Utilizing virtual reality for gender-affirming voice training: surveying the attitudes and perspectives of potential consumers

Abstract

Background: Undertaking voice and communication training is an important part of the gender‐affirming journey for many trans, gender‐diverse and non‐binary individuals. Training supports the alignment of voice with gender identity helping to reduce gender dysphoria as individuals are better able to connect with their voices. However, for training to be effective, regular practice is needed and the demands of training can often be difficult to meet. Aims: To investigate the interest, attitudes and perspectives on the use of immersive virtual reality (VR) to support gender‐affirming voice and communication training by transgender, gender non‐binary and gender‐diverse people, and speech–language pathologists providing gender‐affirming voice and communication training. Methods & Procedures: A mixed‐methods survey (i.e., collecting quantitative data through multiple‐choice question and qualitative data through free text questions) was hosted online from 23 August to 21 September 2021. A total of 17 questions asked about technology use, and attitudes and perspectives towards VR. The survey included video examples of three different voice‐activated VR applications to prompt participant responses about the technology. Outcomes & Results: A total of 70 survey responses were included in the analysis. All participants had previous experience using smart phones, but only 27.2% had previously used VR. Four key themes were identified relating to potential uptake of VR in gender‐affirming voice and communication training: (1) general audience appeal, (2) perceived therapeutic value, (3) exposure to or protection from harm and (4) relatability to real life. Conclusions & Implications: VR games may represent a viable option to support practice of voice exercises. Gamification through VR is likely to motivate some to increase frequency of practice. VR applications that are used in voice training need to be fit‐for‐purpose, and detailed co‐design is necessary to build appropriate applications for future use. This study provides a foundation to inform the design, development and implementation of VR applications to be used in gender‐affirming voice training. WHAT THIS PAPER ADDS: What is already known on the subject?: Speech–language pathologists work closely with transgender and gender‐diverse individuals to help them achieve gender congruent voice and communication. Clients need to undertake regular and ongoing practice outside of training sessions to achieve and maintain their ideal voice. Motivation and adherence to regular practice sessions remain an ongoing challenge. What this study adds to the existing knowledge: This study explores the use of immersive VR technologies to create safe, motivating and enjoyable environments to encourage regular practice of gender‐affirming voice and communication exercises. It engages stakeholders in an early‐stage participant‐involved design to gauge interest in, and perspectives on, VR and technology‐based training support tools. The results suggest that voice‐activated VR applications would highly motivate some individuals if they were appropriately designed but would not be ideal for all. What are the actual and clinical implications of this work?: Immersion in VR can be a highly motivating tool to enhance adherence to practice schedules for some individuals. However, tools need to be specifically designed with outcomes in mind to be fit‐for‐purpose, to support individual goals and to minimize the risk of harm. The few existing VR voice‐activated applications that are available require further assessment, and redesign through co‐design with users to functionally and safely support gender‐affirming voice and communication training.