World Voice Day in news : analysis of reports on the Voice Campaign in Brazil

Purpose: To analyze the television reports on the World Voice Day transmitted by Globo TV. Method: We researched television reports broadcasted by Globo Network in regional television news programs from March 15 to April 20, 2013. For the data analysis, the Document Analysis technique was used. The analyzed variables were the following: location, broadcasting period, duration, interviewed professional, mention of multiprofessional work, orientation to the population, and the interview approach (health promotion or disease prevention). Through statistical analysis, the interview approach was considered the outcome and associated with the other variables. Results: On the regions where there are news programs for the researched TV station, the majority made reports about the Voice Campaign. Among these, we discovered that the five regions of Brazil were contemplated, in the morning/afternoon periods, with medium duration of 5.3 minutes. The presence of the speech-language pathologist was observed in greater numbers of the interviews, as also the emphasis on the importance of a multiprofessional work. Regarding the content presented, the interviewees focused on diseases caused by habits that impair the voice, with orientation to the public about what negatively interferes in the vocal well-being. Conclusion: The approach of the interviews was not, in the majority of times, of the same nature (promoting the vocal well-being or preventing voice disorder), and the interprofessional practice is still seen less frequently as a possible work strategy.


INTRODUCTION
The health-related campaigns arrived in Brazil in the late 1910s (1) , in order to inform about health issues that were accessible and could affect a large number of people.In this context, the health officials began to have an alternative to the authoritarian health actions of that time, based on the imposition of compulsory measures.The campaigns become, thus, known as actions aimed at encouraging self-care and preventing diseases that affect a specific group of the population (2) .
Such campaigns started to be seen as transforming processes (3) , able to create opportunities for actions that allow the individual to have a conscious learning, without the intention of controlling his or her life (4) .In this sense, the concepts involved in the preparation of health education actions that are part of the construction of this process of educating are the health promotion and disease prevention.
The health promotion actions in Brazil are very diversified (5) and can cover a single health problem or be linked to the social determinants of health; they can also mobilize only one or more courses of action proposed in the Ottawa Charter, for example, the creation of healthy public policies.The concept of health promotion involves the idea of strengthening the individual and collective capacity to deal with the multiplicity of health conditions (6) , encompassing joint and intersectoral actions that may address various dimensions of the social life of the individuals (5) .
The disease prevention, in its classic definition, is explained as a behavior that has as an immediate goal the nonoccurrence of the disease process, through the interference in the host-agent interaction in the predisposing factors for health disorders (7) .Thus, the prevention seeks to show the individuals that certain diseases can be avoided.
The strategies of health promotion and disease prevention are present in the organized campaigns.The health promotion, as an example of action, can be carried out in the kindergarten by covering different topics, starting with the care as an element of health promotion, formation of hygienic habits based on the education, and even the establishment of a link between health professionals and students (8) .Concerning disease prevention, there are numerous examples to mention, such as the vaccination campaign, introduced in Brazil in 1962 (9) (the first National Campaign Against Smallpox) and "Fashion Targets Breast Cancer" started in 1994 in the United States (10) and in 1995 in Brazil.
Among the themes that stand out in Speech-Language Pathology and Audiology, there is the Voice Campaign as the necessarily educational intervention, with greater population reach, greater media coverage, and involvement of the professionals of the field.
With few records about its history, it is possible to say that the Voice Campaign had its grand and first action in 1999.It was created due to the high rate of laryngeal cancer at the time, which affected more than 15,000 Brazilians a year.This year, more than 40,000 treatments were conducted in different Brazilian states (11) .
In a research carried out in the national journals data platform about the topic Voice Campaigns, there is a record of only one article published in 2002 with the purpose to analyze the news in large circulation newspapers (12) .The authors emphasized the relevance given by the press coverage to the topic in the social and political context of Brazil at the time.
Relying on the inspiration of this study, the aim of this research was to understand the importance given by the television media to the Voice Campaign, the direction of the coverage, and the approach attributed by the interviewees to this campaign.The proposed course was constructed in an attempt to contribute to the knowledge of the advances in the scope of health information, in a perspective that favors health promotion, and is not restricted only to the disease prevention.
The Media Workstation, a tool used in free-to-air TV audience analysis (13) , points out that, among the free-to-air TV stations, Globo ® Network is considered to be the most watched, particularly regarding television journalism (13) , and represents an almost hegemonic insertion, occupying 65% Brazilian homes (Ibope Media Workstation PNT*2013).
In Brazil, a country marked by social inequality, television news programs have an important role to inform the population.The public, this way, turns out to be the one that, while watching, also guides the news stories with its needs (14) .The Globo ® Network systematizes its television journalism in three periods (morning, afternoon, and evening) and within those there is a local television news program, with news directed to the region where it is aired.
Thus, the purpose of this research was to analyze TV reports on the World Voice Day transmitted by Globo ® TV.

METHODS
Among the programs featured by Globo ® Network, we delimited the regional/ local TV news programs that had the Voice Campaign as one of their themes.Considering this criterion, the period established for the analysis was the one in which the reports were aired, that is, from March 15 to April 20, 2013.
The search for the corpus of this research was performed by consulting the official website of the network and the pages of the local news programs, organized in 45 locations, corresponding, thus, to 45 sites.To select the reports that addressed the Voice Campaign, we used the search engine of the websites of the regional TV news programs using the keyword "voice."We considered as a report on this subject any type of mention or journalistic piece aired in the regional TV news programs, within the established period, which had as a theme the Voice Campaign.The data were taken from public domain basis.
For the analysis of this material, the Document Analysis technique was initially used, associating the findings with the current literature on the subject.The documentary approach in this study had as an objective to describe the contents of the documents, in order to ensure the analysis of the information contained in them and allow their exchange, dissemination, and later use, according to the recommendations of the literature on this method (15) .
To analyze the reports, we adopted the selection and the organization techniques based on the literature on the topic Voice Campaign, with the criterion of critical analysis of the document, consisting of description, survey of recurrent issues, pointing out the emerging core, interpretation, and inference (16) .At the end of this process, the variables observed in the analyzed material were the following: regional location where the reports were made (North, Northeast, South, Southeast, and Midwest), broadcasting period (morning, afternoon, and evening), duration (in minutes) of the reports, interviewed professional, mention of multiprofessional work, association between interviewed professional and multiprofessional indication, orientation given by the professionals that participated in the interviews, and, finally, the interview approach: if general care, being, thus, linked to health promotion; or associated diseases, related, then, to disease prevention.
In the actions of health promotion, the emphasis can be educational, such as orientation on general voice care, involving the quality of life of the individuals (5) .The disease prevention aimed to show the individuals that certain diseases can be prevented using educational strategies, but generally associated with a disease (6) .
A specific worksheet was organized to record these data and, then, a descriptive analysis was made, using absolute and relative frequencies, central tendency, and dispersion measures.For the cutoff point of the duration of the interviews, the median value was used.
To investigate the association between the independent variables, namely region, broadcasting period, interviewed professional, duration of the interview and multiprofessional practice, and the outcome variable (interview approach: general care or associated diseases), we used the Fisher's exact test indicated for samples with expected value lower or equal to 5 in the cells.
For the statistical significance, a descriptive level of 5% was adopted.The data were entered into Microsoft Excel ® and analyzed using SPSS version 17.0 for Windows.

RESULTS
In the specified period, from the 45 locations of Globo ® TV station, 31 produced reports on the Voice Campaign in celebration of the World Voice Day, this being the sample of this research.It was possible to observe that the five regions of Brazil were contemplated and, regarding broadcasting time of the stories, they were aired in equal number in the morning and afternoon periods.
On the World Voice Day, celebrated on April 16, 29 (93.5%)reports were broadcasted, and the rest were presented previously.The reports had a mean duration of 5.3 minutes (SD=2.6),median of 5.9, ranging from 1.3 (in Manaus, in the state of Amazonas) to 11.7 minutes (in Boa Vista, in the state of Roraima) (Table 1).
The Brazilian Society of Speech-Language Pathology and Audiology (SBFa), one of the institutions that stimulates the organizing of the Voice Campaign, was the only scientific entity mentioned in the reports, with a total of 7 (22.6%)mentions, and, in one of the TV news programs (Bom Dia Cidade/SP -Marília), it was erroneously referred to as Brazilian Association of Speech-Language Pathology and Audiology.
We observed that 21 reports (67.7%) made a reference to diseases associated with the voice, and these were mentioned during the interviews with the objective of proposing behavioral changes so that the subject does not develop them.Among those brought by the interviewees, cancer (11-30.5%)or tumor (9-25%), nodules (7-19.5%),and vocal cords paresis (5-14%) stood out for the frequency of mentions.Gastroesophageal reflux disease (2-5.5%) and vocal cord paralysis (2-5.5%) were also mentioned by the interviewees.
In the 10 (32.3%) reports that referred to general care to maintain a healthy voice and, therefore, were consistent with the promotion of health and vocal well-being, the emphasis was given to the issue of vocal expressiveness, addressing the importance of doing activities, such as singing lessons, and the influence of body posture in the voice projection.
Regarding the professionals involved in the reports to publicize the Voice Campaign and provide other information, the presence of the speech-language pathologist was observed in greater numbers (24-77.4%),and in these, for the most part (22-96%), there was a commentary on performing vocal techniques, especially the tongue trill (13-60%).In 19 (61.3%) interviews in which the speech-language pathologist participated, the importance of a multiprofessional work was emphasized (Table 1).
When the variables region, broadcasting period, interviewed professional, interview duration, and mention to the multidisciplinary practice were associated with the outcome denominated interview approach (general care or associated diseases), we noted that none of them had a statistically significant difference (Table 2) (p>0.050).
In the analysis regarding the association between the professional responsible for giving the interview, in this case speech-language pathologist or physician (otorhinolaryngologists or other specialty) and indication for multiprofessional monitoring (Table 3), statistically significant difference (p=1.000) was not recorded.Also, no statistically significant difference was observed between speech-language pathologists (p=0.099)(Table 4).

DISCUSSION
In the characterization of the reports aired by the Globo ® Network, it can be observed that the Northeast region was the one with the highest number of interviews on TV news programs about the World Voice Day.Although this variable (region) has not shown statistical difference, according to data (17) , this is the region with the highest incidence of laryngeal cancer compared to others.Interestingly, there was frequent use of the terms "cancer" and "tumor" (although also with no statistically significant difference compared to other regions) in the context of orientations such as "...see a doctor" or "...avoid smoking, drinking alcoholic beverages," orientations that show the preventative nature of the information, with focus limited to the voice-related diseases.
Two interviews were conducted prior to the date in question (World Voice Day), probably to publicize the activities to be held in the city.As for the duration of reports, the TV news programs still follow the dynamic format, where the top stories of the day are presented with an average duration of 30 minutes, which demands from the journalist responsible for the theme the adaptation of his or her report according to the available time to present it (18) .The length of the local TV news program, first edition, broadcasted in the afternoon period is 45 minutes, and the second edition, transmitted in the evening period, lasts 15 minutes.The reports about the Voice Campaign had a mean duration of 5 minutes, a significant time compared to the total duration of TV news programs.
The speech-language pathologists were the professionals most sought out to address the issue in the interviews.The Voice Day commemoration began in 1999 as an initiative of the Brazilian Society of Laryngology and Voice (SBLV), which had physicians, speech-language pathologists, and singing teachers as participants (11) .In 2002, SBLV was extinguished, and the Brazilian Association of Laryngology and Voice was created in its place, restricting the participation to physicians.Thus, the institutions (Brazilian Association of Laryngology and Voice and Brazilian Society of Speech-Language Pathology and Audiology) have separately continued the Voice Campaigns, encouraging professionals of the field to take action over the years.
The predominant clinical training of the speech-language pathologist reflects in his or her orientations.Assuming that "health is the absence of disease", the injuries are presented to the viewer as justification for necessary changes in behavior.As a result, aspects related to the multidimensionality of the voice, as cultural and social influences involved in voice production, tend to not be much considered in the orientations, excluding the possibility of an interprofessional care that may assist the individual from different perspectives, such as in the discussions of care strategies adopted between physicians and speech-language pathologists according to the singularity of the patient and the indication, should the need arise, of the singing teacher or vocal coach in the care for the voice.
Regarding the professionals mentioned by the interviewees, the importance of teamwork was emphasized by the majority, and the population was oriented to seek the care of two   Currently, the speech-language pathologist is increasingly being invited to address health-related issues in the media available to the public.The demand for the health professional is based on the assumption that he or she has a profile of access to the population that may facilitate the transformation, addressing the needs of a particular context (19) .Thus, the instrumentalization of this professional is required to contextualize his or her speech in view of the demands of the population and the possibilities of intervention according to the current public policies.Despite being included in health promotion and disease prevention issues since the last century (mid-1970 and 1980), in his or her daily practice the speech-language pathologist still faces difficulty to appropriate these concepts, a fact that reflects in the discourse directed to the population and the health education and communication processes (20) .
As for the technique showed by many of the interviewed speech -language pathologists (tongue trill), it is a routine practice of speech-language pathologists because it is helpful in actions of prevention and treatment of voice disorder.
In a study with 32 women without vocal complaints, the vocal techniques, including the tongue trill, improved the voice quality, glottal closure, and muco-undulatory vibration of the vocal cords (21) .Especially in vibration techniques, the individuals reported that, after their completion, they realized that there is improvement in the vocal projection, ease of production, and voice quality (22) .
The tongue trill is an example of technique that can be disseminated among the population, because its benefits are multiple and contemplate all age groups, genders, and levels of education.However, one must remember that it should be performed as described by professionals of the field so as to not adversely interfere with other aspects of voice production.The strategy to disclose a technique for the good of the population, without restricting its use to a certain disease, can be characterized as an action of health promotion.
It is necessary to consider that health information can contribute both in health promotion and in disease prevention, as it provides a change in the behavior of the individuals.However, the way that the orientations are presented can place the individual as the only one responsible for the disease process, since if he or she does not "obey" the recommendations might end up having the disease.What interferes in this process of accountability is the way the information is presented to the population and the strategies available to deal with the health problems in question.It up to the speech-language pathologist to be aware of this issue, as only informing what is bad for your voice today is not enough.
Thus, the autonomy of the individual for the alternative of searching vocal care is limited and there is little room for the knowledge of the existing interprofessional work when it comes to voice, even though the literature considers the multidimensional aspects of paramount importance in the voice care (23) .It is notorious that the vocal care is not restricted to the clinic, but involves other aspects that deal with the expressiveness in singing and public speaking, for example.The difficulty in achieving interprofessional practices routinely requires investments in studies about the subject and, in such cases, specifically, about the training of health professionals (24) .An example that can be highlighted is the formation of chorus in Basic Health Units, which often begins with the initiative of community workers and ultimately involves different health professionals.The ultimate goal is not just singing, but the involvement of the participants in this activity sensitizes them about the aspects worked by Speech-language Pathology and Audiology (breathing, articulation, auditory perception, and phonation) in addition to the emotional, social aspects, among others.
Increasingly, the health professional is demanded about the need to work in teams and value each of their members.This work provides the exchange of experiences and the construction of goals together, factors that lead to the better care of those who seek those professionals, as well as better professional training 24 .Although the educational institutions should be alert to the need of preparing different professionals to this joint action, as recommended by the current healthcare system in the country, much still lies ahead.
It is noteworthy that, for the discussion on bringing the speech-language pathologist closer to the Public Health, it is necessary to advance in the recognition of the new paradigm of Health Promotion, which can provide a contextualized action and meet the expectations of the contemporary health care model, since the technical/ hospital-centered model no longer meets the emergence of necessary changes to people's health (25) .From this perspective, health is more than absence of disease; it is to enable individuals to take ownership of mechanisms to provide them better quality of life associated with well-being.Physical activity, for example, is a strategy that promotes the well-being and, in the case of the Voice Campaigns, could be stimulated, because, besides the relationship with vocal production, through breathing, it will bring benefits to the individual in several aspects, favoring better quality of life.
So, with the approach to this concept and the modification in the organismic profile, the reports on the Voice Campaign can be privileged spaces of Health Education for speech-language pathologists and other professionals, when considered as a reunion of people from different social, economic, and cultural realities and, above all, with attention to the various representations of health (26) .
In the analysis of the interviews about the Voice Campaigns, one may notice a gap between the strategies established in these campaigns and the conception of health promotion.In particular, the health promotion has as its basic axis strengthening the autonomy of the individuals and social groups, as well as guaranteeing free access and contextualized choice option according to their demand and need, without the interference of preestablished models (6) .The information provided to the population in the reports about the Voice Campaign follow, in general, the precept of disease prevention.Even if there is the possibility to address the issue of vocal well-being in the selfcare perspective, and the numerous opportunities to express by adjusting, the professional invited to be interviewed, most of the time the speech-language pathologist, ultimately directs the information in a prescriptive form only for the habits that can News about the Voice Campaign in Brazil CoDAS 2015;27(5):492-7 interfere with the voice production related to health injuries.In some cases, it is noteworthy that the speech-language pathologist has no autonomy to direct the interview and the content to be exposed.The summaries of the news programs are built and then the professional is invited to speak on the subject.
The data presented seem to indicate the need for studies on the perspective of analyzing and discussing the inclusion of health professionals, and especially the speech-language pathologist, in the media so that there is a discourse both coherent and contextualized with the current political and social situation and the population is the main beneficiary (12) .

CONCLUSION
In the year of 2013, all the regions of Brazil were contemplated with television reports on Globo ® Network about the Voice Campaign in commemoration of the World Voice Day.The speech-language pathologist was the professional that addressed the issue in most of these reports, which had a mean duration of 5.3 minutes and were broadcasted mainly in the morning and afternoon periods.There is no predominance in the focus of the interviews (to promote vocal well-being or prevent the voice disorders).One can suggest that perhaps the speech-language pathologist is not aware of the approach of the interviews.The interprofessional practice is still seen, less frequently, as a possible work strategy.
*RD participated in all the stages of preparation and writing of the article; SPPG contributed to the construction of the results and discussion; LPF contributed to all stages of the article and to the preparation of the initial idea.

Table 1 .
Number and percentage of television reports aired on the

Table 2 .
Association between the variable interview approach versus the independent variables

Table 4 .
Analysis of the association between interview approach versus multidisciplinary indication, only for speech-language pathologists

Table 3 .
Analysis of the association between the variable interviewed professional versus multidisciplinary indication