Relationship between occupational data, symptoms and voice evaluation of teleservice operators

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1 Relatioship betwee occupatioal data, symptoms ad voice evaluatio of teleservice operators Relação etre dados ocupacioais, sitomas e avaliação vocal de operadores de telesserviços Origial Article Aa Paula Dassie-Leite 1, Luciaa Loureço 2, Mara Behlau 3 ABSTRACT Purpose: To relate data regardig geder, age ad legth of time o the job with voice symptoms ad the results of vocal evaluatio of teleservice operators. Methods: A quatitative retrospective aalysis was carried with 404 medical records regardig periodic evaluatios of employees from bak istitutios with owed headquarters cotaied i the files of a compay of occupatioal medicie, 259 wome, 145 me, with ages betwee 18 ad 53 years (mea 30.48). The study had a descriptive exploratory desig. Results: Wome preseted greater quatity of voice symptoms (mea 1.69) ad voice alteratios (=33; 12.7%) tha me (mea 1.12; =6; 4.1%). No differece was foud betwee the amout of voice symptoms ad the auditory-perceptive evaluatio whe related to age ad legth of time o the job. Employees with eutral voices (=365; 90.35%) preseted lesser symptoms (1.41) tha employees with o-eutral voices (=39; 9.65%; mea 2.21). Thirty-four (87.2%) of the 39 employees with o-eutral quality of voice preseted larygopharygeal resoace, ad 21 (53.8%) preseted low pitch. Operators with moderate voice alteratio preseted icreased loudess whe compared to the operators with discreet alteratio. Coclusio: Wome preset greater rate of voice symptoms ad disorders. There is o relatioship betwee the icrease of age ad legth of time performig teleoperator fuctios with the icrease of the umber of symptoms ad vocal alteratios. Alteratios of pitch, loudess ad resoace are related to alteratios o the quality of voice. Keywords: Voice; ; Voice disorders, Occupatioal diseases; Aswerig services INTRODUCTION The speech laguage therapy practice with teleservice operators ad the search for improvemet i occupatioal health are gaiig space ad projectio i our coutry over the last years, due to expasio of this segmet i the labor market. It was recetly approved Appedix II of Regulatory Norm (RN) 17 about teleservice work, which eacts that all operatig ad maagig workers must receive traiig that provides learig The authors ad the compay ivolved i this study declare absece of coflicts of iterest. Study carried out at the Lato Sesu Course i Voice, Cetro de Estudos da Voz CEV São Paulo (SP), Brazil. (1) Speech-Laguage Pathology ad Audiology Departmet, Uiversidade Estadual do Cetro-Oeste UNICENTRO Irati (PR), Brazil. (2) Speech-Laguage Pathology ad Audiology Departmet, Micelli Soluções em Saúde Empresarial São Paulo (SP), Brazil. (3) Postgraduate Program i Huma Commuicatio Disorders: Speech- Laguage Pathology ad Audiology Field, Uiversidade Federal de São Paulo UNIFESP São Paulo (SP), Brazil; Lato Sesu Course i Voice, Cetro de Estudos da Voz CEV São Paulo (SP), Brazil. Correspodece address: Aa Paula Dassie-Leite. Rd. PR-156, Km 07, Rioziho, Irati (PR), Brazil, CEP: pauladassie@hotmail.com Received: 8/5/2009; Accepted: 8/9/2009 the work-related illesses, as well as their causes ad effects that may be related to the vocal duties (1). Accordig to the Brazilia Associatio of Teleservices ( Associação Brasileira de Teleserviços - ABT), i recet years the sector has achieved 235% growth, becomig oe of the largest employers i the coutry. The mai cotractor is the sector of fiacial services ad 25.4% of compaies have over five hudred workstatios. Most operators are females (76.8%) ad time of traiig before begiig work is geerally 4.4 weeks. Approximately 74% of these workers have the secodary level of educatio ad 22% are uiversity graduates (2). The teleservice operator geerally belogs to a youg populatio, aged betwee 20 ad 40, who has just completed high school or is attedig college (3). Curretly, some compaies have ivested i their ow call ceters ad have adopted career plas to the operators. This meas that older professioals are already i the market, with more time i the fuctio ad, i may cases, with higher educatio. Compay-owed call ceters, i geeral, provide better workig coditios ad better salary to the telemarketers. However, research does ot explai or differetiate these professioals accordig to their place of work (owed or outsourced call ceters) (4,5). Rev Soc Bras Fooaudiol. 2011;16(1):59-63

2 60 Dassie-Leite AP, Loureço L, Behlau M I this study, it is believed that this differetiatio is crucial, because the workig coditios ca be directly related to the vocal health of the operator. Therefore, it is ot possible to have a geeralized profile of this group of professioals. Durig the speech laguage therapy sessio at the stage of diagosis, it is essetial to uderstad the realities ad specific eeds of the orgaizatio. The physical eviromet requires a thorough aalysis, sice it may determie the success of a teleservice ceter or be the major geerator of problems (2). Therefore, this research is justified ad becomes relevat, sice it cotributes to the discussio about the role of speech laguage therapy with teleservice operators. Compaies have sought excellece i quality of services for cliets, as well as quality of life for the telemarketer. Curretly, teleservice is a area of much value, as a proper commuicatio with the cliet ca cotribute to build the good image of the compay. The telemarketer, without the aid of body ad facial commuicatio, depeds exclusively o the voice to captivate the cliet ad achieve the proposed goal (6). I a recet study, a survey of twety-five thousad vocal assessmets was coducted by a compay of occupatioal health ad it was cocluded that teleservices operators have more voice disorders i periodic examiatios tha i admissio examiatios (7). I a iteratioal study, it was cocluded that the operator has twice the chace to preset oe or more vocal symptoms tha those who do ot perform this fuctio (8). This may occur due to the fact that these professioals kow very little about the professioal use of voice, usig egative habits frequetly (such as lack of proper hydratio ad isufficiet vocal rest) (5,9). Studies show some of the probable factors related to occupatioal voice disorders, such as iadequate ergoomic coditios, poor room acoustics, excessive voice demad, improper vocal habits, stress ad metal exhaustio (10-14). Thus, there are studies that show the importace of vocal traiig activities for operators (15,16). A recet study assessed the occurrece of vocal symptoms before ad after a eight-week vocal traiig program to teleservice operators. Participats were compared to a cotrol group, composed of operators who did ot atted the traiig, but also aswered a questioaire o the occurrece of vocal symptoms o both occasios. The authors cocluded that there was o reductio of symptoms i the experimetal group after traiig; however, the cotrol group (utraied) had a higher umber of symptoms after eight weeks, idicatig that the traiig program ca be helpful i prevetig the accumulatio or exacerbatio of vocal symptoms (17). Some of the vocal symptoms ad complaits most referred by the operators are vocal fatigue, throat discomfort, throat clearig ad hoarseess, which may cause larygeal alteratios or ehace the possibility of vocal destabilizatio (8,10). I additio, a tese vocal productio, hyperasal resoace, pharygolarygeal resoace ad high itesity levels ca cause the cliet to have a egative impressio of the operator (18). Therefore, gettig to kow better the profile of teleservice operators may cotribute to desig the speech laguage therapy s role with these professioals ad to create specific vocal health programs for differet groups, accordig to their eeds. The goal of the preset study was to relate occupatioal data referrig to geder, age ad legth of time i the fuctio with voice symptoms ad perceptual voice aalysis of teleservice operators, employees of bak istitutios owed call ceters, cosiderig that the eviromet ad work coditios ca be directly related to the developmet of voice symptoms ad disorders. METHODS This study was approved by the Ethics Committee of the Cetro de Estudos da Voz CEV (No. 0215/07). It is a retrospective aalysis of 404 charts referrig to periodical evaluatios of employees of bak istitutios with owed call ceters, which appeared i the archives of a occupatioal medicie compay. The study had quatitative aalysis ad a descriptive exploratory desig. The director of the compay provided iformed coset. All research was i accordace with the Resolução Brasileira do Coselho Nacioal de Saúde. As iclusio criteria, the charts should be related to teleservice operators of bak istitutios owed call ceters, with complete data of idetificatio, age, time i the fuctio, relatio of vocal sigs ad symptoms ad data of perceptual assessmet of voice. All operators should have at least six moths i the fuctio. The vocal assessmet should have bee coducted by the speech therapist employed i the occupatioal medicie compay, with prove experiece i Voice (voice specialist or master degree). We excluded charts with icomplete iformatio ad also from idividual workig as lead operators or supervisors, ad operators of outsourced call ceters). I each chart, there was a relatio of the te most frequet symptoms reported by voice professioals, ad the operators could mark as may optios as they cosidered ecessary, accordig to their complaits. The optios icluded hoarseess, voice loss, pai or burig to speak, fatigue or effort to speak, dry throat, throat clearig, burig i the chest or stomach, eck ad shoulders tesio, rhiitis or allergies, larygitis, pharygitis or siusitis. Regardig the perceptual evaluatio, we aalyzed the followig parameters: voice quality, voice type, degree of disorder, resoace, pitch ad loudess. The evaluatio data were statistically compared with data from sigs ad symptoms, age ad time i the fuctio. For statistical aalysis, we used the oparametric tests of Ma-Whitey ad Kruskal- Wallis for comparig two variables, ad Chi-square to see if the two variables ad their levels had statistical depedece. We adopted a sigificace level of RESULTS The results show that females had a greater umber of vocal symptoms (1.69) tha males (1.12), with statistical differece (p<0.001). I additio, there were differeces whe comparig variables of geder ad voice quality (p=0.005), with more females with o-eutral voice quality (altered voice) tha males (Table 1). There was o relatio betwee umber of symptoms, age, time i the fuctio ad data from perceptual assessmet (Ta- Rev Soc Bras Fooaudiol. 2011;16(1):59-63

3 Occupatioal ad vocal data from teleoperators 61 Table 1. Relatio betwee geder ad umber of symptoms/voice quality Geder Average Neutral (N) No-eutral (N) Female * Male * Statistically sigificat (p 0.05) Ma-Whitey Test Table 2. Relatio betwee symptoms/voice quality ad age/time i the fuctio Age Average N Neutral No-eutral 18 to to to to over Time (years) i the fuctio Average N Neutral No-eutral up to to to to over Kruskal-Wallys ad Chi-Square tests (p 0.05) ble 2). Therefore, the results show that there is either higher frequecy of vocal symptoms, or greater umber of altered voices i workers with a more advaced age or with loger time i the fuctio. The results also show the compariso betwee the amout of reported symptoms ad data from the perceptual assessmet of voice (Table 3). It is observed that employees with voices cosidered eutral have lower umber of vocal symptoms tha employees with voices cosidered o-eutral, with statistical tedecy for differeces betwee the groups. However, there was o relatio betwee the umber of symptoms ad the degree of voice disorder of employees with o-eutral voice quality. Thus, operators with mild ad moderate degree of voice disorder have similar amout of voice symptoms. We also obtaied correlatios of data o perceptual assessmet. The parameter voice quality (with the degree of disorder) was related to the parameters pitch, loudess ad resoace (Table 4). Regardig the compariso betwee pitch ad resoace, we observed that most of the 39 employees with o-eutral voice quality had pharygolarygeal resoace ad more tha half had low pitch. The table also shows that most of the operators with moderate degree of voice disorder had high loudess, which was ot observed with operators with mild degree of disorder. DISCUSSION The first studies ivolvig teleservice operators focused o the aalysis of the vocal profile of this populatio (3,5,8,11). However, this segmet has expaded the market for speech Table 3. Relatio betwee the average umber of symptoms ad voice quality/degree of disorder Average Neutral 1.41 No-eutral * Degree of disorder Average Mild 2.41 Moderate 1.75 * Statistically sigificat (p 0.05) Ma-Whitey Test therapists ad it is importat to develop further research so that we ca work more properly with these workers. Some of the results with sigificat differece i this study corroborate the literature. Wome had more symptoms ad thus more voice disorders tha me (19). However, it is importat to say that this data is also related to wome s predispositio to develop lesios due to physiological posterior triagular gap (20). The umber of symptoms reported by operators is lower tha the umbers idicated i other studies, as well as the umber of altered vocal assessmets (7,9). The results for this kid of ivestigatio may vary greatly due to the various types of teleservice operatios, with differet requiremets, evirometal coditios ad risk factors for occupatioal health. We must cosider that the results of this study reflect the profile of teleservice operators workig i compaies-owed call ceters ad with career pla. Operators with voice disorders have more symptoms tha operators with o disorders. Still, the average of symptoms for both geders was low whe compared to the average of the geeral populatio, which may suggest that the operator Rev Soc Bras Fooaudiol. 2011;16(1):59-63

4 62 Dassie-Leite AP, Loureço L, Behlau M Table 4. Relatioship betwee voice quality ad pitch/resoace ad betwee degree of voice disorder ad loudess Resoace No-eutral Neutral Balaced Larygopharygeal 34 4 Hypoasal 2 7 Hyperasal 1 1 Pitch No-eutral eeds a tougher vocal tract ad a balaced vocal productio to stay loger i the fuctio/positio. People with more time i the fuctio did ot show icreased symptoms or voice disorders tha operators with less time. These results are differet whe compared to a study relatig admissio ad periodic vocal evaluatios of teleservice operators (7). The authors, however, have ivestigated the etire populatio of teleservice operators met at a occupatioal medicie compay, with very diverse profiles. The fact that older operators with more time i the fuctio do ot have icreased voice symptoms may be cosidered a very importat factor for them to keep their jobs for a log period of time. This allows us to discuss the work o teleservice, which has bee regarded as a temporary job ad ow Neutral Normal Low High 1 1 Loudess Degree of voice disorder Mild Moderate Normal 24 8 Low 0 3 High 3 1 * Statistically sigificat (p 0.05) Chi-Square Test <0.026* seems to be providig opportuities for professioal growth. Regardig the perceptual assessmet, operators with oeutral voice quality had icreased loudess, pharygolarygeal resoace ad low pitch. These perceptual characteristics ca provide importat data o possible cadidates do develop voice disorders, ad should be cosidered durig the speech therapist evaluatio, eve though there is ot a chage i voice quality itself. The perceptual data reiforce the importace of research to idetify characteristics which may be precursors of future vocal problems, such as the study that foud there is a icrease i fudametal frequecy of voice durig the operator s work day. This may suggest a icreased larygeal tesio, a risk factor to develop dysphoia (21). The positive relatio amog the variables (resoace ad pitch x voice quality ad loudess x degree of disorder) allows us to ifer that isolated chages of these parameters could be precursors of voice problems. Accordigly, early idetificatio could be crucial to maitaiig vocal health of operators. CONCLUSION Teleservice operators of bak istitutios with owed call ceters have low occurrece of symptoms ad voice disorders. There is o relatio betwee advacig age ad icreasig time i the fuctio with icreased rates of symptoms ad voice disorders. Operators with o-eutral voice quality (altered) have a higher umber of vocal symptoms. Chages i pitch, loudess ad resoace are related to chages i voice quality. The results support the iferece that the perceptual data may be importat to idetify possible cadidates to develop vocal problems throughout their professioal careers. For cofirmig such hypothesis, further research is eeded, with better cotrolled variables ad with data regardig the diagosis of voice disorders of the operators. The preset study shows differet results compared to other studies, fact that reiforces the idea that the workplace may play a crucial role i the developmet of symptoms ad voice disorders. Therefore, teleservice operators must be evaluated o their differeces ad diversities, so that we ca have a more accurate diagosis of these workers. Rev Soc Bras Fooaudiol. 2011;16(1):59-63

5 Occupatioal ad vocal data from teleoperators 63 RESUMO Objetivo: Relacioar dados referetes a gêero, idade e tempo a fução com os sitomas vocais e os resultados da avaliação vocal de operadores de telesserviços. Métodos: Foi realizada aálise retrospectiva e quatitativa de 404 protuários referetes a avaliações periódicas de fucioários de istituições bacárias com cetrais próprias costates o arquivo de uma empresa de medicia ocupacioal, 259 mulheres, 145 homes, com idades etre 18 e 53 aos (média 30,48). O estudo teve caráter exploratório descritivo. Resultados: Mulheres apresetam maior quatidade de sitomas vocais (média 1,69) e alteração de voz (=33; 12,7%) do que homes (média 1,12 e =6; 4,1%). Não houve difereça etre quatidade de sitomas vocais e dados da avaliação perceptivo-auditiva quado relacioados à faixa etária e tempo a fução. Fucioários com vozes eutras (=365; 90,35%) apresetaram meor úmero de sitomas (1,41) que fucioários com vozes ão eutras (=39, 9,65%, média 2,21). 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