Development and application of a vocal health and hygiene game in adults

Roza, Ana Paula; Gielow, Ingrid; Vaiano, Thays; Behlau, Mara

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Sumário

Original Article • CoDAS 31 (4) • 2019 • https://doi.org/10.1590/2317-1782/20182018184 copy

Development and application of a vocal health and hygiene game in adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To develop a game on vocal health and hygiene (VoxPedia) and apply it to adults aiming to investigate knowledge about vocal health and the vocal self-assessment in this population.

Methods

The study sample was composed of 293 adults, of which 204 were women and 129 were voice professionals, invited to participate through digital media. Participants completed to the following forms and instruments: 1) Informed Consent Form (ICF); 2) Identification Data form; 3) Voice Handicap Index: 10 (VHI-10) protocol; 4) Vocal Health and Hygiene Questionnaire (VHHQ); 5) VoxPedia quiz.

Results

The VoxPedia quiz was developed using simple and dynamic questions that allowed the participants to know their performance in real time. Data collected through this quiz showed that voice professionals reported reduced voice handicap and had higher scores in the VHHQ and VoxPedia. Voice professionals or not, participants who answered wrongly to the nature of impact of health aspects in the VHHQ reported increased voice handicap in the VHI-10; however, despite the self-reported handicap, most of them did not report voice complaints. In contrast, when voice complaints were reported, the participants not always perceived handicap or searched for vocal therapy.

Conclusion

The VoxPedia quiz presented some concepts on vocal health and hygiene to the participants. In addition, it enabled the study of the relation between knowledge about vocal care and voice self-assessment. The data suggest that individuals with greater knowledge about vocal health and hygiene show better voice self-assessment, those with worse voice self-assessment do not perceive voice problems, and those who perceive voice problems do not necessarily seek professional assistance.

Keywords
Voice; Speech, Language and Hearing Sciences; Self-assessment; Mobile Applications; Software; Therapy Computer-Assisted

Most voted items of the VHHQ	Questions of the VoxPedia quiz	Answer choices
Effortless speech	What happens when we speak in an effortful way?	a) Our voice improves because this assists with maintaining its quality
		b) Nothing happens; our voice neither improves nor worsens
		c) Our voice worsens because we strain the muscles
Speech in noise	What effects can speaking for a long time in noisy environment have on our voice?	a) We can feel voice fatigue
		b) We do not feel anything
		c) We can feel that our voice warms up
Vocal abuse	What is vocal abuse?	a) Exercises we do to warm up the voice and speak well
		b) Behavior that worsens the voice, causing fatigue and changes
		c) Behavior we use to save the voice in noisy environment
	What happens when we yell, speak, or sing for a long time in noisy environment?	a) Vocal abuse
		b) Vocal warn-up
		c) Vocal relaxation
	Who is most at risk for a voice problem?	a) Communicative people who use speech and gestures in conversation
		b) Very quiet people who do not like to talk in a group of people
		c) People who speak too much and loudly
Yelling	What can happen to our voice when we yell too much?	a) The voice may become high-pitched
		b) The voice may become low-pitched
		c) The voice may become hoarse
Breathing-speech incoordination	What may be associated with vocal fatigue?	a) Tiredness or pain in the neck region
		b) Pain in the muscles of the tongue and lips
		c) Pain in the body muscles
	What is the most natural way to breathe while speaking?	a) Make short pauses to breathe before we run out of breath
		b) Make long pauses to breathe as soon as we run out of breath
		c)) Make pauses to breathe only when we have already run out of breath
Lack of liquid consumption throughout the day	What can happen to our voice when we drink little water throughout the day?	a) It may become slurred and we may find it difficult to open our mouth
		b) It may become powerful and warmed up
		c) It may become dehydrated and even hoarse
Vocal warm-up	What is the purpose of vocal warm-up?	a) It is useless because the voice warms up with use
		b) It prepares the larynx muscles for voice use
		c) It worsens the voice because it is best to be silent
Vocal fatigue	Which of these three situations is more likely to cause vocal fatigue?	a) Tell a friend a story in a comfortable volume
		b) Imitate your favorite singer by singing loudly at a concert
		c) Sing an entire opera using good voice technique
Healthy vocal habits	What habits can be healthy for both body and voice?	a) Balanced diet and regular exercises
		b) Make use of throat lozenges and sprays and clear your throat
		c) Drinking alcohol, smoking and using drugs
	What is the best way to speak in everyday life?	a) Whisper so that you can save your voice
		b) Speak comfortably to avoid voice fatigue
		c) Speak strongly in order to keep your voice warmed up throughout the day
Vocal exercise	What is the purpose of voice exercises?	a) Balance the functioning of the muscles that produce the voice
		b) Treat allergic conditions
		c) Treat gastroesophageal reflux
Inadequate body posture	What is the best body posture when speaking?	a) It does not matter, because the body is not important in communication, only the voice
		b) Upright body, well-aligned shoulders, and head looking forward
		c) Bent body, head down, and slumped shoulders
	What is the advantage of maintaining an upright posture during speaking?	a) Show little understanding of speech content
		b) Convey the anxiety and insecurity of the speaker
		c) Show confidence and mastery of the topic spoken
Use of microphone in teaching	Why should we use a microphone to teach or lecture?	a) To save the voice, because a microphone amplifies it, avoiding yelling
		b) To masculinize our voice, because the microphone makes the voice low-pitched
		c) To shout and get everyone's attention
Sleep well	What effect can a bad night's sleep have on our voice?	a) None
		b) Fatigue it
		c) Make it better than it was when we went to bed

Outcome	Mean	SD	Q25	Median	Q75
VHI-10	4.03	5.04	0.00	2.00	5.00
VHHQ	27.31	4.50	26.00	29.00	30.00
VoxPedia	17.37	1.09	17.00	18.00	18.00

Outcome	Mean	SD	Q25	Median	Q75	p-value
VHI-10
Female	3.5	4.38	0	2	4	0.023
Male	5.22	6.16	1	3	8	0.023
VHHQ
Female	28.03	3.91	27	29	30	<0.001
Male	25.66	5.29	24	27	29	<0.001
VoxPedia
Female	17.44	0.87	17	18	18	0.123
Male	17.19	1.47	17	18	18	0.123
Voice professional
VHI-10
Yes	2.92	4.27	0	1	3	<0.001
No	4.9	5.43	1	3	8	<0.001
VHHQ
Yes	28.23	4	28	30	30	<0.001
No	26.59	4.75	25.5	28	30	<0.001
VoxPedia
Yes	17.49	0.91	17	18	18	0.030
No	17.27	1.2	17	18	18	0.030

Outcome	VHHQ										p-value
	Above the cut-off					Below the cut-off
	Mean	SD	Q25	Median	Q75	Mean	SD	Q25	Median	Q75
VHI-10	3.76	4.82	0.00	2.00	5.00	6.48	6.29	1.00	4.00	10.00	0.020

Outcome	Voice complaint										p-value
	No					Yes					p-value
	Mean	SD	Q25	Median	Q75	Mean	SD	Q25	Median	Q75
VHHQ	27.20	4.25	26.00	28.00	30.00	27.63	5.14	28.00	29.00	30.00	0.044
VoxPedia	17.32	1.10	17.00	18.00	18.00	17.49	1.05	17.00	18.00	18.00	0.033

Voice complaint	Voice handicap
	No		Yes		p-value
	n	%	n	%	p-value
No	180	61.43	35	11.94	0.003
Yes	53	18.09	25	8.53	0.003

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[1] Conflict of interests: nothing to declare.