Development and Validation of the Vocal Health Literacy Scale (VHLS) for English-Medium Instruction Educators: A
1School of Foreign Languages, Yunnan Agricultural University, Kunming 650201, China.
Abstract:
English-medium instruction (EMI) educators perform sustained occupational voice use and may experience elevated vocal load and voice-related risk. Despite extensive research on teacher voice symptoms, tools to quantify educators' competencies in accessing, understanding, appraising, and applying voice-health information and resources remain limited. This study developed and validated the Vocal Health Literacy Scale (VHLS) for EMI educators. A sequential exploratory mixed-methods design was used across five phases. Phase 1 involved semistructured interviews with EMI educators (N = 12) to elaborate domains and generate items using reflexive thematic analysis. Phase 2 employed a two-round Delphi process with a multidisciplinary expert panel (N = 15) to establish content validity (I-CVI; S-CVI/Ave) and refine the item pool. Phase 3 pilot testing with EMI educators (N = 52) evaluated feasibility, clarity, and preliminary item performance and informed item reduction. Phase 4 large-scale validation with EMI educators in Malaysia (N = 520) used split-sample EFA (n = 260) and CFA (n = 260), reliability estimation (McDonald's ω; Cronbach's α), convergent/discriminant validity (AVE; factor correlations), measurement invariance (gender, teaching context, EMI experience), and external validity testing (vocal hygiene behaviors, help-seeking intention, vocal fatigue). Phase 5 examined test-retest reliability over 14-28 days (N = 82; ICC [3,1]). Qualitative analysis yielded seven domains reflecting both core health literacy processes and occupational/EMI-specific demands. Delphi findings supported excellent content validity (final S-CVI/Ave: relevance = 0.92; clarity = 0.91; EMI-context fit = 0.93) and produced a 48-item draft. Pilot testing supported feasibility and guided refinement to a 38-item version. Large-scale validation supported a seven-factor model explaining 62.4% of variance, with acceptable CFA fit (CFI = 0.947; TLI = 0.941; RMSEA = 0.054; SRMR = 0.058) and high reliability (overall ω = 0.94). Measurement invariance was supported at full/partial scalar levels across subgroups. External validity patterns were theoretically coherent (higher VHLS associated with more frequent hygiene behaviors and stronger help-seeking; and with lower vocal fatigue). The final VHLS is a 35-item, seven-domain, literacy-grounded multidimensional instrument comprising core literacy competencies (access/navigation, understanding, appraisal, help-seeking), behavioral enactment (self-management), and contextual moderators (institutional barriers/supports, EMI-specific vocal load). Domain scores are re--ed as the primary basis for interpretation, whereas the total score should be understood as a broad composite profile of voice-health readiness/capacity rather than a narrow literacy index.
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