Questionário de Saúde e Higiene Vocal (Vocal Health and Hygiene Questionnaire): Development, Validation, and Cutoff Value

Abstract

INTRODUCTION: Vocal hygiene is regarded as a patient-centered behavioral intervention that plays a crucial role in vocal rehabilitation and in the vocal conditioning of professional voice users. Accordingly, the development of an instrument capable of evaluating whether vocal health and hygiene habits effectively distinguish individuals with and without voice disorders - when used as a complementary tool within a multidimensional vocal assessment - could provide valuable guidance for speech-language pathologists in the clinical management of patients with dysphonia and individuals at risk of developing voice problems. The purpose of this study was to develop and validate an instrument for assessing knowledge of health and vocal hygiene. METHODS: Cross-sectional nonrandomized prospective study. A total of 41 voice specialists classified 365 vocal aspects as positive, negative, or having no influence. Additionally, 50 dysphonic and 50 non-dysphonic participants completed the initial version of the Vocal Health and Hygiene Questionnaire (QSHV). The QSHV was submitted to psychometric measures. RESULTS: Of the 365 items, 45 demonstrated inter-rater reliability >0.950. Five items were excluded due to conceptual or semantic redundancy. The initial version of the QSHV comprised 40 items, of which 9 failed to distinguish between dysphonic and non-dysphonic participants and were subsequently removed. Dysphonic participants rated their own vocal quality as poorer, obtained lower QSHV scores, and reported higher vocal handicap. The instrument showed high internal consistency (Cronbach's alpha = 0.881) and excellent test-retest reliability (p = 0.804). The mean QSHV score was 17.84 for dysphonic participants and 29.12 for non-dysphonic participants (p < 0.001). A cutoff score of 23 points on the QSHV achieved optimal sensitivity and specificity (100%). CONCLUSIONS: The QSHV was proved to be a responsive and reliable protocol for evaluation of knowledge in health and vocal hygiene. The findings also indicate that individuals with dysphonia possess less knowledge about vocal health. The QSHV demonstrated strong diagnostic accuracy in distinguishing dysphonic from non-dysphonic individuals.