Resiliency in Firefighters: Using Photovoice to Identify Protective Factors

Main Article Content

Rebecca A. Stout Karen L. Shafer


Due to high levels of occupational hazards, firefighters are prone to psychological maladaptation, ranging from PTSD to burnout. However, it is not well understood why some firefighters persist in their careers while others choose to leave. In this qualitative study, photovoice as a form of digital storytelling was used to understand the factors of resiliency that may contribute to career persistence. Firefighters (n = 7) in a large, suburban fire department in Colorado contributed photographs and discussed the importance of their chosen photographs through individual, in-depth interviews. Using the theoretical lens of the resiliency portfolio model consisting of self-regulation, interpersonal relationships, and meaning making, analysis revealed subthemes that demonstrated firefighters’ capacity for resiliency. Within self-regulation, three subthemes emerged: adrenaline activities, alcohol, and positive coping. Within interpersonal relationships, two subthemes emerged: work-family and mentoring. Within meaning making, three subthemes became apparent: helping others, legacy, and fatalism. Recommendations for fire departments to enhance the dimensions of resilience are made based on the emergent themes with an emphasis on positive coping skills and mentoring.

Keywords: Firefighters, fire service, resilience, psychological maladaptation, resilience portfolio model, interpersonal relationships, meaning-making, self-regulation

Article Details

How to Cite
STOUT, Rebecca A.; SHAFER, Karen L.. Resiliency in Firefighters: Using Photovoice to Identify Protective Factors. Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 23 feb. 2024. doi:
Research Articles


1. Dyal M-AA, Smith TD, DeJoy DM, Moore BA. Occupational stress and burnout in the fire service: Examining the complex role and impact of sleep health. Behavior Modification. 2021;46(2):374-394. doi:10.1177/01454455211040049
2. Jo I, Lee S, Sung G, et al. Relationship between burnout and PTSD symptoms in firefighters: The moderating effects of a sense of calling to firefighting. International Archives of Occupational and Environmental Health. 2017;91(1):117-123. doi:10.1007/s00420-017-1263-6
3. Smith TD, Hughes K, DeJoy DM, Dyal M-A. Assessment of relationships between work stress, work-family conflict, Burnout and Firefighter Safety Behavior Outcomes. Safety Science. 2018;103:287-292. doi:10.1016/j.ssci.2017.12.005
4. Smith TD, Mullins-Jaime C, Dyal M-A, DeJoy DM. Stress, Burnout and diminished safety behaviors: An argument for total worker health® approaches in the fire service. Journal of Safety Research. 2020;75:189-195. doi:10.1016/j.jsr.2020.09.010
5. Stout, RA, Kostamo, S, West, S. Burnout, compassion fatigue, and vicarious trauma among wildfire responders. Journal of Emergency Management. 2021;19(5):451-460. doi:10.5055/jem.0653
6. Cocker FM, Joss N. Compassion fatigue among healthcare, emergency and Community Service Workers: A systematic review. PsycEXTRA Dataset. 2017. doi:10.1037/e510112017-001
7. Dane BO. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (psychosocial stress series no. 23) edited by Charles F. Figley. New York: Brunner/Mazel, 1995. 268 pp. $37.95 hardback, ISBN 0-87630-759-4. Social Work. 1997;42(2):207-207. doi:10.1093/sw/42.2.207-a
8. Kim R, Ha JH, Jue J. The moderating effect of compassion fatigue in the relationship between firefighters’ burnout and risk factors in working environment. Journal of Risk Research. 2020;23(11):1491-1503. doi:10.1080/13669877.2020.1738529
9. Stout, RA & Kostamo, SM. Firefighters’ experiences with burnout, compassion fatigue, and vicarious trauma: A photovoice project. Journal of Ethnographic & Qualitative Research. 2021;16(1):35–50.
10. Firefighter deaths by cause and nature of injury. NFPA statistics - Firefighter deaths by cause and nature of injury. Accessed February 23, 2023.
11. Leiter, MP & Maslach, C. Six areas of worklife: A model of the organizational context of burnout. Journal of Health and Human Services Administration. 1999;21(4):472-89.
12. Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-111. doi:10.1002/wps.20311
13. Wooding, C, Cormier, ML, Bernstein, M, & Zizzi, S. An exploration of the factors that influence West Virginia firefighters’ health behaviors. Journal of Ethnographic & Qualitative Research. 2018;13(2):134–154.
14. Koopmans, E, Wagner, SL, Schmidt, G, & Harder, H. Emergency response services suicide: A crisis in Canada? Journal of Loss & Trauma. 2017;22(7):527–539.
15. Park, H, Kim, JI, Min, B, Oh, S, & Kim, JH. Prevalence and correlates of suicidal ideation in Korean firefighters: A nationwide study. BMC Psychiatry. 2019;19.
16. Harvey, SB, Milligan-Saville, JS, Paterson, HM, Harkness, EL, Marsh, AM, Dobson, M, Kemp, R, Bryant, RA. The mental health of fire-fighters: An examination of the impact of repeated trauma exposure. Australian & New Zealand Journal of Psychiatry. 2016;50(7):649–658.
17. Baranowsky, AB, Gentry, JE. Compassion satisfaction manual. (1999). Psych Ink.
18. Gulliver, SB, Zimering, R, Knight, J, Morissette, S, Kamholz, B, Meyer, E, Keane, T, Pennington, M, Denman, T, Carpenter, T, Kimbrel, N. Tobacco and alcohol use among firefighters during their first 3 years of service. Psychology of Addictive Behaviors. 2018;32(3):255–263.
19. Haddock, CK, Day, RS, Poston, WSC, Jahnke, SA, & Jitnarin, N. Alcohol use and caloric intake from alcohol in a national cohort of U.S. career firefighters. Journal of Studies on Alcohol and Drugs. 2015;76(3):360-366.
20. Lebeaut A, Tran JK, Vujanovic AA. Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity. Addictive Behaviors. 2020;106:106353. doi:10.1016/j.addbeh.2020.106353
21. Grych J, Hamby S, Banyard V. The resilience portfolio model: Understanding healthy adaptation in victims of violence. Psychology of Violence. 2015;5(4):343-354. doi:10.1037/a0039671
22. Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology. 2007;92(6):1087-1101. doi:10.1037/0022-3514.92.6.1087
23. Hamby S, Grych J, Banyard V. Resilience portfolios and poly-strengths: Identifying protective factors associated with thriving after adversity. Psychology of Violence. 2018;8(2):172-183. doi:10.1037/vio0000135
24. Strack RW, Orsini MM, Ewald DR. Revisiting the roots and aims of Photovoice. Health Promotion Practice. 2022;23(2):221-229. doi:10.1177/15248399211061710
25. Liebenberg L. Photovoice and being intentional about empowerment. Health Promotion Practice. 2022;23(2):267-273. doi:10.1177/15248399211062902
26. Nykiforuk CIJ, Vallianatos H, Nieuwendyk LM. Photovoice as a method for revealing community perceptions of the built and Social Environment. International Journal of Qualitative Methods. 2011;10(2):103-124. doi:10.1177/160940691101000201
27. About photovoice - ethical photography for Social Change. PhotoVoice. Published July 19, 2022. Accessed February 23, 2023.
28. Musoke D, Ssemugabo C, Ndejjo R, Molyneux S, Ekirapa-Kiracho E. Ethical practice in my work: Community health workers’ perspectives using photovoice in Wakiso District, Uganda. BMC Medical Ethics. 2020;21(1). doi:10.1186/s12910-020-00505-2
29. Gaboardi M, Santinello M, Disperati F, et al. Working with people experiencing homelessness in Europe. Human Service Organizations: Management, Leadership and Governance. 2022;46(4):324-345. doi:10.1080/23303131.2022.2050330
30. Lindow P, Yen IH, Xiao M, Leung CW. “You run out of hope”: an exploration of low-income parents’ experiences with food insecurity using Photovoice. Public Health Nutrition. 2022;25(4):987-993. doi:10.1017/S1368980021002743
31. Martinez-Vargas C, Walker M, Mkwananzi F. Access to higher education in South Africa: Expanding capabilities in and through an undergraduate photovoice project. Educational Action Research. 2019;28(3):427-442. doi:10.1080/09650792.2019.1612767
32. O’Donovan J, Namanda AS, Hamala R, Winters N, Bhutta MF. Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by Community Health Workers: A photovoice study in Mukono District, Uganda. International Journal for Equity in Health. 2020;19(1). doi:10.1186/s12939-020-01158-8
33. Shumba TW, Moodley I. Part 1: A review of using photovoice as a disability research method: Implications for eliciting the experiences of persons with disabilities on the Community Based Rehabilitation Programme in Namibia. African Journal of Disability. 2018;7. doi:10.4102/ajod.v7i0.418
34. Wang C, Burris MA. Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior. 1997;24(3):369-387. doi:10.1177/109019819702400309
35. Miller T. Telling the difficult things: Creating spaces for disclosure, Rapport and ‘collusion’ in qualitative interviews. Women's Studies International Forum. 2017;61:81-86. doi:10.1016/j.wsif.2016.07.005
36. The Life Paths Research Center. Published October 21, 2022. Accessed February 10, 2023.
37. Hamby S, Grych, J, Banyard, VL. Life paths measurement packet: Finalized scales. Life Paths Measurement Packet: Finalized Scales. Published 2015. Accessed February 10, 2023.
38. Deterding NM, Waters MC. Flexible coding of in-depth interviews: A twenty-first-century approach. Sociological Methods & Research. 2018;50(2):708-739. doi:10.1177/0049124118799377
39. Coleman P. Validity and reliability within qualitative research in the caring sciences. International Journal of Caring Sciences. 2021;14(3):2041-2045.
40. Johnson, RB. Examining the validity structure of qualitative research. Education. 1997;118(2):282-292.
41. Guion, LA, Diehl, DC, McDonald D. Triangulation: Establishing the validity of qualitative studies. University of Florida Extension, Institute of Food and Agricultural Sciences.
42. Malterud K. Qualitative research: Standards, challenges, and guidelines. The Lancet. 2001;358(9280):483-488. doi:10.1016/s0140-6736(01)05627-6
43. Rheinhardt, A, Kreiner, G, Gioia, D, Corley, K. Conducting and publishing rigorous qualitative research. In C. Cassell, A. L. Cunliffe, & G. Grandy (Eds.), The SAGE Handbook of Qualitative Business and Management Research Methods 2018. (pp. 515-531). SAGE. https://doi. Org/10.4135/9781526430212
44. Guest, G, MacQueen, KM, Namey, EE. Validity and reliability (credibility and dependability) in qualitative research and data analysis. Applied Thematic Analysis. 2012:79-106. SAGE.
45. Fusch P, Fusch GE, Ness LR. Denzin’s Paradigm Shift: Revisiting triangulation in qualitative research. Journal of Social Change. 2018;10(1). doi:10.5590/josc.2018.10.1.02
46. Quintão C, Andrade P, Almeida F. How to improve the validity and reliability of a case study approach? Journal of Interdisciplinary Studies in Education. 2020;9(2):273-284. doi:10.32674/jise.v9i2.2026
47. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: Exploring its conceptualization and Operationalization. Quality & Quantity. 2017;52(4):1893-1907. doi:10.1007/s11135-017-0574-8
48. Yule K, Houston J, Grych J. Resilience in children exposed to violence: A meta-analysis of protective factors across ecological contexts. Clinical Child and Family Psychology Review. 2019;22(3):406-431. doi:10.1007/s10567-019-00293-1
49. Garber J, Braafladt N, Zeman J. The regulation of SAD affect: An information-processing perspective. The Development of Emotion Regulation and Dysregulation. 1991:208-240. doi:10.1017/cbo9780511663963.011
50. Griffin JD, Sun IY. Do work-family conflict and resiliency mediate police stress and burnout: A study of state police officers. American Journal of Criminal Justice. 2018;43(2):354-370. doi:10.1007/s12103-017-9401-y
51. Anasori E, Kucukergin KG, Soliman M, Tulucu F, Altinay L. How can the subjective well-being of nurses be predicted? Understanding the mediating effect of psychological distress, psychological resilience and emotional exhaustion. Journal of Service Theory and Practice. 2022;32(6):762-780. doi:10.1108/JSTP-01-2022-0008
52. Huaman N, Morales-García WC, Castillo-Blanco R, et al. An explanatory model of work-family conflict and resilience as predictors of job satisfaction in nurses: The mediating role of work engagement and communication skills. Journal of Primary Care & Community Health. January 2023:1-11. doi:10.1177/21501319231151380
53. McIlveen P, Perera HN, Baguley M, et al. Impact of teachers’ career adaptability and family on professional learning. Asia-Pacific Journal of Teacher Education. 2019;47(2):103-117. doi:10.1080/1359866X.2018.1444141
54. Cox, M, Norris, D, Cramm, H et al. Public safety personnel family resilience: A narrative review. International Journal of Environmental Research and Public Health. 2022;19(5224):5224. doi:10.3390/ijerph19095224
55. Wu T-J, Yuan K-S, Yen DC, Xu T. Building up resources in the relationship between work–family conflict and burnout among firefighters: Moderators of guanxi and emotion regulation strategies. European Journal of Work and Organizational Psychology. 2019;28(3):430-441. doi:10.1080/1359432X.2019.1596081
56. Maynard-Patrick S, Baugh SG. The role of felt obligation to mentor in mentor performance : An exploration of generalized reciprocity in mentoring. Career Development International. 2019;24(7):619-635. doi:10.1108/CDI-11-2018-0286
57. Dunlap S. Frametown: Addressing declining volunteerism through empowering female engagement. Fire. 2020;3(3):27. doi:10.3390/fire3030027
58. Eriksen C, Waitt G, Wilkinson C. Gendered Dynamics of wildland firefighting in Australia. Society & Natural Resources. 2016;29(11):1296-1310. doi:10.1080/08941920.2016.1171938
59. Blaney LMC, Wilde D, Hill R. Transcending adversity: Resilience in volunteer firefighters. International Journal of Emergency Services. 2020;10(2):161-176. doi:10.1108/ijes-10-2019-0055
60. Ho SM, Lo RS. Dispositional hope as a protective factor among medical emergency professionals: A preliminary investigation. Traumatology. 2011;17(4):3-9. doi:10.1177/1534765611426786
61. Ricciardelli R, Carleton RN, Groll D, Cramm H. Qualitatively unpacking Canadian public safety personnel experiences of trauma and their well-being. Canadian Journal of Criminology and Criminal Justice. 2018;60(4):566-577. doi:10.3138/cjccj.2017-0053.r2
62. Smith, LE, Serfioti, D, Weston, D, Greenberg, N, & Rubin, GJ. Adherence to protective measures among healthcare workers in the UK: A cross-sectional study. Emergency Medicine Journal: EMJ. 2022;39(2):100-105. doi: