Advertisement

Development and Initial Psychometric Evaluation of the Self-Efficacy Scale for Voice Modification in Trans Women

  • Georgia Dacakis
    Correspondence
    Address correspondence and reprint requests to Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria 3086, Australia.
    Affiliations
    Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
    Search for articles by this author
  • Jaco Erasmus
    Affiliations
    Gender Clinic, Monash Health, Clayton, Victoria, Australia
    Search for articles by this author
  • Ulrika Nygren
    Affiliations
    Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
    Search for articles by this author
  • Jennifer Oates
    Affiliations
    Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
    Search for articles by this author
  • Sterling Quinn
    Affiliations
    Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
    Search for articles by this author
  • Maria Södersten
    Affiliations
    Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
    Search for articles by this author

      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 access
      One-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 Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Dhejne C
        • Van Vlerken R
        • Heylens G
        • et al.
        Mental health and gender dysphoria: a review of the literature.
        Int Rev Psychiatry. 2016; 28: 44-57https://doi.org/10.3109/09540261.2015.1115753
        • Coleman E
        • et al.
        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)
        • Davies S
        • Goldberg JM
        Clinical aspects of transgender speech feminization and masculinization.
        Int J Transgenderism. 2006; 9: 167-196https://doi.org/10.1300/J485v09n03_08
      1. 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)
        • Pausewang Gelfer M
        • Van Dong BR
        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
        • Söderpalm E
        • Larsson A
        • Almquist SA
        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
        • Mills M
        • Stoneham G
        • Davies S
        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
        • Leyns C
        • Papeleu T
        • Tomassen P
        • et al.
        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
        • Oates J
        • Dacakis G
        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
        • Oates J
        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)
        • Verdolini-Marston K
        • Burke MK
        • Lessac A
        • et al.
        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
        • Hapner E
        • Portone-Maira C
        • Johns MM
        A study of voice therapy dropout.
        J Voice. 2009; 23: 337-340https://doi.org/10.1016/j.jvoice.2007.10.009
        • Van Leer E
        • Hapner ER
        • Connor NP
        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
        • Bandura A
        Social Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice-Hall, Englewood Cliffs, NJ1986
        • Chen G
        • Gully SM
        • Eden D.
        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
        • Bandura A
        • Locke EA
        Negative self-efficacy and goal effects revisited.
        J Appl Psychol. 2003; 88: 87-99https://doi.org/10.1037/0021-9010.88.1.87
        • Bandura A
        Self-efficacy: toward a unifying theroy of behavioral change.
        Psychol Rev. 1977; 84: 191-215https://doi.org/10.1037/0033-295X.84.2.191
        • Ashford S
        • Edmunds J
        • French DP
        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
        • Bandura A
        Guide for constructing self-efficacy scales.
        (eds)in: Urdan T Pajares F Self-Efficacy Beliefs of Adolescents. 2006 (307-337)
        • Grant JS
        • Kinney MR
        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
        • Grant JS
        • Davis LL
        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
        • Sherer M
        • Maddux JE
        • Mercandante B
        • et al.
        The self-efficacy scale: construction and validation.
        Psychol Rep. 1982; 51: 663-671https://doi.org/10.2466/pr0.1982.51.2.663
        • French DJ
        • Holroyd KA
        • Pinell C
        • et al.
        Perceived self-efficacy and headache-related disability.
        Headache. 2001; 40: 647-656https://doi.org/10.1046/j.1526-4610.2000.040008647.x
        • Kroll T
        • Kehn M
        • Ho PS
        • et al.
        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
        • Anderson RM
        • Funnell MM
        • Fitzgerald JT
        • et al.
        The diabetes empowerment scale.
        Diabetes Care. 2000; 23: 739-743https://doi.org/10.2337/diacare.23.6.739
        • Dharma C
        • Scheim AI
        • Bauer GR
        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
        • Catelan RF
        • Saadeh A
        • Lobato MIR
        • et al.
        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
        • Yang X
        • Wang L
        • Hao
        • et al.
        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
        • Walinsky D
        • Rofkahr C
        • et al.
        • dickey lm
        Career decision self-efficacy of transgender people: pre- and posttransition.
        Career Dev Q. 2016; 64: 360-372https://doi.org/10.1002/cdq.12071
        • Betz NE
        • Klein KL
        • Taylor KM
        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
        • Barlow J
        • Wright C
        • Cullen L
        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
        • Hill BJ
        • Rosentel K
        • Bak T
        • et al.
        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
        • Victorino KR
        • Hinkle MS
        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
        • Ornstein AF
        • Manning WH
        Self-efficacy scaling by adult stutterers.
        J Commun Disord. 1985; 18: 313-320https://doi.org/10.1016/0021-9924(85)90008-5
        • Babbitt E
        • Cherney L
        Communication confidence in persons with aphasia.
        Top Stroke Rehabil. 2010; 17: 214-223https://doi.org/10.1310/tsr1703-214
        • Hu A
        • Isetti D
        • Hillel AD
        • et al.
        Disease-specific self-efficacy in spasmodic dysphonia patients.
        Otolaryngol - Head Neck Surg (United States). 2013; 148: 450-455https://doi.org/10.1177/0194599812472319
        • Van Leer E
        • Connor NP
        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
        • Gillespie AI
        The Influence of Clinical Terminology on Self-Efficacy for Voice.
        University of Pittsburgh, 2005 (Masters thesis) (Accessed December 16, 2021)
        • Gillespie AI
        • Verdolini K
        The influence of clinical terminology on self-efficacy for voice.
        Logop Phoniatr Vocol. 2011; 36: 91-99https://doi.org/10.3109/14015439.2010.539259
        • Iwarsson J
        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
        • Roy N
        Optimal dose–response relationships in voice therapy.
        Int J Speech Lang Pathol. 2012; 14: 419-423https://doi.org/10.3109/17549507.2012.686119
        • Abur D
        • Subaciute A
        • Kapsner-Smith M
        • et al.
        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
        • Iwarsson J
        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
        • Portney LG
        • Watkins MP
        Foundations of Clinical Research: Applications to Practice.
        Pearson/Prentice Hall, Upper Saddle River, NJ2015 (3rd ed)
        • Nunnally J
        • Bernstein I
        Psychometric Theory.
        3rd ed. McGraw-Hill, New York, NY1994
        • Field A
        Discovering Statistics Using IBM SPSS Statistics.
        5th ed. SAGE Publications, Thousand Oaks, CA2015
        • Clark LA
        • Watson D
        Construct validity: basic issues in objective scale development.
        Psychol Assess. 1995; 7: 309-319
        • Ladhari R
        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
        • McGraw KO
        • Wong SP
        Forming inferences about some intraclass correlation coefficients.
        Psychol Methods. 1996; 1: 30-46https://doi.org/10.1037/1082-989X.1.1.30
        • Shrout PE
        • Fleiss JL
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428https://doi.org/10.1037/0033-2909.86.2.420
        • Koo TK
        • Li MY
        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
      2. R: A language and environment for statistical computing [Computer Software]. Versions 3.6.3-4.1.0.. R Core Team; 2020, 2021.

      3. IBM SPSS Statistics for Windows [Computer Software]. Version 27.0. IBM Corp.; 2020.

        • Iwarsson J
        • Morris DJ
        • Balling LW
        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
        • Haskell JA
        • Baken RJ
        Self perception of speaking pitch levels.
        J Speech Hear Disord. 1978; 43: 3-8https://doi.org/10.1044/jshd.4301.03
        • Beaton DE
        • Bombardier C
        • Guillemin F
        • et al.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine. 2000; 25: 3186-3191https://doi.org/10.1097/00007632-200012150-00014
        • Bujang MA
        • Omar ED
        • Baharum NA
        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
        • Bujang MA
        • Baharum N
        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
        • Baruch Y
        Response rate in academic studies - a comparative analysis.
        Hum Relations. 1999; 52: 421-438https://doi.org/10.1177/001872679905200401
        • Bjelland I
        • Dahl AA
        • Haug TT
        • et al.
        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