Validation of a Self-Perception Voice Protocol for Trans Women: Trans Woman Voice Questionnaire.

Abstract

Objective: To validate the Trans Woman Voice Questionnaire (TWVQ) in Brazilian Portuguese for measuring vocal self-perception in transgender women.

Method: This is a quantitative, methodological study. The validation process included steps for assessing validity, reliability, and responsiveness. The sample had five voice specialists, 85 transgender women, and 40 cisgender women. The voice specialists evaluated the TWVQ items using the Content Validity Index (CVI). Target population participants completed the TWVQ three times: initially, after 2-14 days, and following a voice intervention from a speech-language-hearing pathologist.

Results: The overall CVI in the content validation phase was 0.89. For the Item CVI (I-CVI), 13 out of 30 items scored below the expected threshold (<0.8) and were revised by the authors. The full protocol was administered to 20 participants from the target population, and 14 items required adjustments. Following item revision, the protocol was readministered to the target population, and all items were deemed adequate. The second validation phase involved 65 transgender women, administering the instrument at three moments: initial application (test), reapplication after 7-14 days (retest), and a third application after the voice intervention (responsiveness). For the final TWVQ version, items 1 ("People have trouble hearing me when I speak in noisy places") and 26 ("People who don't know me find my voice unusual") were excluded due to low communality. Confirmatory Factor Analysis validated the three-factor, 28-item TWVQ-Br model: Factor 1 with 15 items (voice-gender congruence), Factor 2 with 11 items (voice production and impact), and Factor 3 with 2 items (vocal restriction). Reliability was found for the internal consistency of the TWVQ-Br and test-retest reliability. Responsiveness indicated a significant change in construct scores following the voice intervention, with lower TWVQ-Br scores postintervention. The TWVQ-Br distinguished transgender and cisgender women across all factors and total scores (P < 0.001 for all).

Conclusion: The TWVQ's validation in Brazilian Portuguese led to significant adjustments to enhance alignment with the experiences of Brazilian transgender women. Certain items that did not contribute to the instrument's objectives were removed, and three factors were extracted. The final instrument had high reliability in test-retest analysis, high sensitivity with score changes postintervention, and the capacity to differentiate between transgender and cisgender women based on protocol scores, indicating that it specifically meets transgender women's needs.