由新型移动应用程序提供的性别肯定嗓音训练：混合方法研究。

文献信息

中文摘要

背景： 性别肯定嗓音训练（GAVT）减少了跨性别和性别不一致（TGNC）个体的性别不一致感，但仍受限于费用和专科服务提供者的稀缺。移动健康（mHealth）是弥合这些可及性差距的桥梁；然而，在嗓音临床科学领域，高质量、临床指导的mHealth应用程序很少。
目的： 我们之前创建了一个免费移动应用程序（Attuned；Weill Cornell Medicine和Ithaca College），通过由言语语言病理学家和喉科医生叙述的结构化教学视频、练习和音高追踪工具提供临床指导的GAVT，并与TGNC个体社区顾问委员会共同开发。这项混合方法研究旨在评估该应用程序的可用性和用户的印象。
方法： 通过口口相传以及通过女同性恋、男同性恋、双性恋、跨性别、酷儿或疑问（LGBTQ+）社区组织进行广告，在全国范围内招募成年TGNC个体。参与者完成了基线半结构化访谈和人口统计学调查，使用Attuned一周，并完成了关于其印象的第二次访谈。访谈被逐字转录并在MaxQDA（VERBI Software GmbH）中进行归纳编码。三位作者独立生成编码本，并通过共识进行协调，然后两位作者将最终编码本应用于其余转录稿（共识前一致性95.7%；Cohen κ=0.86）。Attuned还由两位具有mHealth评估经验且未参与应用程序开发的评审者使用移动应用程序评定量表（MARS）、洲际医疗统计（IMS）医疗信息学功能评分、疾病控制中心（CDC）修改版清晰沟通指数、医学研究所（IOM）创建健康素养mHealth应用程序的策略、患者教育材料评估工具（PEMAT）和系统可用性量表（SUS）进行评估。教学脚本的可读性也使用6种经过验证的公式进行评估。
结果： 18名TGNC个体完成了研究（中位年龄27.5岁，年龄范围19-50岁）。10人认同为女性和/或跨性别女性，6人认同为非二元或性别不一致，2人认同为男性或跨性别男性。确定了八个主题。参与者认为嗓音是他人对其性别感知的关键决定因素，与嗓音相关的性别烦躁很常见。费用和难以找到服务提供者是GAVT的主要障碍，现有的免费资源被视为缺乏结构和不可信。使用后的印象总体积极，特别是关于结构化课程、音高追踪器、便利性和免费获取，但缺乏个性化反馈是一个关键限制。平均得分为MARS 4.21/5（SD 0.53）；IMS功能6.5/11（SD 0.7）；CDC指数82.5%（SD 24.7%）；IOM策略28.5/33（SD 2.1）；PEMAT可理解性和可操作性100%，SUS 92.5/100（SD 10.6），大多数可读性公式处于或低于八年级水平。
结论： 嗓音对TGNC个体的性别认同至关重要；然而，结构化和负担得起的GAVT在很大程度上仍然难以获得。Attuned在这一初始队列中受到积极接受，并在可用性、健康素养和可读性方面得分很高，尽管研究结果受到潜在默许偏差和评审者作者角色的限制。

英文摘要

BACKGROUND: Gender-affirming voice training (GAVT) has reduced gender incongruence for transgender and gender-nonconforming (TGNC) individuals, but remains limited by cost and scarcity of specialized providers. Mobile health (mHealth) is a bridge to these access gaps; yet, few high-quality, clinically informed mHealth apps exist within voice clinical sciences.
OBJECTIVE: We previously created a free mobile app (Attuned; Weill Cornell Medicine and Ithaca College) to deliver clinically informed GAVT through structured instructional videos narrated by a speech-language pathologist and a laryngologist, practice exercises, and pitch-tracking tools, developed with a community advisory board of TGNC individuals. This mixed methods study aimed to assess the app's usability and users' impressions.
METHODS: Adult TGNC individuals were recruited nationwide via word of mouth and advertising through lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community organizations. Participants completed a baseline semistructured interview and demographics survey, used Attuned for one week, and completed a second interview regarding their impressions. Interviews were transcribed verbatim and coded inductively in MaxQDA (VERBI Software GmbH). Three authors independently generated codebooks that were reconciled via consensus, then 2 authors applied the finalized codebooks to the remaining transcripts (preconsensus agreement 95.7%; Cohen κ=0.86). Attuned was also evaluated by 2 reviewers experienced in mHealth evaluation and not involved in the app development, using the Mobile App Rating Scale (MARS), the Intercontinental Medical Statistics (IMS) Institute for Health Care Informatics Functionality Scores, the Centers for Disease Control (CDC) Modified Clear Communication Index, the Institute of Medicine (IOM) strategies for creating health-literate mHealth apps, the Patient Education Materials Assessment Tool (PEMAT), and the System Usability Scale (SUS). Readability of the didactic scripts was also assessed with 6 validated formulas.
RESULTS: Eighteen TGNC individuals completed the study (median age 27.5 years, age range 19-50 years). Ten identified as women and/or transgender women, 6 as nonbinary or gender-nonconforming, and 2 as men or transgender men. Eight themes were identified. Participants identified voice as a crucial determinant of others' perceptions of their gender, with voice-related dysphoria common. Cost and difficulty finding providers were primary barriers to GAVT, and existing free resources were viewed as unstructured and untrustworthy. Postuse impressions were largely positive, particularly regarding the structured curriculum, pitch tracker, convenience, and free access, though lack of individualized feedback was a key limitation. Mean scores were 4.21/5 (SD 0.53) for MARS; IMS functionality, 6.5/11 (SD 0.7); CDC index, 82.5% (SD 24.7%); IOM strategies, 28.5/33 (SD 2.1); and PEMAT understandability and actionability 100%, and SUS 92.5/100 (SD 10.6), with most readability formulas at or below an eighth-grade level.
CONCLUSIONS: Voice is central to gender identity for TGNC individuals; yet, structured and affordable GAVT remains largely inaccessible. Attuned was positively received by this initial cohort and scored highly on usability, health literacy, and readability, though findings are limited by potential acquiescence bias and the raters' authorship roles.