JMIR Publications

ABSTRACT

Background:

Gender-affirming voice and communication modification training (VCMT) has demonstrated promising results in reducing gender incongruence for transgender and gender non-conforming (TGNC) individuals, but it remains difficult to access. Mobile health (mHealth) is a promising avenue to bridge these access gaps.

Objective:

Our group has previously created a free mobile application (Attuned™) to deliver evidence-based gender-affirming VCMT. We undertook a mixed-methods study to assess the app’s usability and impact.

Methods:

Participants were recruited via word of mouth and advertising through LGBTQ+ organizations. After an initial semi-structured interview, participants explored the Attuned™ app for one week. A second semi-structured interview was conducted to assess impressions of the app. Interviews were transcribed, and thematic content analysis was conducted by two independent researchers using an inductive approach. Attuned™ was also evaluated by two independent reviewers via a battery of validated scales for mHealth tools, including the Mobile App Rating Scale, the Intercontinental Medical Statistics Institute for Healthcare Informatics Functionality scores, the Centers for Disease Control Modified Clear Communication Index, the Institute of Medicine Strategies for Creating Health Literate mHealth Applications, the Patient Education Materials Assessment Tool, and the System Usability Scale. Readability was also assessed via the Flesch–Kincaid Reading Level, Flesch–Kincaid Reading Ease, Gunning-Fog Index, Coleman-Liau Index, SMOG Index, and New Dale-Chall.

Results:

Eighteen TGNC individuals completed the study. Participants identified voice as a crucial determinant of others’ perceptions of their gender, as well as their own dysphoria and self-confidence. Participants cited cost and difficulty finding providers as primary barriers to VCMT, despite desire for this treatment; some participants had accessed online resources but often doubted their trustworthiness. Impressions of the app’s content were largely positive, especially the clearly structured instruction and the pitch tracker function. However, participants highlighted the lack of feedback as a major limitation. Attuned™ scored highly on measures of usability, health literacy, and readability.

Conclusions:

Our results re-emphasize the crucial importance of the voice for TGNC individuals. Attuned™ was well-received by TGNC users, many of whom identified early changes in their voices.