An integrated empirical and computational study to decipher help-seeking behaviors and vocal stigma

Abstract

Professional voice users often experience stigma associated with voice disorders and are reluctant to seek medical help. This study deployed empirical and computational tools to (1) quantify the experience of vocal stigma and help-seeking behaviors in performers; and (2) predict their modulations with peer influences in social networks. Experience of vocal stigma and information-motivation-behavioral (IMB) skills were prospectively profiled using online surveys from a total of 403 Canadians (200 singers and actors and 203 controls). Data were used to formulate an agent-based network model of social interactions on vocal stigma (self-stigma and social-stigma) and help-seeking behaviors. Network analysis was performed to evaluate the effect of social network structure on the flow of IMB among virtual agents. Larger social networks are more likely to contribute to an increase in vocal stigma. For small social networks, total stigma is reduced with higher total IMB but not much so for large networks. For agents with high social-stigma and risk for voice disorder, their vocal stigma is resistant to large changes in IMB ( > 2 standard deviations). Agents with extreme IMB and stigma values are likely to polarize their networks faster in larger social groups. We integrated empirical surveys and computational techniques to contextualize vocal stigma and IMB beyond theory and to quantify the interaction among stigma, health-seeking behavior and influence of social interactions. This work establishes an effective, predictable experimental platform to provide scientific evidence in developing interventions to reduce health stigma in voice disorders and other medical conditions. Voice professionals such as singers and actors can experience stigma if they have a voice disorder. This stigma can result from their personal experience and knowledge (internalized) or be based on input from their peers, employment, and healthcare providers (externalized). To understand how negative vocal stigma spreads, we surveyed the stigma experience of voice professionals and developed computational models. We find that people tend to have more polarized stigma experiences when they are in larger social groups. Vocal stigma is not changed by a person’s knowledge, beliefs, and tendency to seek help. Our method could be used to study other stigmatized health conditions. Our research could also be used to reduce stigma and promote more equitable health care for vocal professionals with a voice disorder. Glick et al. investigate the stigma experience and help-seeking behavior in professional singers and actors using de novo data and social simulation. They find that vocal performers experience greater discrimination against their vocal injury with simulation data also predicting that vocal stigma could be worsened with larger social groups.