Adherence to Voice Therapy: A Scoping Review of Influencing Factors, Support Strategies, and Evidence Gaps

The purpose of this scoping review was to summarize the existing literature on adherence to behavioral voice therapy. The aims were to describe how adherence has been defined and measured, to identify factors reported to influence therapy attendance and continuation, and to highlight strategies used to support adherence.

Data were identified and charted using the PRISMA-ScR framework and JBI guidance for scoping reviews. Searches were conducted across MEDLINE Complete, CINAHL Complete, APA PsycINFO, Web of Science Core Collection, Scopus, and selected gray literature sources from database inception to January 2026. Studies involving children or adults referred for or attending voice therapy were included if they reported outcomes related to adherence, attendance, or dropout.

Across included studies, adherence to voice therapy was consistently low, with dropout rates ranging from approximately 30% to 65%. Adherence was infrequently defined and was most commonly operationalized using attendance or therapy completion metrics. Factors examined in relation to adherence spanned individual, psychosocial, therapeutic, and organizational domains. Individual factors included motivation, perceived symptom impact, and readiness for behavioral change. Psychosocial factors such as employment demands, financial burden, caregiving responsibilities, and transportation barriers were commonly reported. Therapy- and clinician-related factors included clarity of goal setting, perceived relevance of therapy tasks, clinician-patient rapport, and structured follow-up practices. Telehealth- and technology-based supports were associated with improved attendance in some contexts. System-level factors were less frequently examined.

Research on adherence to voice therapy remains heterogeneous and methodologically limited. High dropout rates persist across clinical contexts, and substantial variability exists in how adherence is conceptualized and measured. Greater consistency in adherence definitions and increased attention to patient-reported and service-level factors are needed to advance understanding of engagement in voice therapy.