Summary
Objective
To develop a self-efficacy questionnaire for voice modification related to gender
affirmation and to examine the internal consistency and test-retest reliability of
the questionnaire among a cohort of trans women.
Methods
This study was undertaken in two phases. In phase I, four Speech- Language Pathologists
(SLPs) and four trans women informed the development of the Self-Efficacy Scale for
Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory,
data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice
with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest
reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized
by consensus among the authors into like groups.
Results
Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1)
Change (items related to changing voice); 2) Perception (items related to the ability
to perceive changes in voice; 3) Psychological (items related to engaging in voice
practice despite psychological barriers; 4) Logistical (items related to engaging
in voice practice despite logistical barriers). In Phase II, initial psychometric
analysis was applied to the full questionnaire as well as to the subcategories. The
Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal
consistency. Item-total correlation analysis indicated that individual items correlated
with the questionnaire total score, but that they generally correlated more strongly
with the total score for the relevant subcategory. The Cronbach's alpha for the four
subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus
supporting the reliability of the new scale. Good test-retest reliability was demonstrated
for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence
interval, 0.73-0.90, P < 0.001) and was moderate to good for the four subcategories.
Conclusion
The findings of the current study are promising, suggesting that both the full SES-VMTW
and the four subcategories can provide consistent and reliable insight into self-efficacy
for trans women aiming to modify their voice as part of their gender affirmation.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Mental health and gender dysphoria: a review of the literature.Int Rev Psychiatry. 2016; 28: 44-57https://doi.org/10.3109/09540261.2015.1115753
- Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People [7th Version].World Professional Association of Transgender Health, 2012 (Available at:) (Accessed March 8, 2021)
- Clinical aspects of transgender speech feminization and masculinization.Int J Transgenderism. 2006; 9: 167-196https://doi.org/10.1300/J485v09n03_08
- Adler R Sandy H Pickering J. Voice and Communication Therapy for the Transgender/Gender Diverse Client: A Comprehensive Clinical Guide. Plural Publishing, Oxford2019 (3rd ed)
- A preliminary study on the use of vocal function exercises to improve voice in male-to-female transgender clients.J Voice. 2013; 27: 321-334https://doi.org/10.1016/j.jvoice.2012.07.008
- Evaluation of a consecutive group of transsexual individuals referred for vocal intervention in the west of sweden.Logop Phonatrics Vocol. 2004; 29: 18-30https://doi.org/10.1080/14015430310021618
- Toward a protocol for Transmasculine Voice: A Service Evaluation of the Voice and Communication Therapy Group Program, including long-term follow-up for trans men at the London gender identity clinic.Transgender Heal. 2019; 4: 143-151https://doi.org/10.1089/trgh.2019.0011
- Effects of speech therapy for transgender women: a systematic review.Int J Transgender Heal. 2021; 0: 1-21https://doi.org/10.1080/26895269.2021.1915224
- Transgender voice and communication: research evidence underpinning voice intervention for male-to-female transsexual women.Perspect Voice Voice Disord. 2015; 25: 48-58https://doi.org/10.1044/vvd25.2.48
- Evidence-based practive in voice training for trans women.(eds)in: Adler R Hirsch S Pickering J Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide. Plural Publishing, 2019 (3rd ed.87-103)
- Preliminary study of two methods of treatment for laryngeal nodules.J Voice. 1995; 9: 74-85https://doi.org/10.1016/S0892-1997(05)80225-5
- A study of voice therapy dropout.J Voice. 2009; 23: 337-340https://doi.org/10.1016/j.jvoice.2007.10.009
- Transtheoretical model of health behavior change applied to voice therapy.J Voice. 2008; 22: 688-698https://doi.org/10.1016/j.jvoice.2007.01.011
- Social Foundations of Thought and Action: A Social Cognitive Theory.Prentice-Hall, Englewood Cliffs, NJ1986
- General self-efficacy and self-esteem: Toward theoretical and empirical distinction between correlated self-evaluations.J Organ Behav. 2004; 25: 375-395https://doi.org/10.1002/job.251
- Negative self-efficacy and goal effects revisited.J Appl Psychol. 2003; 88: 87-99https://doi.org/10.1037/0021-9010.88.1.87
- Self-efficacy: toward a unifying theroy of behavioral change.Psychol Rev. 1977; 84: 191-215https://doi.org/10.1037/0033-295X.84.2.191
- What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis.Br J Health Psychol. 2010; 15: 265-288https://doi.org/10.1348/135910709×461752
- Guide for constructing self-efficacy scales.(eds)in: Urdan T Pajares F Self-Efficacy Beliefs of Adolescents. 2006 (307-337)
- Using the delphi technique to examine the content validity of nursing diagnoses.Int J Nurs Terminol Classif. 1992; 3: 12-22https://doi.org/10.1111/j.1744-618X.1992.tb00193.x
- Focus on quantitative methods: selection and use of content experts for instrument development.Res Nurs Heal. 1997; 20: 269-274https://doi.org/10.1002/(sici)1098-240x(199706)20:3<269::aid-nur9>3.3.co;2-3
- The self-efficacy scale: construction and validation.Psychol Rep. 1982; 51: 663-671https://doi.org/10.2466/pr0.1982.51.2.663
- Perceived self-efficacy and headache-related disability.Headache. 2001; 40: 647-656https://doi.org/10.1046/j.1526-4610.2000.040008647.x
- The SCI Exercise Self-Efficacy Scale (ESES): Development and psychometric properties.Int J Behav Nutr Phys Act. 2007; 4: 2-7https://doi.org/10.1186/1479-5868-4-34
- The diabetes empowerment scale.Diabetes Care. 2000; 23: 739-743https://doi.org/10.2337/diacare.23.6.739
- Exploratory factor analysis of two sexual health scales for transgender people: trans-specific condom/barrier negotiation self-efficacy (T-Barrier) and trans-specific sexual body image worries (T-Worries).Arch Sex Behav. 2019; 48: 1563-1572https://doi.org/10.1007/s10508-018-1383-4
- Condom-protected sex and minority stress: Associations with condom negotiation self-efficacy, “passing” concerns, and experiences with misgendering among transgender men and women in brazil.Int J Environ Res Public Health. 2021; 18https://doi.org/10.3390/ijerph18094850
- Sex partnership and self-efficacy influence depression in Chinese transgender women: Aa cross-sectional study.PLOS One. 2015; 10: 1-13https://doi.org/10.1371/journal.pone.0136975
- Career decision self-efficacy of transgender people: pre- and posttransition.Career Dev Q. 2016; 64: 360-372https://doi.org/10.1002/cdq.12071
- Evaluation of a short form of the career decision-making self-efficacy scale.J Career Assess. 1996; 4: 47-57https://doi.org/10.1177/106907279600400103
- A job-seeking self-efficacy scale for people with physical disabilities: preliminary development and psychometric testing.Br J Guid Couns. 2002; 30: 37-53https://doi.org/10.1080/030698880220106500
- Exploring individual and structural factors associated with employment among young transgender women of color using a no-cost transgender legal resource center.Transgender Heal. 2017; 2: 29-34https://doi.org/10.1089/trgh.2016.0034
- The development of a self-efficacy measurement tool for counseling in speech-language pathology.Am J Speech-Language Pathol. 2019; 28: 108-120https://doi.org/10.1044/2018_AJSLP-18-0012
- Self-efficacy scaling by adult stutterers.J Commun Disord. 1985; 18: 313-320https://doi.org/10.1016/0021-9924(85)90008-5
- Communication confidence in persons with aphasia.Top Stroke Rehabil. 2010; 17: 214-223https://doi.org/10.1310/tsr1703-214
- Disease-specific self-efficacy in spasmodic dysphonia patients.Otolaryngol - Head Neck Surg (United States). 2013; 148: 450-455https://doi.org/10.1177/0194599812472319
- Use of portable digital media players increases patient motivation and practice in voice therapy.J Voice. 2012; 2: 447-453https://doi.org/10.1016/j.jvoice.2011.05.006
- The Influence of Clinical Terminology on Self-Efficacy for Voice.University of Pittsburgh, 2005 (Masters thesis) (Accessed December 16, 2021)
- The influence of clinical terminology on self-efficacy for voice.Logop Phoniatr Vocol. 2011; 36: 91-99https://doi.org/10.3109/14015439.2010.539259
- Facilitating behavioral learning and habit change in voice therapy - Theoretic premises and practical strategies.Logop Phoniatr Vocology. 2015; 40: 179-186https://doi.org/10.3109/14015439.2014.936498
- Optimal dose–response relationships in voice therapy.Int J Speech Lang Pathol. 2012; 14: 419-423https://doi.org/10.3109/17549507.2012.686119
- Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders.Sci Rep. 2021; 11: 1-11https://doi.org/10.1038/s41598-021-92250-8
- Facilitating behavioral learning and habit change in voice therapy-theoretic premises and practical strategies.Logoped Phoniatr Vocol. 2014; 5439: 1-8https://doi.org/10.3109/14015439.2014.936498
- Foundations of Clinical Research: Applications to Practice.Pearson/Prentice Hall, Upper Saddle River, NJ2015 (3rd ed)
- Psychometric Theory.3rd ed. McGraw-Hill, New York, NY1994
- Discovering Statistics Using IBM SPSS Statistics.5th ed. SAGE Publications, Thousand Oaks, CA2015
- Construct validity: basic issues in objective scale development.Psychol Assess. 1995; 7: 309-319
- Developing e-service quality scales: a literature review.J Retail Consum Serv. 2010; 17: 464-477https://doi.org/10.1016/j.jretconser.2010.06.003
- Forming inferences about some intraclass correlation coefficients.Psychol Methods. 1996; 1: 30-46https://doi.org/10.1037/1082-989X.1.1.30
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428https://doi.org/10.1037/0033-2909.86.2.420
- A guideline of selecting and reporting intraclass correlation coefficients for reliability research.J Chiropr Med. 2016; 15: 155-163https://doi.org/10.1016/j.jcm.2016.02.012
R: A language and environment for statistical computing [Computer Software]. Versions 3.6.3-4.1.0.. R Core Team; 2020, 2021.
IBM SPSS Statistics for Windows [Computer Software]. Version 27.0. IBM Corp.; 2020.
- Cognitive load in voice therapy carry-over exercises.J Speech Lang Hear Res. 2017; 60: 1-12https://doi.org/10.1044/2016_JSLHR-S-15-0235
- Self perception of speaking pitch levels.J Speech Hear Disord. 1978; 43: 3-8https://doi.org/10.1044/jshd.4301.03
- Guidelines for the process of cross-cultural adaptation of self-report measures.Spine. 2000; 25: 3186-3191https://doi.org/10.1097/00007632-200012150-00014
- A review on sample size determination for cronbach's alpha test: a simple guide for researchers.Malaysian J Med Sci. 2018; 25: 85-99https://doi.org/10.21315/mjms2018.25.6.9
- A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: A review.Arch Orofac Sci. 2017; 12 (Available at:): 1-11
- Response rate in academic studies - a comparative analysis.Hum Relations. 1999; 52: 421-438https://doi.org/10.1177/001872679905200401
- The validity of the hospital anxiety and depression scale.J Psychosom Res. 2002; 52: 69-77https://doi.org/10.1016/S0022-3999(01)00296-3
Article info
Publication history
Published online: May 02, 2022
Accepted:
March 10,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
