Developing a Firefighter Occupational Health Questionnaire Using Focus Groups: The FORWARD study

Background and Objective: Firefighters (FF) are frequently obese and are at high risk for CVD. Few validated instruments are available that assess the unique working conditions and health behaviors of firefighters who work on a 24 hr-shift system. Our goal was to develop an occupational health questionnaire informed by focus groups of FF's for use in a study of obesity among firefighters. Methods: The research team prepared an “initial questionnaire” for FF's including domains and items about working conditions informed by a literature review and used in a preliminary web-survey. Four focus groups (2 of firefighters and engineers, 1 of captains, and 1 of battalion chiefs) were conducted.. The FF's were asked to review the domains and items in the “initial questionnaire” in terms of relevance to their work experiences, clarity of wording, and missing domains or questionnaire items. Results: 21 firefighters participated in the focus groups. Across the focus groups, five domains appeared to be most relevant: workload (e.g., # of shifts), job demands, quality of leadership, sleep problems, and eating culture at work and two domains appeared to be least relevant: reward and discrimination/harassment. Focus group members pointed out that the wording of several items was unclear and alternative wording was suggested (e.g., substitute “company” for “group”). Conclusion: The focus groups pointed to the possibility of significant differences in the interpretation of items among groups particularly by job title. Focus groups proved to be a very effective method for developing a firefighter occupational health questionnaire.