Knowledge, attitudes, and practice patterns related to vocal hygiene among conservatory students in China

To assess vocal hygiene knowledge, attitudes, voice-related practices, and educational needs among conservatory students in mainland China. Self-reported voice symptoms, previous clinician-diagnosed voice disorders, and symptom-management behaviours were evaluated as secondary outcomes.

This cross-sectional study used a self-administered online questionnaire and convenience sampling. A total of 315 conservatory students were included. The questionnaire comprised six sections assessing participant characteristics, voice disorder history and symptoms, vocal hygiene knowledge, attitudes, voice-related practices, and educational needs. Correlation analyses, multivariable linear regression, and separate multivariable logistic regression models for nine voice-related practices were performed.

The median knowledge score was 8 (interquartile range [IQR], 7-9), and the median attitude score was 7 (IQR, 5-8). Frequent whispering had the lowest correct-response rate (26.0%) and the highest proportion of "Do not know" responses (40.0%). Knowledge and attitude scores were weakly positively correlated (Spearman's ρ = 0.143, p = 0.011). Frequent throat clearing was reported by 44.1% of participants, whereas 41.3% reported warming up before singing and 27.9% reported cooling down afterwards. Each one-point increase in knowledge score was associated with higher odds of warming up before singing (adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI], 1.11-1.47; false discovery rate-adjusted p = 0.006), but knowledge score was not associated with any of the seven potentially harmful practices. Each additional recent voice symptom was associated with higher odds of all seven potentially harmful practices (aOR range, 1.25-1.97; all false discovery rate-adjusted p ≤ 0.016). As secondary findings, 196 participants (62.2%) reported at least one recent voice symptom, but only 21 of these participants (10.7%) sought care from a school medical institution or hospital. Overall, 273 participants (86.7%) expressed interest in obtaining further vocal hygiene information.

Conservatory students demonstrated generally favourable vocal hygiene knowledge and attitudes, but specific knowledge gaps and limited translation of knowledge into appropriate voice-related practices remained. These findings identify priorities for targeted, practice-oriented vocal health content and clearer healthcare-seeking pathways in conservatory settings.