Objectives: To understand the influences associated with durability and diffusion of benefits of a fire service wellness program.
Methods: Qualitative assessment of group interviews.
Results: Five years following a controlled worksite wellness trial, behavioral improvements were durable and had diffused to control participants. These findings were associated with firefighters' team orientation, enacted healthy norms and competitiveness regarding the results of annual health assessments. The original intervention trial appeared to initiate individual change that coalesced into group effects. Secondary influences included increasing public awareness about health, newly hired younger firefighters, and a modicum of administrative support. Culture shift was achieved at the workplace.
Conclusions: Although the fire service is a unique occupation, these findings suggest general strategies to achieve durable positive health change in other occupational settings.