Developing a mobile application for gender-affirming voice training: A community-engaged approach

Objectives: To date, there has yet to be a rigorous exploration of voice and communication modification training (VCMT) among transgender and gender-nonconforming (TGNC) individuals using digital technology. We sought to evaluate and describe the iterative process of app development using a community-based approach. Methods: An interprofessional team of voice health care professionals, application developers, designers, and TGNC community members was assembled to conceive the functionality, content, and design of a mobile app to support VCMT for TGNC people. Six TGNC individuals, identified primarily by word of mouth, joined the development team as a Community Advisory Board (CAB). The CAB provided input on app content development, design choices, and user experience, with collaboration across disciplines and integration of TGNC community members throughout app development; the applicability of CBPR principles was evaluated throughout the development process. Results: Iterative cycles of content creation and feedback produced multiple substantial changes during the app's development, including added functionality, improved inclusivity and accessibility, and design and branding enhancements. Several successful outcomes from our approach were identified, including the recruitment of dedicated CAB members and interprofessional collaboration that included community members. Challenges included integration of multiple different approaches and levels of expertise, navigating TGNC individuals' participation without exploitation, and creating high-quality content on a limited budget. Conclusions: Our process demonstrates the value of including a CAB in the design of a digital VCMT platform, and suggests a potential for community-based participatory research (CBPR) in laryngology and speech language pathology, where uptake of this framework has remained limited. Level of Evidence: Level 5.