Barriers to Voice Therapy Attendance in a Language‐Diverse Population

Abstract

Objectives/Hypothesis: Voice therapy is an effective treatment for many voice disorders, but success depends on attendance and adherence. Many factors hinder treatment attendance, and language discordance with the provider may present an additional obstacle to attending therapy. This study evaluates factors associated with voice therapy attendance at a languagediverse, safety-net hospital.Study Design: Retrospective chart review. Methods: Retrospective review of adult patients referred to speech language pathology for treatment of voice disorders from January, 2018 to April, 2019. Primary spoken language, interpreter collaboration, and patient demographics were obtained from medical records. Multivariate analysis compared patient factors with voice therapy attendance versus nonattendance.Results: Of 422 patients, 219 (52%) attended at least one therapy session, whereas 203 (48%) did not attend (n = 120) or schedule therapy (n = 83). In multivariate analysis, only the association between public insurance and nonattendance was statistically significant (P = .016). After adjusting for interpreter use and interval between referral and first appointment, patients with private health insurance were 2.35 times more likely to attend therapy compared to those with public insurance (95% confidence interval: 1.18-4.71). Non-English language; interpreter collaboration; distance from hospital; and patient demographics, including age, gender, ethnicity, and birthplace, did not significantly correlate with attendance.Conclusions: In a culturally and language-diverse cohort of dysphonic patients, individuals with public health insurance were significantly less likely to attend voice therapy. Language-discordant therapy and interpreter collaboration was not a statistically significant barrier to therapy attendance. Additional investigation is warranted to optimize allocation of voice therapy resources for those with public health insurance and for diverse speakers of all languages.

Demographic differences in the treatment of unilateral vocal fold paralysis

“…Prior studies have shown that patients with private insurance are more likely to attend voice therapy in comparison to those with public insurance. 12 , 24 This observation was confirmed by our data. With this additional evidence, it may be inferred that public insurance is a surrogate of lower socioeconomic status and highlights underlying barriers such as lack of reliable transportation or time away from work and family to attend repeated voice therapy sessions.…”

“…Insurance status and different levels of coverage have previously been shown to impact decision-making in treatment selection for many laryngeal pathologies. Prior studies have shown that patients with private insurance are more likely to attend voice therapy in comparison to those with public insurance 12,24. This observation was confirmed by our data.…”