Abstract
The present study sought (1) to determine if any evidence could be found of an influence of clinical language on self-efficacy for voice in adults with voice problems; and (2) to determine the number of subjects that would be required to undertake future large-scale study around this question, if warranted, based on effect sizes determined in the present investigation. The study¡¦s relevance has to do with prior concerns raised in the literature that common clinical language in voice care¡Xspecifically language indicating vocal ¡§abuse and misuse¡¨ as causal factors in selected voice disorders--has potential to harm self-efficacy for voice, which in turn may compromise patient compliance with treatment and thus clinical outcome (Verdolini, 1999). Fourteen teachers with self-reported voice disorders of unknown etiology were recruited as participants. Subjects were randomly assigned to one of two 15-min standardized, videotaped educational exposures by an unbiased clinician who was unaware of the experimental questions. One exposure described the origins of common voice problems in teachers in terms of vocal ¡§abuse/misuse¡¨ (N=7). The other exposure described the problems in terms of ¡§phonotraumatic behaviors and muscular tension¡¨ (N=7). Before and immediately after exposures, subjects completed a visual analogue scale Voice Self-Efficacy Questionnaire that was specially designed for the study, that assessed situation-neutral self-efficacy for voice. Psychometric evaluation of the tool indicated strong intra-rater and test-retest reliability (r d. 99; r d .78 respectively). The groups were also found to have no significant differences between them at the pre-test level, thus showing that amount of change on the post-test Voice Self-Efficacy Questionnaire were not influenced by individual subject differences on the pre-test. More conceptually interesting, binomial tests indicated that the majority of responses to self-efficacy questions reliably increased pre- to post exposure in the ¡§phonotrauma/muscle tension¡¨ (20/28 responses; p < .05), whereas no reliable change in scores was seen in the ¡§abuse/misuse¡¨ group (11/28 responses increased; non-significant). A Chi-Square test was conducted, and as with the binomial test, found a statistical difference between the 11 increased/28 possible self-efficacy responses of the ¡§abuse/misuse¡¨ group, and the 20/28 increased self-efficacy responses of the ¡§phonotrauma¡¨ group to the < .05 level. Results provide preliminary support for the hypothesis that clinical exposure to ¡§abuse/misuse¡¨ language may harm patients¡¦ self-efficacy for voice, not necessarily by decreasing pre-exposure self-efficacy but by compromising increases in self-efficacy that may normally be expected with patient education, as reported for other domains. The issue of self-efficacy for voice should be pursued in larger-scale studies in other laboratories. Effect sizes based on the present data indicated that at least 20 subjects per group (N=40 total) would be required to assess the effects of the noted terminology on voice-related self-efficacy shifts parametrically, using a similar experimental design.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08192005-123706 |
| Date | 23 August 2005 |
| Creators | Gillespie, Amanda I |
| Contributors | Christine Dollaghan, PhD, Katherine Verdolini, PhD, William Klein, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08192005-123706/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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