a positive outlook 8 9% Organizational Change: Improve physical environment at work 3 4% Table 6 Findings from 2023 Workforce Health Needs Assessment Survey Construct Freq (%) of “High” Rating Level of Concern Perceived Stress 130 (78%) Very High Proactive Communication 38 (23%) Very High Work Overload 51 (69%) High Time Scarcity 57 (66%) High Job-related Communication 65 (39%) High Work Breaks 52 (39%) High Emotional Exhaustion 97 (59%) High Coping Overload 93 (56%) High Work-Life Conflict 88 (53%) High Mental Health Days 87 (52%) Moderate Work Recognition 94 (56%) Moderate Work Engagement 99 (59%) Moderate Mental Health Status 100 (60%) Moderate Depression Symptoms 65 (39%) Moderate Performance Impact 62 (37%) Moderate Work Autonomy 108 (65%) Moderate Anxiety Symptoms 54 (33%) Moderate Note. Data from 167 survey participants at four schools. Variables listed from highest to lowest level of concern. (Very High = ≥ 75% unfavorable responses, High = 50–74% unfavorable responses; Moderate = 25–49% unfavorable responses). Declarations Acknowledgements: We gratefully acknowledge assistance with data collection efforts received from participating Connecticut schools in two school districts. We particularly appreciate the assistance of the project champions, principals and educator design team members in recruiting participants for Photovoice and survey data collection. The authors would also like to thank the educators, staff, and administrators who participated in our study. Dedication: This paper is dedicated to the memory of Dr. Lisa M. H. Sanetti, an inspiring colleague and dear friend, whose vision and commitment to educator well-being paved the way for the Total Teacher Health project. Funding : This publication was supported by Grant Number U19 OH012299 from the U.S. National Institute for Occupational Safety and Health (NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. Total Worker Health ® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by CPH-NEW does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or NIOSH. Conflicts of interest/Competing interests: The authors have no relevant financial or non-financial interests to disclose. Ethics approval and c onsent to participate: All procedures were reviewed and approved by the Institutional Review Board of the University of Connecticut Health Center. The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained by all study participants. Availability of data and material: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Code availability: The code that supports the findings of this study are available on request from the corresponding author. Author contributions : AD, JC, ST, and MM contributed to the study conception and design, and operationalization of methods. AD, ST, MM, NC, LM and AH contributed to data analysis. All authors helped to interpret results. The first full draft of the manuscript was written by LM and AD, and JC commented on several versions of the manuscript. All authors read and approved the final manuscript. Consent for publication: Obtained References Steiner ED, Woo A. Job-related stress threatens the teacher supply: Key findings from the 2021 state of the U.S. teacher survey. Rand Corporation. 2021;25(8). 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Dugan AG, Decker RE, Austin HL, Namazi S, Shaw WS, Bellizzi KM, Blank TO, Cherniack MG, Tannenbaum SH, Swede H, Hundal J, Cavallari JM. Work-health conflict among breast cancer survivors: Associations with cancer self-management, quality of life, and anticipated turnover. Occup Health Sci. 2024;8(2):315–35. Eby LT, Casper WJ, Lockwood A, Bordeaux C, Brinley A. Work and family research in IO/OB: Content analysis and review of the literature (1980–2002). J Vocat Behav. 2005;66(1):124–97. Frank AW. From sick role to practices of health and illness. Med Educ. 2013;47(1):18–25. Wilson KS, Baumann HM. Capturing a more complete view of employees’ lives outside of work: The introduction and development of new interrole conflict constructs. Pers Psychol. 2015;68(2):235–82. Kuykendall L, Tay L, Ng V. Leisure engagement and subjective well-being: A meta-analysis. Psychol Bull. 2015;141(2):364–403. Carr A, Cullen K, Keeney C, Canning C, Mooney O, Chinseallaigh E, O’Dowd A. Effectiveness of positive psychology interventions: a systematic review and meta-analysis. J Posit Psychol. 2021;16(6):749–69. Donaldson SI, Lee JY, Donaldson SI. Evaluating positive psychology interventions at work: A systematic review and meta-analysis. Int J Appl Posit Psychol. 2019;4(3):113–34. Wang MT, Degol JL. School climate: A review of the construct, measurement, and impact on student outcomes. Educational Psychol Rev. 2016;28(2):315–52. Sottimano I, Guidetti G, Converso D, Viotti S. We cannot be forever young, but our children are: A multilevel intervention to sustain nursery school teachers’ resources and well-being during their long work life cycle. PLoS ONE. 2018;13(11):e0206627. Madigan K, Cross RW, Smolkowski K, Strycker LA. Association between schoolwide positive behavioural interventions and supports and academic achievement: A 9-year evaluation. Educational Res Evaluation. 2016;22(7–8):402–21. Jennings PA, Snowberg KE, Coccia MA, Greenberg MT. Improving classroom learning environments by cultivating awareness and resilience in education (CARE): Results of two pilot studies. J Classr Interact 2011 Jan 1: 46(1):37–48. Hagermoser Sanetti LM, Boyle AM, Magrath E, Cascio A, Moore E. Intervening to decrease teacher stress: A review of current research and new directions. Contemp School Psychol. 2021;25(4):416–25. Cann R, Sinnema C, Rodway J, Daly AJ. What do we know about interventions to improve educator wellbeing? A systematic literature review. J Educ Change. 2024;25(2):231–70. Liebenberg L. Thinking critically about photovoice: Achieving empowerment and social change. Int J Qualitative Methods. 2018;17(1):1–9. Anderson OS, August E, Goldberg PK, Youatt E, Beck AJ. Developing a framework for population health in interprofessional training: An interprofessional education module. Front Public Health. 2019;7:58. Pew Research Center. (2025). Tech Adoption Trends: Mobile Fact Sheet. Retrieved Jan 31, 2026, from https://www.pewresearch.org/internet/fact-sheet/mobile/?utm_source=chatgpt.com Carpenter D, Nieva V, Albaghal T, Sorra J. Development of a planning tool to guide research dissemination. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools, and Products) Rockville (MD). Agency for Healthcare Research and Quality (US); 2005. Dugan AG, Punnett L. Dissemination and implementation research for occupational safety and health. Occup Health Sci. 2017;1(1–2):29–45. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8961242","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607171875,"identity":"2a035fac-f208-4549-be3d-ed7e3e9319f2","order_by":0,"name":"Alicia G. 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Educators in the United States (U.S.) commonly experience stress, burnout, and job-related depression (1). They report high stress and clinically significant anxiety and depression, which are associated with higher turnover intentions (2). Beyond adverse mental health outcomes, teachers also experience physical health consequences associated with chronic occupational stress. Chronic stress among teachers is linked to fatigue and adverse changes\u0026nbsp;in biological indicators of stress, such as atypical cortisol levels\u0026nbsp;(3,4).\u0026nbsp;\u0026nbsp;Similarly, there is a consistent association between teacher burnout and a range of physical health outcomes, including biomarkers indicating hypothalamic-pituitary-adrenal (HPA) axis dysregulation and inflammation (cytokines), as well as somatic complaints (e.g., headaches), illnesses (e.g., gastroenteritis), and voice disorders\u0026nbsp;(5)\u003c/p\u003e\n\u003cp\u003eStress has been shown to adversely affect teacher-student relationships, which may give way to academic, social, and behavioral challenges among students\u0026nbsp;with consequences that extend beyond the classroom\u0026nbsp;(6).\u0026nbsp;Different and intersecting identities (e.g., sex, race, age, socioeconomic status) can contribute to the sources, experiences, and consequences of\u0026nbsp;teacher stress, shaping both exposure to stressors and vulnerability to their effects, with impacts including adverse mental health outcomes and greater exhaustion (7). Stress has long impacted educators\u0026rsquo; ability to provide high-quality learning environments, a pattern that was significantly exacerbated during the COVID-19 pandemic\u0026nbsp;(8).\u003c/p\u003e\n\u003cp\u003eTeacher turnover rates are approximately 16% annually, comprising about 8% who leave the profession and another 8% who move to different schools (9). The majority leave voluntarily (10), and of those who exit the profession, two-thirds do so for reasons other than retirement, indicating that most teachers leave in the early- or mid-stages of their careers (11). Turnover data indicate that approximately 10% of teachers leave after their first year, and about 17% leave after five years (12,13). Teacher departure is attributed to various factors including inadequate financial compensation, limited opportunities for career advancement, and notably, stress (14,15). The onset of the COVID-19 pandemic in the U.S. prompted additional and compounding reasons for turnover and worsened the existing teacher shortage, drawing attention to longstanding issues of stress, burnout, and retention within the profession (8,9,14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne study found that the desire to exit the teaching profession increased significantly during the 2020\u0026ndash;2021 academic year coinciding with the early COVID-19 pandemic years, with one in four teachers expressing intent to leave, compared to one in six before the pandemic (1). During the pandemic, researchers observed deteriorating teaching conditions, finding associations between teacher distress and insufficient administrative support, student behavioral problems, increasing job demands, technical challenges due to remote teaching, and mismatches between actual and preferred instructional modalities (1,10,16). Collectively, these findings underscore an urgent need for effective, scalable interventions to address persistent stress, burnout, and adverse mental and physical health outcomes among educators.\u003c/p\u003e\n\u003cp\u003eThe job demands-resources (JD-R) model is a useful framework for understanding work-related stress and provides valuable insights into the burnout and mental health difficulties experienced by educators. Job demands may be physical, cognitive, emotional, social, or organizational in nature, requiring sustained effort in one\u0026rsquo;s work role and incurring physiological and psychological costs (17). Similarly, job resources may be physical, psychological, social, or organizational elements that are instrumental in achieving work objectives, reduce job demands and associated strain, and encourage personal growth, learning, and advancement (17). Personal resources may be beneficial aspects of oneself (e.g., optimism, self-efficacy) that people draw from to conduct work and life activities (18). The JD-R model posits that when job demands outweigh available resources, it results in burnout and strain (17,18). Conversely, having adequate job and personal resources can mitigate the strain caused by excessive job demands and directly contribute to worker engagement and overall well-being (17,18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn educators,\u0026nbsp;stress arises from an imbalance between demands and resources operating at multiple levels, including institutional (e.g., class size, administrative expectations), classroom (e.g., student behavior), and personal (e.g., self-efficacy, coping skills) levels (19).\u0026nbsp;Research consistently shows that excessive institutional and classroom demands, such as administrative workload related to\u0026nbsp;testing and paperwork\u0026nbsp;and challenging student behaviors, are among the most stressful aspects of teaching and are associated with emotional exhaustion, reduced professional accomplishment, as well as disengaged students (20). Teachers who experience persistent mismatches between demands and available resources are at higher risk for stress and burnout, and report lower job satisfaction and occupational commitment, whereas teachers with access to greater resources\u0026nbsp;report less stress and more job satisfaction (21). Notably, a recent meta-analysis identified\u0026nbsp;better resources at school, more job autonomy, and\u0026nbsp;higher salaries\u0026nbsp;as key factors associated with teacher retention (22).\u0026nbsp;Together, these findings underscore the central role of demands-resources balance as a determinant of teacher well-being and reinforce the need for interventions that reduce excessive demands while strengthening organizational and personal resources.\u003c/p\u003e\n\u003cp\u003eSeveral recent systematic reviews\u0026nbsp;of stress and burnout interventions have been conducted, collectively covering over 30 years of research from 1987-2022 (23,24,25)\u0026nbsp;The most recent review found that nearly half of interventions focused on mindfulness-based approaches, including\u0026nbsp;yoga, and just over one-third involved cognitive behavioral therapy (CBT) or rational emotive behavior therapy (REBT). The remaining interventions included sports-based physical activity programs, stress reduction training, social and emotional development, and prayer (23). This pattern illustrates a predominant emphasis on individual-level solutions, such as improving self-care and coping skills, rather than organizational change interventions that address systemic, workplace-level contributors to poor teacher well-being.\u003c/p\u003e\n\u003cp\u003eThe limited attention paid to organizational change interventions in both research and practice has been notable (26,27). However, the U.S. National Institute for Occupational Safety and Health promotes a Total Worker Health\u0026reg; approach, emphasizing organizational change rather than relying solely on individual workers to achieve well-being amid persistent structural stressors (28). While teachers may possess effective coping skills, the impact of these skills is constrained when workplace conditions continue to cause harm. Accordingly, employer accountability and the prioritization of worker well-being as an organizational objective are essential for effective interventions (28).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eA Participatory Intervention Method to Improve Worker Well-Being\u003c/h3\u003e\n\u003cp\u003eThe Total Teacher Health (TTH) research project is a multi-phase intervention study conducted in public schools aimed at protecting and promoting educator health and well-being (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The project uses an adapted version of the Center for Promotion of Health in the New England Workplace\u0026rsquo;s \u003cem\u003eHealthy Workplace Participatory Program\u003c/em\u003e toolkit, a structured process designed to identify, prioritize, and remediate root causes of health, safety, and well-being concerns across worker populations (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The toolkit is an intervention designed to systematically generate and implement context-specific workplace health initiatives at both the organizational- and individual-levels. This evidence-based process engages a design team of frontline workers (subject matter experts of their job and work conditions) to assess workforce health needs and develop tailored interventions, with support from a steering committee of organizational leaders who oversee activities and facilitate implementation. The adapted version of the Healthy Workplace Participatory Program that the TTH project uses, entitled the \u003cem\u003eEducator Well-being Program\u003c/em\u003e, was tailored for educators and previously pilot-tested by Sanetti and colleagues (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe first task of the design team is to conduct a workforce health needs assessment to identify priority concerns and inform subsequent intervention development, implementation, and evaluation. While engaging workers in identifying workplace hazards and health concerns enhances intervention relevance and effectiveness (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), traditional needs assessment methods such as surveys and focus groups can require substantial time, resources, and expertise that may not be available, posing a barrier to the independent functioning and long-term sustainability of the program. For example, implementing the Healthy Workplace Participatory Program within the corrections workforce required several months for survey development and analysis, as well as specialized assistance from subject matter experts in research to develop data collection methods and analyze findings (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo address these feasibility challenges, the TTH research team piloted Photovoice as an alternative needs assessment approach with the potential to rapidly identify educator health priorities. Photovoice is a participatory action research method in which community members, defined as individuals connected by shared experiences and a collective interest in health and well-being (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), use photographs and narratives to document lived experiences, promote dialogue, and advocate for improvements in health and well-being (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Although Photovoice has been used successfully in some workplace contexts, its application remains limited (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In addition to its feasibility, the TTH project selected Photovoice because its use of visual imagery may more effectively facilitate shared learning about health and safety concerns and engage decision-makers in initiating organizational change as compared to conventional methods used with the Healthy Workplace Participatory Program.\u003c/p\u003e \u003cp\u003eThis paper describes the process and findings from the implementation of Photovoice across four public schools in the northeastern U.S., demonstrating the feasibility and utility of Photovoice as a workforce health needs assessment tool among a novel worker population: elementary school educators and staff. The Photovoice needs assessment is guided by two research questions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) \u003cem\u003eHow do elementary public school educators and staff perceive the impact of their work on their well-being?\u003c/em\u003e and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) \u003cem\u003eWhat individual- and organizational-level factors do educators perceive as modifiable to improve well-being?\u003c/em\u003e In addition, we compare findings generated through Photovoice with those obtained from a traditional needs assessment method, a survey, to examine the degree of convergence in health priorities identified across the two approaches.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFor both the Photovoice and survey data collections described below, participants were recruited from four elementary schools across two suburban school districts in the northeastern U.S. (two schools per district). These schools were recruited as sites for participation in the TTH research study (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Participants were educators and staff working in jobs including: regular classroom teacher, unified arts teacher (art, music, physical education), instructional aide (paraeducators, tutors), substitute teacher, secretary (or other clerical support staff), or student support services (e.g., school counselor, school psychologist, social worker, school nurse, etc.). All research protocols were approved by the UConn Health Institutional Review Board.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePhotovoice Procedure\u003c/h2\u003e \u003cp\u003ePhotovoice was conducted at three schools in October 2023 and one school in January 2024. The Photovoice activity required a six-week implementation timeline that included recruitment (3 weeks), the Photovoice activity (2 weeks), and qualitative data analysis (1 week). To recruit participants, TTH team members distributed study flyers at school staff meetings, and school principals emailed flyers to staff. Flyers included study information and enrollment instructions and indicated that participants were required to have a smartphone to participate. Participants were compensated with a \u003cspan\u003e$\u003c/span\u003e50 e-gift card to an online retailer for the successful completion of the two-week Photovoice activity.\u003c/p\u003e \u003cp\u003eUpon enrollment, participants first completed a voluntary, brief demographic survey and then received an email containing written and video instructions explaining the study purpose and Photovoice process. A designated Photovoice Coordinator (AH) served as the primary point of contact for participants throughout the study, with all communication conducted through a dedicated TTH Project smartphone. The Photovoice Coordinator documented all text-based communications with participants.\u003c/p\u003e \u003cp\u003ePhotovoice data collection occurred over two weeks. At the beginning of each week, the Photovoice Coordinator texted participants a specific question (\u0026ldquo;prompt\u0026rdquo;), which participants were instructed to answer by taking photographs using their smartphones. The Week 1 prompt was intentionally broad to capture both work conditions and their effects, asking: \u0026ldquo;\u003cem\u003eHow does your current work situation affect your mental well-being and happiness?\u0026rdquo;\u003c/em\u003e The Week 2 prompt focused on potential solutions, asking: \u0026ldquo;\u003cem\u003eIf you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now?\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003cp\u003ePer the Photovoice instructions, participants were encouraged to take one to two photographs per day that reflected their response to the weekly prompt. At the end of each week, participants were instructed to review all photographs taken, select five images that best represented their response to the prompt, write a brief caption for each image, and submit the five photographs with captions to the Photovoice Coordinator via text message.\u003c/p\u003e \u003cp\u003eTo support participation and adherence, the Photovoice Coordinator sent standardized text communications each week, including: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the weekly prompt on Monday morning (7:00 AM), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) a reminder on Thursday morning (7:00 AM) to continue taking photographs, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) a reminder on Saturday morning (10:00 AM) to submit five photographs with captions by Sunday evening. After receiving submissions each Sunday, the Photovoice Coordinator confirmed receipt via text message. Following completion of Week 2, participants were invited via text message to complete a brief survey evaluating their experience with the Photovoice process.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhotovoice Data Analysis\u003c/h3\u003e\n\u003cp\u003eWe calculated descriptive statistics, including means, standard deviations, and frequencies for all information collected from the brief demographic survey.\u003c/p\u003e \u003cp\u003eSubmitted photographs and accompanying captions were compiled by the Photovoice Coordinator into a centralized Word document for analysis. Prior to coding, the research team reviewed all photographs and captions to ensure that no confidential information or inappropriate content was included. A thematic analysis approach was used to identify patterns and themes across the Photovoice data.\u003c/p\u003e \u003cp\u003eThe academic researcher leading the Photovoice project (AD) reviewed all qualitative data (photographs and captions) to develop an initial coding scheme (codebook) for each Photovoice question, identifying major themes and subthemes. An inductive analytic approach was used, whereby themes emerged from the data rather than being predetermined (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Separate codebooks were developed for Week 1 (educator well-being concerns) and Week 2 (perceived solutions).\u003c/p\u003e \u003cp\u003e Two coders (ST, MM, NC, LM) were assigned to each of the two participating schools and followed a multi-step coding process. First, Coder 1 applied the initial coding scheme to all data and, if needed, made edits to the coding scheme in consultation with the project lead. Next, Coder 2 independently coded all data using the (revised) coding scheme and if necessary, proposed additional refinements. Initial interrater agreement was calculated, and coding discrepancies were discussed until consensus was reached. When disagreements could not be resolved by the coders, the full Photovoice research team decided on final code assignments. Once 100% agreement was achieved, the dataset was finalized to only include mutually agreed-upon codes. Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e present the final codebooks for Week 1 and Week 2, respectively.\u003c/p\u003e \u003cp\u003eInsert Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here\u003c/p\u003e\n\u003ch3\u003eSurvey Procedure\u003c/h3\u003e\n\u003cp\u003eA cross-sectional survey developed for the TTH research project to assess workforce health needs was administered across four schools between October 2023 and May 2024, with data collection occurring at three schools in October 2023 and at one school in May 2024 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Working with school administrators, research staff visited each school during staff meetings and professional development days to introduce the study and provide the opportunity to ask questions before taking the survey. Participants received an information sheet and were provided a link to the online survey. For survey completion, they were offered the incentive of being entered into a drawing for a \u003cspan\u003e$\u003c/span\u003e50 gift card. The online survey consisted of standardized measures of worker well-being outcomes and psychosocial risk factors; it required a mean time of 45 minutes for completion (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Survey data enabled us to identify variables of the greatest health-related concern, due to their especially low or high values. Survey measures used to assess these variables are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003eSurvey Data Analysis\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics including frequencies, means, and standard deviations were calculated for sociodemographic variables. Missing data were minimal and handled using listwise deletion. Dichotomization was used for all study variables that assessed workplace psychosocial risks and well-being outcomes. This approach offered a clearer interpretation and comparison of the data for stakeholders, as well as for decision-making and intervention planning purposes. Thus, survey response options were recoded to create dichotomous high versus low variables. For example, a one-item measure of mental health status was originally rated on a continuous scale from 1 (\u003cem\u003epoor\u003c/em\u003e) to 5 (\u003cem\u003eexcellent\u003c/em\u003e). We collapsed responses of 3 (\u003cem\u003egood\u003c/em\u003e) through 5 (\u003cem\u003eexcellent\u003c/em\u003e) into a single \u0026ldquo;good to excellent\u0026rdquo; group to categorize individuals with higher mental health status and collapsed responses 1 (\u003cem\u003epoor\u003c/em\u003e) and 2 (\u003cem\u003efair\u003c/em\u003e) into a single \u0026ldquo;poor to fair\u0026rdquo; group to categorize individuals with lower mental health status. Other variables were dichotomized using predetermined cut points to indicate high versus low values. For instance, a 10-item perceived stress measure with response options ranging from 0 (\u003cem\u003enever\u003c/em\u003e) to 4 (\u003cem\u003every often\u003c/em\u003e) was scored using a predefined cut point of 14, such that summative scores\u0026thinsp;\u0026ge;\u0026thinsp;14 indicated higher stress, while scores\u0026thinsp;\u0026lt;\u0026thinsp;14 indicated lower stress. For each variable, we calculated frequencies and percentages of participants reporting \u0026ldquo;high\u0026rdquo; responses.\u003c/p\u003e \u003cp\u003eBased on these percentages, we further assigned a level of concern to each variable in order to facilitate easy identification of priority areas for intervention development. Levels of concern related to each variable were assigned as follows: very high concern if\u0026thinsp;\u0026ge;\u0026thinsp;75% participants were adversely affected, high concern if 50\u0026ndash;74% were adversely affected, and moderate concern if 25\u0026ndash;49% were adversely affected. Adverse responses were defined as a low percentage of responses on health-promoting indicators (e.g., mental health status) and a high percentage of responses on health-compromising indicators (e.g., perceived stress).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePhotovoice Results\u003c/h2\u003e \u003cp\u003eA total of 20 school staff from four elementary schools completed the Photovoice activity, with all four TTH schools represented. One school made up the majority of the sample (65%, n\u0026thinsp;=\u0026thinsp;13) due to high participation rates. Participants primarily identified as cisgender female (100%), White (94%), and non-Hispanic (83%). The mean age of participants was 39.2 years (ranging from 26\u0026ndash;60 years) and the mean job tenure was 10.0 years (ranging from 0\u0026ndash;20 years). Participants included 30% instructional aides (paraeducators, tutors), 20% regular classroom teachers, 15% unified arts teachers (art, music, physical education), 15% student instructional services (e.g., special education teachers, interventionists, English as a Second Language teachers, instructional coaches), 15% student support services (e.g., school counselors, school psychologists, social workers, school nurses), and 5% substitute teachers.\u003c/p\u003e \u003cp\u003eOnly 15 participants submitted photos and captions in both weeks; 6 people submitted photos in either Week 1 or Week 2, but not both. During Week 1, 18 school staff members submitted 100 photos; during Week 2, 17 school staff members submitted 85 photos. Initial inter-coder agreement was good (Week 1 was 0.69; Week 2 was 0.66) per established guidelines advising that .61 to .80 indicates substantial agreement (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). All coding discrepancies were discussed until complete agreement on the final code was reached. We have summarized the frequency of themes and sub-themes for both Week 1 and Week 2 in Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Each theme and sub-theme is described with photo and caption examples provided in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;7.\u003c/p\u003e \u003cp\u003eInsert Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e here\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eWeek 1: Work Effects on Well-being\u003c/h3\u003e\n\u003cp\u003eIn Week 1 participants answered the question: \u003cem\u003e\u0026ldquo;How does your current work situation affect your mental well-being and happiness?\u0026rdquo;\u003c/em\u003e with some respondents commenting on aspects of work while others commented on impacts on well-being. We coded 100 responses and three main themes emerged: High Job Demands and Low Job Resources Decrease Well-being (38%), Personal Self-care Needed for Well-being (45%), and Well-being Impacts (17%). Each theme was further broken down into sub-themes.\u003c/p\u003e \u003cp\u003e\u003cb\u003eTheme 1: High Job Demands and Low Job Resources Decrease Well-being.\u003c/b\u003e Under the job demands and resources theme, work overload was the most common subtheme (n\u0026thinsp;=\u0026thinsp;18), with participants describing feeling \u0026ldquo;stretched thin\u0026rdquo; and \u0026ldquo;all over the place\u0026rdquo; as tasks increased, work piled up, and demands pulled them in multiple directions. Many reported dissatisfaction with their job performance due to disorganization, falling behind, and being unable to complete assigned work. Lack of time resources was the second most common subtheme (n\u0026thinsp;=\u0026thinsp;10); participants described \u0026ldquo;never having enough time\u0026rdquo; for required tasks, bringing work home, working longer hours, and having no time for breaks. The emotional demands subtheme (n\u0026thinsp;=\u0026thinsp;8) reflected participants\u0026rsquo; deep care for students, alongside the strain of managing their significant mental health needs and challenging behaviors that affected staff physical and psychological well-being. Finally, the other lacking resources subtheme (n\u0026thinsp;=\u0026thinsp;2) included a lack of effective communication and workplace support.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 2: Personal Self-care Needed for Well-being.\u003c/b\u003e Under the personal self-care theme, participants emphasized that their challenging work situation required the need to nurture their well-being through two key approaches. Maintaining a positive outlook in life and at work was the most common subtheme (n\u0026thinsp;=\u0026thinsp;28) and included cultivating positive feelings such as gratitude, having a sense of accomplishment, seeing the job as meaningful and rewarding (i.e., students are safe, confident, and happy while learning and growing into good people), enjoyment of workplace relationships (with colleagues, students and parents), and positive self-talk (e.g., \u0026ldquo;I can do this\u0026rdquo;). Leisure coping (using leisure activities to manage stress) was the second most common subtheme (n\u0026thinsp;=\u0026thinsp;17). Participants reported that to reduce or prevent work stress, they used leisure activities that enabled them to detach from work, restore energy, and improve mood, including relaxation practices, time in nature, recreational activities with other educators, and social connection with friends and family.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;2 here\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 3: Well-being Impacts.\u003c/b\u003e Under the well-being impacts theme, participants most frequently reported physical impacts (n\u0026thinsp;=\u0026thinsp;9), including tension headaches, physical exhaustion, and changes in health behaviors such as increased caffeine or alcohol use. Psychological impacts (n\u0026thinsp;=\u0026thinsp;5) included emotional exhaustion and feeling overwhelmed. Participants also described work\u0026ndash;life conflict (n\u0026thinsp;=\u0026thinsp;3), with work demands spilling into nonwork time, interfering with personal needs and home responsibilities.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e here\u003c/p\u003e\n\u003ch3\u003eWeek 2: Changes to Improve Well-being\u003c/h3\u003e\n\u003cp\u003eIn Week 2, participants answered the question: \u0026ldquo;\u003cem\u003eIf you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now\u003c/em\u003e?\u0026rdquo; We coded a total of 85 responses and two main themes emerged: Organizational Change Solutions to Improve Well-being (71%) and Individual Change Solutions to Improve Well-being (29%). Each theme was further broken down into sub-themes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 1: Organizational Change Solutions to Improve Well-being.\u003c/b\u003e Under the organizational change theme, the most common subtheme was improving the psychosocial work environment (n\u0026thinsp;=\u0026thinsp;16), including promoting peace, reducing chaos, fostering supportive coworker relationships, receiving recognition and appreciation from administrators, fairer and higher pay, wellness initiatives, flexible work arrangements, and support for taking personal days. Addressing time-related concerns was the second most common subtheme (n\u0026thinsp;=\u0026thinsp;13) and included needing sufficient time during the workday for task completion, organizing, collaboration, communication, and preparation, as well as reports of chronic time pressure and extended work hours that affected evenings and weekend free time. The reducing or sharing workload subtheme (n\u0026thinsp;=\u0026thinsp;10) involved desires to lighten demands on teachers and students, limit curriculum changes and new initiatives, hire additional and experienced staff, and use team-teaching models. The better support for student behaviors subtheme (n\u0026thinsp;=\u0026thinsp;10) included providing staff with effective tools for managing students\u0026rsquo; mental health and behavioral needs, consistently implementing student discipline practices, and receiving greater support from student families. The support for work breaks theme (n\u0026thinsp;=\u0026thinsp;8) reflected staff\u0026rsquo;s need for time for restroom use, eating or drinking something, movement, mental health breaks, and connection with coworkers. The least common subtheme was improving the physical work environment (n\u0026thinsp;=\u0026thinsp;3), and included better temperature control and having larger or permanent workspaces.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e here\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 2: Individual Change Solutions to Improve Well-being.\u003c/b\u003e Under this theme, more opportunities for leisure coping was the most frequently mentioned subtheme (n\u0026thinsp;=\u0026thinsp;17) and involved using activities to detach from work, restore energy, and improve mood, including hobbies, relaxation, time in nature, recreation with other educators, and socializing with family and friends. The practicing a positive outlook subtheme (n\u0026thinsp;=\u0026thinsp;8) reflected the deliberate cultivation of positive emotions, a sense of job-related accomplishment and meaning, enjoyment of workplace relationships, and the use of positive self-talk related to work.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e here\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Results\u003c/h2\u003e \u003cp\u003eA total of 167 school staff from all four elementary schools completed the workforce health needs assessment survey. Participants primarily identified as cisgender female (91%), White (74%), and non-Hispanic (85%). The mean age of participants was 40.3 years (ranging from 23\u0026ndash;64 years), the mean job tenure was 7.4 years (ranging from 0\u0026ndash;28 years), and the mean tenure in education was 13.6 years (ranging from 0\u0026ndash;36 years). Participants included 39% regular classroom teachers, followed by 19% student instructional services (e.g., special education teachers, interventionists, English as a Second Language (ESL) teachers, instructional coaches), 16% instructional aides/paraeducators, 13% student support services (e.g., school counselors, school psychologists, social workers, school nurses, etc.), 8% unified arts teachers (art, music, physical education), 1% substitute teachers, and 4% other staff (administrator, librarian or media specialist, secretary or other clerical support, coordinator/supervisor)\u003c/p\u003e \u003cp\u003eResults indicated some workplace well-being challenges and psychological risks among staff in the four schools (see Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Participants\u0026rsquo; perceived stress was the highest concern identified (78% rated stress as being high), with other mental well-being concerns including emotional exhaustion (59%), coping overload (56%), work-life conflict (53%), low work engagement (59%), job performance impact (37%), mental health status (60%), depression symptoms (39%), and anxiety symptoms (33%). Regarding psychosocial risk factors, aside from one overarching job demand, work overload (69%), all other identified concerns related to job resources. These included time scarcity (66%), as well as a lack of: proactive communication (23%), job-related communication (39%), work breaks (39%), mental health days (52%), work recognition (56%), and work autonomy (65%).\u003c/p\u003e \u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we used Photovoice, a participatory action research method based on daily photo-journaling, to assess educator health in public schools. Photovoice offers a quicker, user-friendly alternative to traditional assessment methods, particularly for workplaces or practitioners seeking to implement the \u003cem\u003eEducator Well-being Program\u003c/em\u003e independently, without specialized technical support from research experts. Results showed that work affects educators\u0026rsquo; psychological and physical well-being in various ways, largely through high job demands and limited resources; findings overlapped substantially with results from a workforce needs assessment survey. Photovoice respondents shared that they use personal self-care practices to counteract the effects of work, particularly through leisure coping and a positive outlook. Organizational and individual change solutions were identified to improve well-being, with most responses emphasizing the strong need for organizational change.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTeaching and Well-being Effects\u003c/h2\u003e \u003cp\u003eOur first research question examined how elementary public-school educators perceive the impact of work on their well-being, an important topic given that occupational effects on worker health are often overlooked (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In addition to describing well-being impacts, participants identified the work conditions that most strongly influenced their well-being and the personal resources needed to remain resilient.\u003c/p\u003e \u003cp\u003eWe identified adverse work impacts on well-being (17% of responses), including physical and psychological symptoms and work-life conflict, consistent with prior research (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). A novel finding was the perceived effect of work on health behaviors (e.g., caffeine use and physical activity), an area that has received limited attention, though recent qualitative work similarly identified teacher job stress as linked to unhealthy behaviors such as insufficient sleep, reduced physical activity, and poor diet (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants (38%) attributed diminished well-being to two key job demands, work overload and emotional demands related to student behavior, as well as to insufficient job resources, particularly lack of time, communication, and breaks from work. These findings align with research identifying workload, student behavior, time constraints, resource limitations, and administrative factors as major sources of teacher distress (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). Work role overload and intensification, widely documented among teachers internationally, occur when excessive demands hinder individuals\u0026rsquo; ability to complete their work effectively, leading to stress, burnout, and reduced performance (\u003cspan additionalcitationids=\"CR63 CR64 CR65 CR66\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). High emotional exhaustion, a central component of burnout, has prompted growing research on teachers\u0026rsquo; emotional job demands, such as frequent exposure to emotionally challenging situations, the requirement for performing emotional labor, and expectations to sustain positive interpersonal relationships (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLack of time (time scarcity) has been widely associated with teachers completing work outside of scheduled work hours (\u003cspan additionalcitationids=\"CR70\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). In this study, time was conceptualized as a lacking job resource, but one that enables task completion, breaks, and personal life, drivers of engagement and positive outcomes, consistent with the JD-R model (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Other studies alternatively conceptualize time as a demand (time pressure) which, along with workload and difficult student behavior, have been shown to have associations with teachers\u0026rsquo; stress, poor well-being, and withdrawal (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). Although fewer responses in our study mentioned other resource shortages (apart from time), recent work shows that limited time and social resources can negatively affect teachers\u0026rsquo; cognitive-behavioral functioning (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e), suggesting a need for further research on resources, particularly in socioeconomically disadvantaged schools.\u003c/p\u003e \u003cp\u003eA substantial portion of responses (45%) emphasized the need for self-care practices, particularly leisure coping and maintaining a positive outlook. Within the JD-R model, optimism is considered a personal resource linked to work engagement and well-being (\u003cspan additionalcitationids=\"CR76\" citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e), but other dimensions of a positive outlook have received limited attention within the JD-R framework. Specifically, additional positive factors identified in our findings (e.g., relationships, accomplishment, meaning) may be more fully understood through the PERMA model of positive psychology, which posits that five core elements contribute to human flourishing: positive emotions, engagement, relationships, meaning, and accomplishments (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). Although these constructs have been less frequently studied than optimism among teachers, they have been associated with higher teacher quality of life(\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e) and remain underexamined as personal resources within the JD-R model.\u003c/p\u003e \u003cp\u003eTeachers described leisure coping as essential for managing stress and restoring personal resources through detachment, relaxation, and rest (\u003cspan additionalcitationids=\"CR81\" citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). Prior research with teachers similarly shows that leisure predicts work engagement and reduced fatigue (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e), that restorative non-work experiences (especially detachment, relaxation, control, mastery, meaning, and affiliation) enhance well-being (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e), and that work-to-leisure conflict relates to poorer satisfaction and higher turnover intentions (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Leisure coping has rarely been examined as a personal resource within the JD-R model (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e), but has often been conceptualized through the effort-recovery model, which explains how regular recovery from work-related effort can prevent stress, and that insufficient recovery results in sustained biopsychosocial activation and chronic strain (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). Studies with teachers indicate that leisure supports recovery when it enables relaxation and psychological detachment from work, whereas engaging in work-related activities during nonwork time impedes recovery (\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBy highlighting personal resources that support motivation, engagement, and well-being, our findings align with the health-facilitation pathway of the JD-R model, contrasting with much of the JD-R literature, which emphasizes the health-impairment pathway whereby heavy job demands lead to burnout (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e). Our study contributes to emerging research on social and emotional self-care practices among workers facing overload and time pressure in both their work and family roles (\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e), and advances understanding of the work-life interface by showing work\u0026rsquo;s effect on other life roles that promote good health and functioning, such as the leisure role and health role (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan additionalcitationids=\"CR92 CR93\" citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). Our findings on self-care practices also demonstrate the value of qualitative methods in capturing detailed insights into teachers\u0026rsquo; lived experiences that were not accessible through our survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIndividual and Organizational Solutions\u003c/h2\u003e \u003cp\u003eOur second research question asked teachers which individual and organizational factors could be modified to improve well-being. Although leisure coping to manage work-related stress was among the most frequently suggested changes, individual-level strategies appeared in only 29% of responses and largely mirrored psychological self-care themes revealed in earlier Week 1 findings, including maintaining a positive mindset and leisure coping. This pattern suggests that individual strategies may function as compensatory responses when adequate structural supports are lacking and unhealthy work conditions feel intractable. Notably, more educators emphasized the need for leisure coping (20%) than for maintaining a positive mindset (9%), indicating a potential unmet need for recovery and insufficient opportunities to mentally detach from work. Further, while adopting a positive outlook is a cognitive shift that requires little additional time, engaging in preferred leisure activities such as reading, spending time outdoors, connecting with loved ones, and engaging in enjoyable pursuits, depend on time resources that participants described as scarce, due to excessive work hours other free time constraints. Interventions informed by leisure science may be considered to improve the feasibility and effectiveness of leisure coping (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e), alongside positive psychology approaches that promote optimism and other facilitators of well-being (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost proposed solutions (71%) involved organizational changes. Teachers frequently emphasized improving the psychosocial work environment through school policies and practices that promote a calm, well-organized setting, strengthen administrator and coworker support, provide recognition, offer wellness initiatives, support the use of work breaks and personal days, and improve employment conditions (e.g., higher salaries, flexible work arrangements). Although school climate initiatives have been widely used to improve student academic and behavioral outcomes (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e), few interventions have targeted the psychosocial climate to improve educator well-being (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e). We were not able to find any intervention study that enhances teacher well-being by improving their conditions of employment (e.g., via higher wages, expanded leave, reduced class sizes, and protected planning time), which are more commonly addressed through union bargaining and policy advocacy. Our findings showed that some proposed solutions emphasized better support for students\u0026rsquo; psychological and behavioral needs (e.g., addressing aggressive, destructive, or antisocial behaviors via mental health services, effective discipline, family support), which are well-established for improving student outcomes (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e), but have received limited attention regarding teacher well-being.\u003c/p\u003e \u003cp\u003eMost proposed solutions in our study aligned with well-being concerns previously identified with the Week 1 prompt, particularly excessive workload and time scarcity. Teachers suggested reducing or redistributing workloads and providing dedicated time for preparation, organization, and communication. Despite strong evidence linking educator workloads and time scarcity as the primary drivers of burnout and turnover, few evidence-based interventions directly address these concerns; only limited research on an individual-level mindfulness and motivation intervention, has shown a reduction in perceived time urgency (task-related hurry and general hurry) (\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, our finding regarding teachers\u0026rsquo; preferences for organizational solutions reflects the contemporary approach for protecting and promoting worker health that emphasizes organizational change (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This contrasts with most existing teacher interventions that focus on individual-level strategies such as stress-reduction, though systematic review evidence (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e) indicates that organizational initiatives such as fostering collaboration and trust, are among the most effective methods to improve educator well-being (\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePractical Significance\u003c/h2\u003e \u003cp\u003eAlthough our results align with much of the existing research on experiences and determinants of teacher well-being, this study is novel in using Photovoice to conduct a workforce health needs assessment. The first phase of the \u003cem\u003eEducator Well-being Program\u003c/em\u003e involves assessing workforce health and identifying priority concerns to guide later intervention development, implementation, and evaluation. Needs assessments are typically conducted through surveys or focus groups, which can require significant expertise, time, and resources, posing obstacles to implementation. The TTH research team piloted Photovoice as an alternative because of its potential feasibility and rapid turnaround, and these expectations were largely met. Moreover, post-project evaluations showed that over 90% of participants rated the process positively, describing the process as simple, appropriate, acceptable, and engaging, as well as fun, creative, and meaningful for self-reflection.\u003c/p\u003e \u003cp\u003eWhere prior Healthy Workplace Participatory Program studies have taken up to nine months to design and administer workforce health assessment surveys and analyze results (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), the Photovoice process was completed in six weeks, with half that time spent recruiting participants. Instead of months spent developing a survey, this health needs assessment method required only one hour for the research team to consider and select two Photovoice prompts, which participants addressed through smartphone photographs and captions. These responses allowed us to identify themes that captured key contributors to educator well-being and potential solutions. This approach may be especially useful for organizations without access to dedicated researchers or survey designers, as the qualitative analysis of photos and captions is relatively simple and easy, can be completed in a few hours, and requires minimal training. Beyond efficiency, Photovoice also served as a reflective and motivating process that helped participants better understand their shared workplace challenges and consider mobilization for change.\u003c/p\u003e \u003cp\u003ePhotovoice findings substantially overlapped with results from the health needs assessment survey conducted in the same four schools, supporting content validity. Both methods identified concerns related to psychological well-being, emotional demands, work\u0026ndash;life conflict, recovery time, recognition, workload, and time scarcity. Lack of communication emerged as a priority in the survey but appeared only minimally in Photovoice, possibly because most Photovoice participants came from one school with strong communication practices. Photovoice revealed perspectives not captured by the survey, particularly regarding the psychosocial environment, conditions of employment, and self-care behaviors, likely because the survey did not include items addressing these constructs. This highlights the value of qualitative approaches for uncovering unanticipated insights.\u003c/p\u003e \u003cp\u003eFollowing the Photovoice data analysis, study findings were shared with participants, design teams, administrators, and school staff through a handout and video summarizing themes and displaying examples of images and captions. Dissemination of results aimed to promote dialogue about strengths and concerns, build enthusiasm for well-being solutions, and inform leaders who have the power to influence working conditions (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e). The emphasis on sharing findings with administrators and school staff reflects the importance of communication and collaboration within participatory action research, which requires cooperation across various levels of influence to effectively address complex health issues (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e). Using visual images and direct quotes powerfully amplifies participants\u0026rsquo; voices, generating a vivid and persuasive account of lived experience that can drive organizational change and mobilize resources for targeted, timely well-being interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eSimilar to a daily diary approach, using daily photographs over a two-week period was a strength that may have reduced recall bias, though photos may still reflect social desirability bias. However, the short data-collection window also captured only a specific point in the school year, which may not represent experiences across the full academic school year. For example, data collection occurred around Halloween, when participants reported increased student behavioral challenges due to schedule disruptions, heightened excitement, and sugar consumption. Future Photovoice studies should carefully consider timing and concurrent events that may coincide with the data collection period, such as testing schedules, holiday or seasonal disruptions, and different periods in the school year (i.e., beginning, end) that can affect classroom dynamics.\u003c/p\u003e \u003cp\u003eThe sample included 20 participants (roughly 12% the 167 workers who participated in the survey), so findings should be interpreted cautiously and may not represent the broader population. Future research should examine optimal sample sizes for Photovoice research, although the volume of photos in our study generated suggests that manual coding may remain feasible even with larger samples. This is particularly relevant for workplaces and practitioners seeking to implement workforce health needs assessments independently, without support from subject-matter experts in research. We were able to feasibly code data by organizing photos and captions within a Word document, though similar low-tech sorting could also be done by printing materials for manual review. Future research should also explore the use of qualitative data analysis software (e.g., NVivo, ATLAS.ti) to support more efficient organization and coding of Photovoice data. Regardless of whether it is used in research or practice, or the technology used for analysis, Photovoice offers a relatively simple and timely method for gathering actionable insights in real-world settings compared with traditional assessment methods such as surveys or focus groups.\u003c/p\u003e \u003cp\u003eBecause the study used convenience sampling, caution is warranted when generalizing findings from the self-selected participants to the broader population of educators. The sample primarily consisted of white women from a wealthy northeastern U.S. state, which does not reflect educators working in more resource-limited or emotionally-demanding contexts. Future work should recruit more diverse and representative samples, including teachers of color and intersecting identities, and apply a social ecological lens to examine occupational health disparities across school districts and geographic regions (e.g., urban vs. rural). Participation also required smartphone access, which may have excluded some individuals, although 91% of U.S. adults own a smartphone (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, the Photovoice process was less participatory than intended due to time constraints, and several common Photovoice practices were not implemented. For example, educators, who are subject-matter experts in their work conditions, were not involved in developing the two prompts used to assess their well-being experiences and impacts, nor were they engaged in theme development, coding, or analysis, which may have limited interpretation and strength of findings. Participants also did not have opportunities to discuss their photos collectively or present their shared results at a report-out session with management and coworkers (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In addition, we did not co-develop with teachers an explicit dissemination plan to share their findings broadly with relevant stakeholders (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). Future Photovoice projects should fully incorporate participatory research practices, including the collaborative development of assessment questions, analysis, and strategies for disseminating results to stakeholders.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe used Photovoice, a qualitative photo-journaling method, to conduct a workforce health needs assessment, gathering public school educators\u0026rsquo; perspectives on their well-being and their ideas for improving it, to inform future workplace interventions. The method proved feasible and time-efficient for the research team and was perceived by participants as simple, acceptable, and appropriate. It effectively identified health and well-being needs, aligning with findings from existing research on educators and with results from a concurrent survey conducted in the same schools. The study affirmed that educators face substantial challenges, including excessive workloads, high emotional demands, and limited resources, that undermine well-being and interfere with personal life. At the same time, our findings offered new insights, highlighting the importance of maintaining a positive outlook and having sufficient leisure time to help educators prevent and recover from work-related stress. Participants also emphasized the need for their organizations to improve the psychosocial work environment and conditions of employment. Although individual self-care was acknowledged as necessary, participants strongly prioritized organizational-level solutions. Overall, our use of Photovoice demonstrates the value of participatory approaches to identify workforce health needs and inform targeted interventions that improve working conditions. Given the unique stressors facing educators and the growing public concern over teacher turnover, such approaches offer a timely, practical way to strengthen educator well-being and retention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoding themes for Week 1 Question: \u0026ldquo;How does your current work situation affect your mental well-being and happiness?\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodebook Description of Type of Support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) High Demands and Low Resources at Work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Work Overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel job tasks are increasing, work is piling up, they are pulled in too many directions at once, work performance is not the best/they are not accomplishing enough, feel disorganized or out of control.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Lack of Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants do not have enough time for job tasks, have to bring work home to finish it, go into work early, work late at home, have no time for breaks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Emotional Demands Related to Student Behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants care deeply about children, that children are emotionally needy, and that children\u0026rsquo;s behaviors are challenging generally. Behavioral challenges were exacerbated by changes to routine because of holiday (Halloween, hyper due to sugar intake) and seasonal change to cold temperature/snow (lack of recess, excitement/distraction).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Other Lacking Resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of clear communication at work, lack of work support in general, not having a routine work role.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Personal Self-Care Needed for Well-Being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Leisure Coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel that their work requires the use of nonwork activities to mentally detach from work, recharge, uplift mood, or prevent/reduce stress including leisure (listening to music, journaling, using humor), relaxation/decompression (calming meditation, nature sounds, exercise, being alone), connecting with nature/getting outside (fresh air, sunshine), recreation with the larger community of teachers (going to happy hour, seeing a show), social support from friends/family.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Positive Outlook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that the person feels their work requires the need to nurture their own positive outlook related to work and life, including positive feelings (joy, gratitude, contentment), a sense of accomplishment, feeling that job is meaningful/rewarding (children are safe, happy, learning, developing into good people, gaining self-esteem), enjoying relationships (with colleagues, students, parents), and using positive self-talk about work (I can do this, I love my job, some days are hard).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Well-Being Impacts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Physical Well-Being and Health Behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel physical symptoms such as tension headaches or exhaustion (tired, fatigued, no energy) or feel their health behaviors are affected, including caffeine use, alcohol use, and physical exercise.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Psychological Well-Being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel psychological symptoms such feeling stress, emotional exhaustion/overwhelmed, dreading work, or feeling anxious.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Work-Life Conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWork demands spillover into non-work time and interfere with personal needs and home responsibilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoding themes for Week 2 Question: \u0026ldquo;If you were able to change your work situation so that it provided you better mental well-being and more happiness, how would it be different from the way it is now?\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodebook Description of Type of Support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Organizational Change Solutions to Improve Well-Being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Reduce or Share Workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants want less of a workload for teachers (and students), feel curriculum changes and other things are increasing their workload, feel they are continually falling behind as workload increases, want to feel more productive, are working harder due to inexperienced (or lack of) staff, want to share their workload (by team teaching with other adults), and do not want to feel depleted by work.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Address Time-Related Concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel problems are time-related, including that the number of job tasks assigned is not achievable in the time allotted (the school day), there is no time to plan/organize, communicate/collaborate, or do class preparation, the workday is too long (starts too early when it is still dark out, ends late because they are pressured to take work home), workweek is too long (have to work weekends to get work done), and often feel rushed/have to race to get things done.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Provide and Support Work Breaks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants need more work breaks to be able to: use bathroom when needed, take a mental health break, sit down, have a drink (stay hydrated), eat a snack, have lunch or a walk with coworker-friends, go out for fresh air, or interact with other adults.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Better Support for Student Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that student behaviors are challenging or exhausting, including students having mental health needs, being aggressive/destructive, needing discipline when they break rules. It was also indicated that teachers need good tools to support students and more support from students\u0026rsquo; families.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Improve Physical Environment at Work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel the physical environment needs to be improved, such as having control over classroom temperature (i.e., functioning heaters/thermostats) or having a bigger space or permanent space to work in.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Improve Psychosocial Environment at Work (In and Outside of Work)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel the psychosocial environment needs to be improved, such as creating peace/lessening chaos, uplifting the spirits of coworker-friends (giving a card or gift), getting feedback or recognition from principal about work performance, paying teachers a better/fairer salary, or offering workplace wellness initiatives (dog therapy). To support work-life balance, offering flexible arrangements (e.g., working from home) and admin/coworkers being supportive of staff taking their personal days.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Individual Change Solutions to Improve Well-Being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Do More Leisure Coping Activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that participants feel it would be helpful to have more opportunity for non-work activities to mentally detach from work, recharge, uplift mood, or prevent/reduce stress including leisure (listening to music, journaling, using humor), relaxation/decompression (calming meditation, nature sounds, exercise, being alone,), connecting with nature/getting outside (fresh air, sunshine), recreation with the larger community of teachers (happy hour, seeing a show), social support from friends/family.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Practice Having a Positive Outlook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny indication that the person is feels it is beneficial to practice having a positive outlook related to work and life, including positive feelings (joy, gratitude, contentment), a sense of accomplishment, feeling that job is meaningful/rewarding (children are safe, happy, learning, developing into good people, gaining self-esteem), enjoying relationships (with colleagues, students, parents), using self-compassion/affirmations and positive self-talk about work (I can do this, I love my job, some days are hard).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMeasures in 2023 Educator Workforce Health Needs Assessment Survey\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct and Measure\u0026rsquo;s Source\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat Measure Assesses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e# of items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeasure\u0026rsquo;s Likert Scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHow High Score Was Calculated\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePsychosocial Risk Factors at Work\u003c/em\u003e:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Overload * (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsked to do excessive amount of work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly agree\u003c/em\u003e) to 4 (\u003cem\u003estrongly disagree\u003c/em\u003e) scale was used to rate the item: \u0026ldquo;I am not asked to do an excessive amount of work\u0026rdquo;. Higher scores indicate greater work overload.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003esomewhat disagree\u003c/em\u003e) and 4 (\u003cem\u003estrongly disagree\u003c/em\u003e) collapsed into one \"somewhat to strongly disagree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Scarcity * (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not have enough time to get job done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly agree\u003c/em\u003e) to 4 (\u003cem\u003estrongly disagree\u003c/em\u003e) scale was used to rate the item: \u0026ldquo;I have enough time to get my job done.\u0026rdquo; Higher scores indicate greater time scarcity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003esomewhat disagree\u003c/em\u003e) and 4 (\u003cem\u003estrongly disagree\u003c/em\u003e) collapsed into one \"somewhat to strongly disagree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProactive Communication (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceive advanced information of decisions, plans, changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003eto a very small extent\u003c/em\u003e) to 4 (\u003cem\u003eto a very large extent\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003eto a large extent\u003c/em\u003e) and 4 (\u003cem\u003eto a very large extent\u003c/em\u003e) collapsed into one \"large or very large extent\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob-related Communication (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceive needed information to do their job well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003eto a very small extent\u003c/em\u003e) to 4 (\u003cem\u003eto a very large extent\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003eto a large extent\u003c/em\u003e) and 4 (\u003cem\u003eto a very large extent\u003c/em\u003e) collapsed into one \"large or very large extent\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Breaks (original TTH-created item)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAble to use restroom when needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003enever\u003c/em\u003e) to 5 (\u003cem\u003ealways\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 4 (\u003cem\u003eoften\u003c/em\u003e) and 5 (\u003cem\u003ealways\u003c/em\u003e) collapsed into one \"often or always\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Days (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeel supported to use sick days for mental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 4 (\u003cem\u003estrongly agree\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003eagree\u003c/em\u003e) and 4 (\u003cem\u003estrongly agree)\u003c/em\u003e collapsed into one \"agree or strongly agree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Autonomy * (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave input about what happens related to their job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 4 (\u003cem\u003estrongly agree\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003esomewhat agree\u003c/em\u003e) and 4 (\u003cem\u003estrongly agree\u003c/em\u003e) collapsed into one \"somewhat to strongly agree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Recognition (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceive recognition for doing a good job at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 5 (\u003cem\u003estrongly agree\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 4 (\u003cem\u003eagree\u003c/em\u003e) and 5 (\u003cem\u003estrongly agree)\u003c/em\u003e collapsed into one \"agree or strongly agree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychological Well-being Outcomes\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Stress (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAppraise life events as unpredictable, uncontrollable, overwhelming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003enever\u003c/em\u003e) to 4 (\u003cem\u003every often\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCut score of 14 used; summative scores\u0026thinsp;\u0026ge;\u0026thinsp;14 indicate moderate to high stress.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Status (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRate their overall mental health as high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003epoor\u003c/em\u003e) to 5 (\u003cem\u003eexcellent\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 3 (\u003cem\u003egood\u003c/em\u003e) to 5 (\u003cem\u003eexcellent\u003c/em\u003e) collapsed into one \"good to excellent\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression Symptoms (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReport high clinical symptoms of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003erarely or none of the time\u003c/em\u003e) to 3 (\u003cem\u003eall of the time\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCut score of 10 used; summative scores\u0026thinsp;\u0026ge;\u0026thinsp;10 indicate high depression symptoms.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety Symptoms (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReport high clinical symptoms of anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003enot at all\u003c/em\u003e) to 3 (\u003cem\u003enearly every day)\u003c/em\u003e and 1 (\u003cem\u003enot difficult at all\u003c/em\u003e) to 4 (\u003cem\u003eextremely difficult\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCut score of 8 used; summative scores\u0026thinsp;\u0026ge;\u0026thinsp;10 indicate high anxiety symptoms.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWork-related Well-being Outcomes\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Exhaustion (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeel depleted emotionally from work, related to burnout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003enever\u003c/em\u003e) to 6 (\u003cem\u003eevery day\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCut score of 27 used; summative scores\u0026thinsp;\u0026ge;\u0026thinsp;27 indicate high exhaustion.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Engagement (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeel like going to work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (\u003cem\u003enever\u003c/em\u003e) to 6 (\u003cem\u003ealways\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 4 (\u003cem\u003eoften\u003c/em\u003e) to 6 (\u003cem\u003ealways\u003c/em\u003e) collapsed into one \"often to always\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoping Overload (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperience work stress exceeding coping ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStress item: 0 (\u003cem\u003enot stressful\u003c/em\u003e) to 10 (\u003cem\u003every stressful\u003c/em\u003e). Coping item: 0 (\u003cem\u003enot well\u003c/em\u003e) to 10 (\u003cem\u003every well\u003c/em\u003e).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDifference scores calculated by subtracting stress score from coping score. Negative values indicate stress exceeding coping ability and were used to classify high coping overload.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformance Impact (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeel workload interferes with work quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003enever\u003c/em\u003e) to 5 (\u003cem\u003ealways\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 4 (\u003cem\u003eusually\u003c/em\u003e) and 5 (\u003cem\u003ealways\u003c/em\u003e) collapsed into one \"usually or always\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork-Life Conflict (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeave home responsibilities undone due to job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 5 (\u003cem\u003estrongly agree\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatings of 4 (\u003cem\u003eagree\u003c/em\u003e) and 5 (\u003cem\u003estrongly agree\u003c/em\u003e) collapsed into one \"agree or strongly agree\" category.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Adapted from Original Measure\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of Themes and Subthemes from Responses to Week 1 Question Across 100 Photos with Captions\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Theme: Sub-Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreq\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal Self-care: Positive outlook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Demands \u0026amp; Low Resources: Work overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal Self-care: Leisure coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Demands \u0026amp; Low Resources: Lack of time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell-being Impacts: Physical well-being \u0026amp; health behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Demands \u0026amp; Low Resources: Emotional demands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell-being Impacts: Psychological well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell-being Impacts: Work-life conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Demands \u0026amp; Low Resources: Other lacking resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of Themes and Subthemes from Responses to Week 2 Question Across 85 Photos with Captions\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Theme: Sub-Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreq\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual Change: Do more leisure coping activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Improve psychosocial environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Address time-related concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Reduce or share workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Better support for student needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Provide and support work breaks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual Change: Practice having a positive outlook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Change: Improve physical environment at work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eFindings from 2023 Workforce Health Needs Assessment Survey\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreq (%)\u003c/p\u003e \u003cp\u003eof \u0026ldquo;High\u0026rdquo; Rating\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevel of\u003c/p\u003e \u003cp\u003eConcern\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery High\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProactive Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery High\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Scarcity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob-related Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Breaks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoping Overload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork-Life Conflict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Recognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformance Impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Autonomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote. Data from 167 survey participants at four schools.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVariables listed from highest to lowest level of concern. (Very High\u0026thinsp;=\u0026thinsp;\u0026ge;\u0026thinsp;75% unfavorable responses, High\u0026thinsp;=\u0026thinsp;50\u0026ndash;74% unfavorable responses; Moderate\u0026thinsp;=\u0026thinsp;25\u0026ndash;49% unfavorable responses).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe gratefully acknowledge assistance with data collection efforts received from participating Connecticut schools in two school districts. We particularly appreciate the assistance of the project champions, principals and educator design team members \u0026nbsp;in recruiting participants for Photovoice and survey data collection. The authors would also like to thank the \u0026nbsp;educators, staff, and administrators who participated in our study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eDedication:\u003c/strong\u003e This paper is dedicated to the memory of Dr. Lisa M. H. Sanetti, an inspiring colleague and dear friend, whose vision and commitment to educator well-being paved the way for the Total Teacher Health project.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e: This publication was supported by Grant Number U19 OH012299 from the U.S. National Institute for Occupational Safety and Health (NIOSH). \u0026nbsp;Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. \u0026nbsp; \u0026nbsp;\u003cem\u003eTotal Worker Health\u003c/em\u003e\u003csup\u003e\u0026reg;\u003c/sup\u003e is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by CPH-NEW does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or NIOSH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConflicts of interest/Competing interests:\u003c/strong\u003e\u0026nbsp; The authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval and c\u003c/strong\u003e\u003cstrong\u003eonsent to participate:\u0026nbsp;\u003c/strong\u003eAll procedures were reviewed and approved by the Institutional Review Board of the University of Connecticut Health Center. \u0026nbsp;The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained by all study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCode availability:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/strong\u003eThe code that supports the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: \u0026nbsp;AD, JC, ST, and MM contributed to the study conception and design, and operationalization of methods. \u0026nbsp;AD, ST, MM, NC, LM and AH contributed to data analysis. \u0026nbsp;All authors helped to interpret results. The first full draft of the manuscript was written by LM and AD, and JC commented on several versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eObtained\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSteiner ED, Woo A. Job-related stress threatens the teacher supply: Key findings from the 2021 state of the U.S. teacher survey. Rand Corporation. 2021;25(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCavallari JM, Trudel SM, Charamut NR, Miskovsky MN, Brennan M, Hiner AJ, Gore RJ, Sanetti LM, Dugan AG. Psychological well-being of U.S. educators remains a post‐pandemic concern: findings from a cross‐sectional study. Am J Ind Med. 2025;68(7):642\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaydon T, Leko MM, Stevens D. 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(2025). \u003cem\u003eTech Adoption Trends: Mobile Fact Sheet.\u003c/em\u003e Retrieved Jan 31, 2026, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pewresearch.org/internet/fact-sheet/mobile/?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.pewresearch.org/internet/fact-sheet/mobile/?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarpenter D, Nieva V, Albaghal T, Sorra J. Development of a planning tool to guide research dissemination. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools, and Products) Rockville (MD). Agency for Healthcare Research and Quality (US); 2005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDugan AG, Punnett L. Dissemination and implementation research for occupational safety and health. Occup Health Sci. 2017;1(1\u0026ndash;2):29\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"educators, schools, health needs assessment, Photovoice, qualitative methods, participatory research methods, Total Worker Health®","lastPublishedDoi":"10.21203/rs.3.rs-8961242/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8961242/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEducators are an at-risk occupational group with high demands and limited resources that drive strain, resulting in mental well-being challenges and high turnover. The Total Teacher Health project develops participatory workplace initiatives to support well-being, emphasizing organizational responsibility for worker health. This study evaluated Photovoice as a feasible and rapid workforce needs assessment method to inform health initiatives. We compared findings with those from a traditional survey.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn 2023, we recruited educators and staff from four public elementary schools in the northeastern U.S. Over two weeks, participants responded to weekly prompts using smartphone photographs and captions. Prompts asked participants (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) how work affected well-being and happiness and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) how work could be changed to better support well-being. Participants submitted five photos with captions each week. Qualitative data were analyzed using inductive thematic analysis. A cross-sectional survey was administered in the same schools using standardized measures of psychosocial risk factors and well-being outcomes; responses were dichotomized to identify high-concern priorities.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants (N\u0026thinsp;=\u0026thinsp;20) were female and White, with a mean age of 39 years. Eighteen participants submitted 100 photos in Week 1 and 85 in Week 2; inter-coder agreement was substantial. Week 1 themes reflected job demands and resources, the need for personal self-care, and well-being impacts. Week 2 emphasized organizational change solutions (improving psychosocial climate and recognition, addressing time pressures, reducing workloads, strengthening student support, providing work breaks) over individual solutions. Survey respondents (N\u0026thinsp;=\u0026thinsp;167) reported similar concerns with job demands such as work overload, lacking resources (time, breaks, autonomy, recognition), and psychological well-being impacts. This suggested convergence between Photovoice and survey methods.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePhotovoice was feasible and time-efficient as a workforce health needs assessment, producing actionable priorities more rapidly than conventional approaches. Findings reinforce that psychological well-being is a concern primarily shaped by imbalances between high demands and limited resources. Most solutions targeted organizational change, though individual self-care practices (leisure coping, positive mindset) were helpful and may have been viewed as necessary to offset unhealthy, intractable system-level conditions. Overall, results support Photovoice as a practical assessment method to inform organizational interventions aimed at improving educator well-being and retention.\u003c/p\u003e","manuscriptTitle":"Using Photovoice to Conduct an Educator Health Needs Assessment: An Accessible Tool to Inform Participatory Organizational Interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 08:59:42","doi":"10.21203/rs.3.rs-8961242/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f0ee03b-d2a6-40ee-a1c0-4607fcaf2c2c","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-13T07:35:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T06:17:35+00:00","index":53,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T07:44:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 08:59:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8961242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8961242","identity":"rs-8961242","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}