Inadequate vocal hygiene habits associated with the presence of self-reported voice symptoms in telemarketers

Prevalence of Voice Problems, Self-Reported Vocal Symptoms and Associated Risk Factors in Call Center Operators (CCOs): A Systematic Review

OBJECTIVE

The purpose of this study was to systematically review the available literature on the prevalence, self-reported voice symptoms, and associated risk factors for the development of voice problems in call center operators (CCO).

STUDY DESIGN

a systematic review METHODS: An electronic search from five databases based on the guidance of preferred reporting of items for systematic reviews and meta-analysis (PRISMA) yielded 15 articles that reported the different aspects of voice problems in CCOs. The methodological quality of the studies was analyzed using the National Institute of Health (NIH) questionnaire.

RESULTS

The career prevalence of voice problems in CCOs varied from 33% to 68%, whereas point prevalence was at 27%. Hoarse/rough voice was the most prominent symptom reported by most of the studies. Vocal fatigue, effortful voice, and breaks/cracks in voice were the other reported vocal symptoms. Long working hours, short breaks between calls, noisy working environment, dry work environment, work stress, stressful calls, limited breaks, prolonged use of voice, insufficient vocal rest, throat clearing, and more caffeinated beverage intake were different risk factors having significant association with telemarketers reporting vocal symptoms.

CONCLUSION

The present study results suggest that CCOs are at higher risk of developing voice problems. Further, the different vocal symptoms reported by CCOs are suggestive of vocal fatigue. In addition, multiple risk factors may be associated with the development of voice problems. However, the available literature is limited, and further studies with a larger sample size are required to corroborate the current findings.

Effects of Sidetone Amplification on Vocal Function During Telecommunication

PURPOSE

Society has become increasingly dependent on telecommunication, which has been shown to negatively impact vocal function. This study explores the use of sidetone regulation during audio-visual communication as one potential technique to alleviate the effects of telecommunication on the voice.

METHOD

The speech acoustics of 18 participants with typical voices were measured during conversational tasks during three conditions of sidetone amplification: baseline (no sidetone amplification), low sidetone amplification, and high sidetone amplification. Vocal intensity, vocal quality (estimated using acoustic measures of the low-high ratio and the smoothed cepstral peak prominence), and self-perceived vocal effort were used to measure the impacts of sidetone amplification on vocal function.

RESULTS

Compared to baseline, there were statistically significant decreases in vocal intensity and increases in low-high ratio in the high level of sidetone amplification condition. Changes in these measures were not significantly correlated. When asked to rank conditions based on their perceived vocal effort, participants most often ranked the high level of sidetone amplification as least effortful; however, the visual-analog ratings of vocal effort were not significantly different between conditions. The smoothed cepstral peak prominence did not change with varying levels of sidetone amplification.

CONCLUSIONS

Vocal intensity decreased with high levels of sidetone amplification. High levels of sidetone amplification also resulted in increases in the low-high ratio, which were shown to be more than just a byproduct of decreased vocal intensity. The impact of sidetone amplification on vocal effort was less clear, but results suggested that participants generally decreased their vocal effort with increased levels of sidetone amplification. This was a preliminary study and future work is warranted in a population of participants with voice complaints and in a more noisy, realistic environments.

Tracking Occupational Voice State with a Visual Analog Scale: Voice Quality, Vocal Fatigue, and Effort

BACKGROUND

Due to elevated vocal health risk in industries such as call centers, there is a need to have accessible and quick self-report tools for voice symptoms. This study aimed to determine if the concurrent and construct validity of three visual analog scales (VASs) of voice quality and symptoms could be used as a screening tool in call center agents.

METHODS

A cross-sectional study was carried out in three call center companies. The Voice Handicap Index-10 (VHI-10) and a vocal hygiene and symptoms survey were administered to 66 call center workers. Further, acoustic parameters including harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), L1-L0 slope, and Alpha ratio were collected. Finally, workers completed three VASs capturing self-perception of vocal effort (VAS-1), voice quality (VAS-2), and vocal fatigue (VAS-3). Linear regression models with bootstrapping evaluated the possible relationship between the three VASs measurements, self-perceived vocal symptoms, and acoustic parameters.

RESULTS

VAS-1 scores were associated with HNR and voice breaks, VAS-2 with voice breaks, and VAS-3 with Alpha ratio. Using the area under a receiver operating characteristic curve (AUC), the highest AUC for detecting an altered VHI-10 questionnaire score was observed for the three VASs. Also, the highest AUC for detecting altered CPPs was reached for the VAS-1.

CONCLUSIONS

VAS as a self-report instrument of vocal symptoms is related to psychosocial voice impairment and alterations of acoustic voice parameters in call center workers. Such instruments could be easily implemented to identify voice complaints in these populations.

LEVEL OF EVIDENCE

2 (Diagnosis research question) Laryngoscope, 133:1676-1682, 2023.

The Effects of Room Acoustics on Self-reported Vocal Fatigue: A Systematic Review

PURPOSE

The main objective of the present systematic review is to quantify the relationship between the room acoustics and self-reported vocal fatigue.

METHODS

A comprehensive literature search and systematic review were conducted using PubMed/MEDLINE, Science Direct, Web of Science, EBSCO, and Scopus databases. Two inclusion criteria were defined: (1) description of a relationship between the room acoustics and self-reported vocal fatigue; and (2) reporting of raw data and/or a statistic of the association between the variables. Risk of bias in the included studies was assessed via the Quality Assessment Tool for Quantitative Studies Effective Public Health Practice Project. The occurrences and frequencies of the most common parameters in the literature are presented, and a quantitative summary of their relationships is reported.

RESULTS

In total, 12 publications met the inclusion criteria. The most relevant measures of self-reported vocal fatigue were the Vocal Fatigue Index (n = 3), Vocal Signs and Symptoms Questionnaire (n = 1), and vocal fatigue visual analog scales (n = 2). The most relevant room acoustic parameters include noise conditions (n = 6) and reverberation time (n = 2). The relationships between the room acoustic parameters and self-reported vocal fatigue are quantified and reported while maintaining the concepts stated in the original articles and outlining their similarities.

CONCLUSION

Overall, background noise and reverberation time were determined to be the most significant independent variables associated with self-reported vocal fatigue. A primary limitation of the evidence was inconsistent measures of self-reported vocal fatigue.

Working as a contact center attendant: Relating purpose, meaning, sustainability and mental health

BACKGROUND

There are companies that can be considered financially successful while creating negative externalities for their workers. This is the case of contact centers.

OBJECTIVE

The objective of this article is to investigate the challenges for a service company (such as a contact center) in reconciling its economic and financial objectives with the promotion of the work dimension, guaranteeing workers the possibility of professional, collective, and human development.

METHODS

This research has a qualitative ethnographic approach. An activity-centered work analysis method, also known as "Ergonomic Work Analysis" (EWA), was carried out in one of the largest companies in the Brazilian contact center market.

RESULTS

The case shows that the achievement of economic-financial objectives of the analyzed company is mainly done by harming the well-being of its workers. In particular, the work of the attendants did not bring any development perspective for them. The prevalence of instrumental rationality in decision-making processes and the asymmetry of power relations between stakeholders are the main reasons why workers' well-being is not considered.

CONCLUSION

The discussion proposes that work-related sciences, such as ergonomics and psychodynamics of work, can bring another type of rationality to the decision-making processes of companies. The work also needs to be sustainable enough to allow the construction and development of professionals, and the health of working population, while improving the company's performance.

The Effect of Vocal Hygiene Education Programs on Voice Quality in Professional Voice Users: A Systematic Review

PURPOSE

This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users.

METHOD

A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias.

RESULTS

Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment).

CONCLUSIONS

Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

Vocal ergonomics with sports coaches: Co-devised approaches to occupational voice

BACKGROUND: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice. OBJECTIVE: The current research aimed to cooperatively consider coaches’ vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use. METHODS: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches’ voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken. RESULTS: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4–14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches’ work-systems continued to influence coaches’ voices in dynamic and complex ways. CONCLUSIONS: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form ‘part’ of broader mechanisms to support coaches’ voice use and vocal health at work.

Systems Approaches to Occupational Vocal Health: Considerations for Community Faith Leaders

Systems thinking approaches can benefit the occupational vocal health of vocally reliant workers. This paper explores community faith leaders as an example of a highly vocally reliant occupation, who may benefit from systems thinking being used to support their vocal occupational health and safety. A scoping review of the current literature regarding faith leaders' occupational voice use and vocal health is detailed, including recognised occupational hazards. This article then discusses the unique and potential use of systems thinking for facilitating faith leaders' vocal occupational health and safety. Rather than using a solely clinical perspective, the sociotechnical systems approach and the biopsychosocial-spiritual approach are noted as particularly pertinent for this occupational group.

Action inquiry and vocal ergonomics: A pilot study with sports coaches

BACKGROUND

Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches.

OBJECTIVE

This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors.

METHODS

This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis.

RESULTS

Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1-2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes.

CONCLUSIONS

These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

Vocal Health, Working Conditions and Their Implications on the Occupational Health of Telemarketers: An Integrative Review

OBJECTIVE

To analyze the national and international literature on vocal health, working conditions and occupational health of telemarketers.

METHODS

A literature review was conducted using the LILACS, PubMed and SciELO databases. The term "telemarketing" was used for all searches, along with the following descriptors: voice, vocal disorders, work condition and occupational health. Articles published in English, Portuguese or Spanish from 2009- 2019 were included. The variables selected for organizing the data were authors, region, first author's education, affiliation, journal, objective, sample, design, and result.

RESULTS

A total of 540 publications were identified in the databases, and after applying the eligibility criteria, 14 articles were included in the final analysis.

DISCUSSION

Of the articles selected for final analysis, there was a concentration of studies in 2014, with a new peak of resumption of research in 2019. Regarding Brazilian studies, there was a concentration of studies from the Southeast region, mostly developed by speech therapists.

CONCLUSION

In the analyzed articles, it was possible to verify the interference of telemarketers' working conditions in their vocal and occupational health.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation

The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).