Action inquiry and vocal ergonomics: A pilot study with sports coaches

Abstract

BACKGROUND:

Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches.

OBJECTIVE:

This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches’ vocally reliant occupational participation, and (ii) consider vocal ergonomic factors.

METHODS:

This research was undertaken at an international tournament for floorball (also known as ‘Innebandy’, ‘Salibandy’, or ‘Unihockey’). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis.

RESULTS:

Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1–2 directly supported coaches’ voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes.

CONCLUSIONS:

These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

Keywords

Voice use vocal health occupational voice users voice ergonomics participatory ergonomics

1 Introduction

Globally, workers’ jobs influence voice use and vocal health [1, 2] of at least 25% to 33% of the labour force [3 –6]. This includes work activities, environments, and broader job participation affecting workers’ voices [1 –6].

Critical vocal reliance increases workers’ risk of adverse vocal health, including experiencing voice symptoms 3 and voice problems 4 Voice problems include difficulties as defined by the voice user and voice disorders diagnosed by health care professionals [60 , 74]. Voice signs (changes in voice noticeable to others) and adverse voice symptoms may be part of the profile within voice problems [74]. [2 , 7–12]. Poor vocal health is also associated with:

Reduced work capabilities and increased workload demands [10, 13];

Diminished psychosocial wellbeing [10, 13];

Ongoing occupational participation challenges (e.g. absenteeism, reduced career trajectory) [13]; and

Broader health problems (e.g. work-related musculoskeletal disorders [14, 15], mental health disorders [13, 16]).

Based on these considerations, voice is advocated for inclusion within occupational health and safety (OHS) approaches for vocally reliant workers [1 , 14]. This includes policy [14], stakeholder education and training [14, 17], and OHS risk identification and management [1 , 14]. Examples of common vocal OHS risk factors include adverse acoustic environments, lengthy voice use, unsupportive postures, and psychosocial factors [14 , 17–19].

1.1 Vocal OHS and sports coaches

Sports coaching is a highly vocally reliant occupation [11 , 20–22], with recognised vocal OHS risk factors [11 , 20–23]. These factors include vocally demanding coaching activities [20 , 23], loud environmental noise [11 , 23], cold weather and associated respiratory illnesses [20, 21], air quality [23], and game specific location restrictions [21, 23]. These factors affect coaches’ voice use patterns and speech intelligibility [11 , 23], including necessitating lengthy voice use [11] and yelling [11 , 23]. Risk factors also affect coaches’ vocal health while coaching (e.g. increased voice symptoms [11 , 23], reduced ease of voice use [20, 21]).

Extant published research considers coaches in seasonal, domestic competitions for football-type sports [11 , 20–23] (e.g. European football/soccer [20 –23], rugby union [11], and Australian rules football (AFL) [11]). The direct applicability of findings from this research has limitations for non-football type sports, due to differences in coaching participation. Sports differ regarding working partnerships (e.g. working solo with players, coaching groups). Coaching locations also vary (e.g. public or team only spaces indoors, and/or outdoors). Similarly, voice use demands are inconsistent during competition (e.g. ongoing during play, remotely via technology, only between playing periods). Therefore, appreciation of in-context, vocally-reliant coaching participation appears a necessary imperative regarding coaches’ vocal OHS.

1.2 Vocal ergonomics

Vocal ergonomics integrates the principles of Human Factors and Ergonomics (HFE) [24 –27], with specific focus on voice [1 , 28]. This includes identifying factors and (re)designing system attributes to support voice users’ activities and system participation.

Aligned with broader HFE [25, 26], vocal ergo-nomics intends to promote, enhance, optimise, and safeguard:

Vocal health, safety, and wellbeing [1 , 28];

Voice-related performance outcomes (e.g. speech intelligibility) for speakers, listeners, and systems [19 , 30]; and

Usability and accessibility needs [27, 31] related to vocally reliant systems.

By deeply understanding and optimising people’s voice-related system participation [24, 25], vocal ergonomics is complementary to vocal OHS. Indeed, vocal ergonomics literature typically explores vocal ergonomic factors based on their implications for occupational vocal health [4 , 33].

However, voice is not yet routinely integrated into most areas of general HFE research and practice [34]. For example, participatory ergonomics approaches empower the active participation of system users in HFE initiatives [35, 36]. Through shared input and actions, these approaches aim to enhance system experiences and outcomes for users [35 , 37–40]. Participatory ergonomics most typically privileges the local knowledge of workers [37 –39]. However, there is current paucity regarding stakeholder collaboration addressing HFE for vocally reliant workers.

1.3 Research aims

This exploratory study investigated how vocal ergonomics can be considered with, by, and for sports coaches. It piloted a participatory approach to vocal ergonomics with floorball (aka innebandy, salibandy, unihockey [41]) coaches. Floorball is a hockey-type [41], indoor, team sport played across three 20-minute periods [42]. Published research has not explored floorball coaches’ voice use and vocal health. Floorball was chosen due to the indoor location, coaches’ vocally reliant involvement throughout games, and researcher access to a major international tournament.

The research aims included:

Understanding vocally reliant coaching participation;

Identifying vocal ergonomic factors (i.e. aspects of the coaching system that impacted on coa-ches’ voices); and

Cooperatively designing vocal ergonomic ap-proaches within the coaching context. This included collaboratively developing, implementing, and evaluating actions. It also incorporated seeking recommendations for future approaches.

2 Methodology

As a form of cooperative action inquiry [43], this study piloted a participatory vocal ergonomics programme (see Fig. 1 and Appendix A). This ascribed to notions of contextually anchored knowledge [43 –45], and was guided by The Participatory Inquiry Paradigm [43].

Fig. 1

Stages of Cooperative Action Inquiry. Note. Dark arrow indicates where analysis directly facilitated subsequent stage of action inquiry. Dash arrows indicate where analysis informed subsequent stage of action inquiry.

Three national coaches collaborated with the lead researcher, who was in the role of subject matter expert (SME). Coaches’ roles within the team were head coach, primary assistant coach, and development coach. Coaches had an average age of 34.33 (SD = 10.79) and average coaching experience of 14.67 years (SD = 11.02). See Table 1 for coach-specific demographic details.

Table 1

Coaches’ demographics

Characteristic	n
Age (years)
25 and under	1
26 to 35	0
36 to 45	2
Gender
Male	3
Broader employment
Business and trade	2
Education	1
Paid coaching	3
Current coaching level
National	3
Seasonal domestic	3
Prior national coaching (years)
Less than 5	1
5 to 10	0
11 to 15	0
16 to 20	1
Over 20	1
Language used while coaching
English	3
German	2

Note. n = number of coaches (total = 3).

Coaches and the SME actively participated [35 , 46] in the action inquiry. Coaches were local experts [38, 47]. As such, their knowledge about vocally reliant coaching held status as relevant to HFE [38]. The SME is a vocal ergonomist and first author of this paper. The SME was also the team’s photographer across the tournament, which facilitated a participant-observer role [48]. Within this article, the term participants refers to coaches and the SME. Coaches’ specific contributions are labelled coaches.

Participants cooperatively undertook shared meaning and decision making [43], to facilitate considered actions and context-anchored inquiry [47]. Inquiry and action drew on participants’ reflective practice insights, broader scientific knowledge, and in-context (local) knowing [49].

Reflexivity [44 , 51] and research quality [52] recommendations from extant literature also supported this research. This included reflexive journaling [51], SME participation analysis, member reflections [52], and critical friends [47, 53]. These actions facilitated empowered and epistemic participation for all participants [43, 50].

2.1 Research context

This action inquiry focused on the coaching group of a national women’s floorball team, and was undertaken during a World Floorball Championships qualification tournament. This tournament occurred in winter at an indoor, multi-purpose, sports stadium. The collaboration spanned the national team’s three days of onsite preparation and four days of competition.

2.2 Data generation and analysis procedures

All research processes adhered to approvals from the SME’s university ethics committee and the sport’s governing bodies (domestic and international). The vocal ergonomics programme spanned four stages, each with various approaches for generating cooperative action inquiry (see Fig. 1 and Appendix A). This encapsulated approximately 75 hours of coaching responsibilities.

The SME undertook categorical aggregation and direct interpretation [54] at the end of each stage, which supported subsequent inquiry. Analysis of the preliminary stage directly facilitated undertaking the development stage, with these findings conveyed to coaches during the latter stage (as indicated by the dark arrow in Figure 1). The SME also conducted deeper, reflexive thematic analysis [44, 55] after the tournament.

On obtaining agreement from coaches, the interviews, search conference, and focus group were audio recorded and transcribed verbatim. Pseudonyms were used for all written notations of coaches’ input (e.g. SME’s fieldnotes, reflexive journal, transcripts). In this paper, these coaches are referred to by the pseudonyms Kristian (head coach), Erik (primary assistant coach), and Lars (development coach).

3 Findings

Three themes were generated from this action inquiry. Theme one presents factors that affected coaches’ voices while coaching. Theme two details vocal ergonomic approaches specifically developed, implemented, and evaluated during this action inquiry. Theme three captures participants’ reflections and recommendations regarding undertaking a collaborative vocal ergonomics programme.

3.1 Factors associated with vocally reliant coaching

Participants identified six factor groupings that affected coaches’ use and experience of voice. These factors are detailed in the following sections.

3.1.1 Coaches’ vocal health factors

Coaching participation was associated with pervasive experiences of voice symptoms, which had implications for coaches’ voice use. All coaches shared experiencing voice symptoms sometimes while coaching.

Experiencing voice symptoms affected coaches’ dynamic vocal delivery (e.g. varied volume, pitch, tone). This interrupted the nuanced voice performance they relied on for coaching success. Lars detailed this interference:

I get croaky voice, I can’t shout loudly. I just can’t really put that much emotion into it. You’ve only got that one monotone, or whatever it is, so you can’t express. So, therefore that takes out a bit of what you’re trying to do (with coaching). It does impact in a big, huge way (Lars, interview).

Voice symptoms occurred across coaching settings (e.g. domestic training sessions, domestic games, international tournaments), but most frequently at major tournaments. This was influenced by tournament activity demands, consecutive days of lengthy coaching, and travel-related factors (e.g. fatigue, dehydration). Coaches often tolerated voice symptoms during tournaments, and anticipated voice symptoms as somewhat inevitable.

Despite the pervasive experiences of voice symptoms, all coaches considered themselves generally ‘vocally well’. They also acknowledged infrequently considering vocal health. No coaches reported medically diagnosed voice problems.

3.1.2 Coaching activity factors

Coaches engaged in diverse vocally reliant activities at this tournament, including team training, game preparations and briefings, games, and post-game performance analysis. During tournament activities, coaches often rapidly altered their vocal loudness, pitch, and tone. Coaches reported that this facilitated players’ performance outcomes.

However, potentially unsafe voice use (e.g. yelling, prolonged talking) was often required to achieve desired team success at tournaments. Kristian described this as “becoming more aggressive in the throat” (Kristian, search conference). Coaches also connected potentially unsafe voice use with performance critical situations (e.g. close-scoring games, timeouts) and experiences of voice symptoms.

Coaches reported finding tournament coaching activities more vocally demanding than other settings (e.g. domestic competitions, development camps, weekly training). This was linked to specific coaching activities and broader contextual factors.

Coaches also reflected that the emotions they experienced while undertaking coaching activities impacted on their voices. Specifically, they associated heightened emotions with altered voice use patterns and experiences of voice symptoms. For example, coaches connected negative emotions (e.g. frustration, anger, disappointment) to experiencing throat tension during coaching. Erik described the link between coaches’ emotions and voice as:

“Emotions also play on your voice. Like after a tough game, you’re always feel it. You’ve obviously been shouting, or it’s a real tight game, or you’re getting pumped. The game situation plays a whole lot to the voice.” (Erik, search conference).

3.1.3 Physical environmental factors

Physical environment at playing locations influenced coaches’ voices, particularly at tournaments. Court temperature and air quality often affected coaches’ hydration habits and caused sensations of dryness in the upper airway. Lars also noted that dusty environments frequently made him cough during coaching, affecting his voice quality.

Echo and excessive noise increased coaches’ experiences of vocal effort. These factors also required elevated vocal loudness to maintain speech intelligibility. Excessive noise was present in almost all coaching settings at this tournament. This noise came from various sources, which coaches shared was common to other tournaments. Lars discussed the impact of noise on coaching:

It’s (noise) around all the time. At tournament training, especially with the girls (athletes), we have music cranking (loud music volume) all the time. So, when we have to stop and do a new drill, the music is often the last thing we think of. It’s sort of forgotten about. I just shout over that. But in the game, you’ve got shoes running - like the squeak on the floor, sticks, umpires’ whistle, general chitter-chatter on the bench, players calling for the ball. So that makes a huge amount of noise. Then obviously in the internationals as well, you’ve got the big crowd. So, you’ve really got to make sure your voice is the one heard and shouting out! (Lars, interview).

3.1.4 Team-related factors

Player characteristics influenced coaches’ voices. Coaches spoke more frequently to support athlete needs with this national team than they would in domestic, seasonal competitions. Coaches attributed this to less familiarity within the national team, and perceived gender-based needs of players as recipients of vocally delivered coaching instructions. Coaches considered that female athletes best responded to conversational-type talking from male coaches, rather than unnecessary yelling. Coaches found this more cognitively demanding than the abrupt yelling they used with male teams.

Participants recognised that coaching roles influenced each coaches’ voice use during tournament coaching. As Lars noted, the head coach often talked more loudly, more often, and for longer periods than other coaches.

3.1.5 Sport-related factors

Floorball’s game requirements required coaches to remain at the team bench during competition play. Participants identified that this location restriction often resulted in coaches yelling to maintain communication with dispersed, moving athletes.

Coaches also found the 30 second temporal limitations of timeouts vocally demanding. This short span necessitated coaches’ rapid and intense voice use, as they delivered critical coaching instructions to their team. Coaches described often experiencing voice symptoms after timeouts.

3.1.6 Supportive personal behaviours for voice

Coaches undertook various actions while coaching that facilitated effective and safe voice use. These were both personal habits and intermittent, but intentional actions to enhance vocal communication with players.

Coaches shared that their voices were often supported by the task modifications undertaken at train-ing and games intended to improve communication with players. For example, coaches reported increa-sed vocal ease from (i) reduced distances between communication partners, and (ii) standing during vocal projection. However, coaches noted limitations in distance modification options during games.

Methods of coaching task modification at this tournament included:

Huddling players together;

Using repeated keywords, which avoided lengthy talk;

Incorporating non-vocally reliant communication (e.g. drawing, gesturing); and

Relaying messages through players, rather than yelling to the team.

Hydration was the only behaviour coaches specifically undertook to alleviate voice symptoms. However, Erik identified that avoiding needing to urinate during coaching often resulted in his inadequate hydration for voice. He suggested this was “like calculating all the time” (Erik, interview), particularly during games.

3.2 Vocal ergonomic approaches

Four bespoke voice support strategies were developed, implemented, and evaluated across this study. Table 2 details each of these vocal ergonomic approaches, including participants’ evaluation of their use.

Table 2
Vocal Ergonomic Approaches

Strategy Rationale Approach and Evaluation

1. Gaining players’ insights on coaches’ voices Athletes are coaches’ primary communication partners. This may afford athletes novel insights into coaches’ voice use. Semi-structured, non-audio recorded meeting between player group and the Subject Matter Expert (SME). This occurred prior to competition, to facilitate implementation of relevant recommendations across the tournament.

Athletes indicated speech intelligibility considerations in coaches’ voice use. These included hard to distinguish terms in the heavy background noise of play (e.g. sub for player substitution and push up for move forward).

Athletes noted supportive attributes of coaches’ voice use (e.g. word repetition, close proximity).

SME provided coaches with summary of meeting. Coaches then addressed these considerations with players at a subsequent team meeting, agreeing to keyword changes and focusing on louder instructions during games.

Coaches deemed this strategy useful in clarifying effective voice use practices for this team.

Coaches recommended earlier timing of player consultation in future programmes.

2. Ongoing feedback discussions Ongoing discussions aimed to facilitate continued sharing from all participants to support sustained action inquiry. This included recognising the novelty of this programme, supporting broader strategy implementation, and to further explore coaches’ vocally reliant participation across this tournament. Participants engaged in 16 discussion sessions across the tournament. These discussions occurred during scheduled coaching meetings (i.e. briefly at period ends, in-depth at end-of-day).

Participants explored facilitators and barriers for coaches’ voices during these discussions.

Recognised facilitators included supportive coaching behaviours (e.g. shared vocal demands, reduced proximity to players for critical voice use, non-vocal communication) and supportive player behaviours (e.g. repeating coaches’ keywords, requesting instruction clarification).

Commonly discussed barriers included players’ performance errors and adverse environmental noise. These recognised barriers often required loud, effortful voice use to support team performance and were too challenging to directly eliminate within the tournament context.

Coaches reported that feedback discussions supported their ongoing attention to voice. As Lars noted: “We have more to think on than the voice, so you are our reminder.” (Lars, focus group).

Coaches recommended increased focus on vocal health during these discussions in future. However, participants recognised that tournament time pressures limited opportunities for in-depth health discussions.

3. Increased movement and postural change Coaches’ voices were adversely affected by far distances between communication partners and static, seated postures. Coaches wore pedometers during competition games.

Coaches reported that while steps were a good indicator of how much they had moved, the pedometers did not promote behavioural change during games. As Lars noted, coaches often forgot they were wearing pedometers during competition times. He suggested that physical stimuli may be more successful in reminding coaches to engage dynamic postures and move closer to athletes, stating “I didn’t think to look. Perhaps if it buzzed?” (Lars, focus group).

4. Specific task adaptation to reduce vocal demands Coaches’ used drawing on the whiteboard while instructing athletes on movement sequences (aka plays). Having access to additional whiteboards may promote this auxiliary communication channel and reduce coaches’ effortful voice use across games. Four additional whiteboards were introduced for tournament games (i.e. five whiteboards available in total).

All coaches utilised whiteboards when discussing plays with athletes during the tournament, particularly in the locker-room. However, they only intermittently used whiteboards during competition periods. While drawing, coaches often sustained loud talking to overcome noise and maintain players’ attention.

Athletes often used whiteboards to explain plays to each other during games. While this may have somewhat reduced coaches’ need to explain or clarify instructions, it was unclear if coaches’ vocal demands lowered during competition play. As Kristian noted: “There was always something to tell the girls (athletes).” (Kristian, focus group).

Coaches identified that presence of additional barriers impaired success of this strategy by necessitating coaches’ continued engagement in demanding voice use (e.g. ongoing player performance errors, communication breakdowns, lack of team familiarity).

Note. SME = Subject Matter Expert. The vocal ergonomist undertook this role as they facilitated the cooperative action inquiry with coaches.

3.3 Programme reflections

Coaches reflected that programme participation cultivated new, actionable insights regarding their voices. This included informing how they undertook vocally reliant coaching at this tournament. For example, Kristian discussed how his increased awareness of environmental factors facilitated personal task modification:

Instead of yelling out when there was so much cheering, and noise, and such things, maybe I was more likely to bring the players in. To hear, you have to be really, really close. Or loud! So maybe I was more a close-to-me coach. (Kristian, focus group).

Coaches recommended that early career coaches would particularly benefit from the experiential learning within this programme.

Coaches suggested that demanding coaching workloads limited their abilities to generally consider voice across all aspects of the tournament. So too did paucity of previous vocal awareness. However, coaches found the SME’s presence facilitated their targeted and emerging focus on voice (e.g. strategy implementation and further contemplations of search conference topics). Further, coaches emphasised the importance of the SME role matching coaches’ needs, as Erik discussed:

At the moment of coaching, I have to coach. I am not (focused) on my voice. So, the feedback (given) when we already meet was useful to me. I would ignore you otherwise (laughter). Sorry, but I mean I would not take it in. Oh, and I liked that I could ask you questions too. Two ways streets . . . that way we can still do the job at hand, which is coaching, without worrying too much. Because, you know at the end of the day, we’ve got to coach the game. (Erik, focus group).

In future programmes, Kristian recommended ongoing capturing of voice performance to support coaches’ reflections:

Now I know, I want to look back (on) how it feels, how it sounds. But I don’t really remember it all, you know, my voice at all times. So maybe if there were video of coaches that we could watch again. Like how we video games to watch players. Or maybe even a number. That way we could look back at our numbers, I sort of want a track-record. (Kristian, focus group).

Coaches also suggested extended programme durations, such as a full domestic season or the entirety of preparation and participation in World Championships.

4 Discussion

Participants collaboratively identified and responded to various vocal ergonomic factors within this action inquiry. The following discusses the nature of this experience in light of extant literature.

4.1 Vocal health

This action inquiry supports broader assertions that vocally reliant workers experience poor vocal health associated with work participation [2 , 7–12]. Coaches shared experiencing voice symptoms while coaching, which negatively affected undertaking vocally reliant coaching demands. Participants also discussed the impacts of tasks themselves, alongside the contributions of contextual factors. This systemic and layered influence from work is similarly reported by and for football coaches [11 , 23], teachers [56 –58], telemarketers [9], and fitness instructors [59].

Coaches in this action inquiry recommended more direct consideration of vocal health during feedback discussions (i.e. strategy 2) and using numeric ratings for ongoing tracking of voice during coaching. Future vocal ergonomics programmes could also more systemically evaluate coaches’ ongoing vocal health through utilising existing questionnaires (e.g. the Voice Capabilities Questionnaire [11, 60]).

4.2 Vocal reliant activities

Coaching activities influenced coaches’ experiences of demanding voice use and voice symptoms. Participants recognised the contributions and interconnectedness of coaches’ sustained and loud voice use, far distances between communication partners, coaches’ adverse postures, and coaches’ psycho-emotional experiences.

Participants within this study recognised various vocal acts (e.g. yelling, shouting, prolonged voice use) associated with coaches’ experiencing voice symptoms. This is similarly reported for broader vocally reliant workers [12, 61]. Potentially unsafe voice use can create phonotrauma, leading to voice symptoms and problems [12, 61]. Responsive to these risks, adequate technical supports [17, 59] and recovery times [14, 15] are advocated as OHS considerations for vocally reliant workers. However, engaging these resources is reportedly challenging for many vocally reliant workers, including football coaches [11] and fitness instructors [17, 59].

Far distances between communication partners are also a recognised vocal OHS risk factor for vocally reliant workers [4, 14]. This is because workers need to increase their vocal loudness to be heard by others, which may lead to unsafe voice use [1, 4]. Adverse postures during voice use also contribute to workers’ experiences of vocal effort, demanding voice use, and vocal fatigue. This includes positioning of the head, neck, shoulders, torso, and pelvis [4 , 15].

Further, extant literature recognises the impacts of psycho-emotional factors on voice for both coaches [21 , 62] and broader vocally reliant workers [56]. This includes associations between heightened emotions, potentially unsafe voice use patterns (e.g. loud voice use), voice symptoms, muscular tension, and burnout [16 , 23].

Two strategies addressed vocally reliant activity factors within this action inquiry. Coaches’ use of pedometers was introduced to address proximity and postural considerations (i.e. strategy 3). Despite the limitations of this strategy, coaches’ recommendations of something that buzzed should be explored to support movement and postural change. This might include movement-based accelerometers.

There were also limitations with the usefulness of specific task modification designed to increase non-vocal communication (i.e. strategy 4). However, future research should explore other task adaptation mechanisms to reduce coaches’ vocal demands (e.g. amplification). Personal amplification is suggested for vocally reliant workers [17 , 63], with advocacy that amplification matches workers’ needs [59]. As such, coaches’ infield insights should guide this recommendation.

4.3 Physical environment

Participants in the current study recognised the negative impact of physical environmental factors on coaches’ voices. This included the presence of pervasive and loud noise across coaching settings. Pervasive, loud noise is a common vocal health risk factor for vocally reliant workers [10, 19]. It contributes to vocal demands, listener demands, and cognitive load [10, 19]. Noise sources reported for football coaches include crowds, adjacent transport systems, and adverse weather [11 , 23]. This noise also increases football coaches’ vocal demands and experiences of voice symptoms [11 , 23].

Reverberation may further contribute to noise within indoor locations [4], which can interfere with speech intelligibility [24]. Presence of reverberation at tournaments may account for floorball coaches’ experiencing echo and difficulties with being heard by players.

Air quality also affected coaches’ voices in this study, with one coach reporting associated chronic cough. Air quality, particularly dry air and air pollutants, also affect football coaches’ voices [23]. Dry air and airborne pollutants can affect vocal folds’ mucous membranes [4, 64], triggering inflammatory responses of the upper airway and chronic cough [32, 65]. Inflammation and cough can cause voice symptoms and problems [12], including itching, sore throat, and impaired voice quality [4, 64]. Low relative humidity, artificial heating, and artificial cooling can cause dry air [32, 65].

Participants from the current study found directly addressing physical environmental risk factors to be too difficult within the tournament context. These concerns mirror extant research advocacy that physical vocal risks be managed in the planning and modification of built environments [19].

4.4 Team

The player and role related factors highlighted within this study do not appear to have been considered in previously published voice literature.

The strategy of player consultation (i.e. strategy 1) addressed identified and potential faciliatory, player-based factors. This included athletes’ perspectives as coaches’ primary communication partners. Existing literature does not routinely explore how listener attributes influence perceived vocal demands for vocally reliant workers. However, broader sports research demonstrates players’ perspectives on coaches’ effective communication [66]. Further, research highlights that coaches and athletes have overlapping, but distinct perspectives within the coach-athlete-performance triad [66, 67]. This supports the inclusion of communication partners in future participatory vocal ergonomics programmes.

Job task organisation contributes to elevated risk of voice-related work limitations, potentially unsafe voice use, and poor vocal health for occupational voice users [10 , 23], including football coaches [11 , 23]. Domestic football coaches have a predictable changing of vocal demands across the working week, with voice symptoms matching this pattern [11 , 23]. However, coaches at tournaments do not have this cyclical fluctuation in vocal demands. This may be why coaches in this action inquiry reported tournaments to be more vocally demanding that other coaching situations.

The SME’s presence for this action inquiry was an additive factor to this team. HFE professionals often attend workplaces to support participatory ergonomic approaches [37, 38], particularly when considering HFE is novel [37]. Coaches reported that collaborating with the SME provided them with new insights and opportunities to address vocal ergonomics. This included ongoing feedback discussions with the SME (i.e. strategy 3), and the programme more broadly. Coaches’ reports also mirrored assertions within participatory ergonomics literature that HFE professionals must meet the knowledge and context needs of workers [36, 37].

4.5 Sport

The sport-specific location restrictions identified within this study are common to those reported by European football/soccer coaches [21]. In both sports, coaches are required to remain located at the bench-area during competition play. The subsequent distance between communication partners requires coaches to increase their vocal projection to successfully deliver messages to players. This vocal behaviour increases coaches’ risks of voice symptoms and voice problems [11 , 62]. No sport-related factors were directly addressed by the programme.

4.6 Personal behaviours

Coaches in this study also demonstrated existing personal behaviours supportive of effective and safe voice use. These general personal supportive behaviours mirror the habitual and coaching outcome orientated behaviours of football coaches [11 , 20–22]. Across existing research, coaches do not typically engage in this behaviour for vocal health [11 , 22]. Further, the current study presents the novel report of a coach avoiding hydration to prevent needing to urinate at work. This has implications if the generic vocal health recommendation of hydration is given to workers [63].

5 Limitations and strengths

This qualitative pilot was undertaken between four participants across seven days. As such, the research holds high particularisation [45], which may limit direct transferability. However, it provides an example of how action inquiry can be used to consider vocal ergonomics within the context of an international sports tournament.

In critiquing research quality, several attributes should be noted. Coaches’ insights into the importance of collaboration and the SME role mirror broader participatory ergonomics literature [36 –38]. However, active researcher involvement heightens potential to unfavourably influence the study. As such, the importance of reflexivity mechanisms (e.g. those outlined in the methodology) cannot be understated.

Valid criticism may also be levelled at this pilot’s focus on one sport, a singular sporting event, and only male coaches. This male representation continues bias within published research reporting on top-level coaches’ voice use and vocal health. Further, data on changing experiences of vocal health were not systematically collected across the tournament. Addressing these considerations was beyond the scope of this pilot, but are strongly advocated for future investigations.

This pilot also holds strength in its richness of data, innovation, and insights regarding collaborative engagement between participants. It appears to be the first study to explore participatory ergonomics for voice. This research is also unique in considering coaches’ local expert knowledge, SME insights, and extant research to support action inquiry regarding vocal ergonomics. Further, it is innovative in exploring occupational voice for coaches outside of football, working at the highly vocally demanding context of an international tournament.

6 Conclusions

Sports coaching is a vocally demanding occupation. Major tournaments require vocally reliant coaching in the presence of various vocal ergonomic factors, some of which contribute to vocal demands and vocal health risks. This action inquiry provides an example of how participatory vocal ergonomics can be engaged with sports coaches to identify and address some of these factors. This research also supports the integration of HFE professionals [34] and vocally reliant workers in meaning and decision making regarding vocal OHS and vocal ergonomics.

Footnotes

Acknowledgments

Acknowledgement is given to the International Floorball Federation (IFF) and the Australian Floorball Association for endorsing this research; and to Dr Lindsay Carey for editorial support for this article. No industry or grant funding was associated with this study. La Trobe University ethical clearance number: FHEC13002.

Conflict of interest

None to report.

Appendix A: Details of action inquiry methods

Table A1.

Action Inquiry Methods

Programme Stage & Timing	Purpose	Data Generation / Collection Method	Approach
Across whole action inquiry		Fieldnotes	The Subject Matter Expert (SME) generated fieldnotes across stages to document events, alongside reflections and conceptual considerations [68]. Three types of fieldnotes were generated.
			•Participatory fieldnotes chronicled the SME and coaches’ shared meaning and decision making.
			•Observational fieldnotes [45 , 68] noted coaches undertaking of coaching duties.
			•Reflective fieldnotes [43 , 68] supported reflexivity and evolving conceptual knowing by consolidating the SME’s participation, observations, and reflections at the end of each session [68].
Preliminary: Pre-game 1	Deeply understand vocally reliant coaching participation	1 : 1, semi-structured interviews	Each coach engaged in a semi-structured interview [69] with the SME. They explored coaches’ experiences of voice, including vocal health, vocal demands, and broader ergonomic factors.
		Coaching observations	The SME observed the team’s onsite tournament preparation to witness coaches’ local contexts and system participation [27, 68]. Observations were informed by the novelty of local contexts [45 , 68], alongside the SME’s knowledge of vocal ergonomics and vocal OHS [4 , 28].
Development: Pre-game 1	Cooperatively develop vocal ergonomics approaches	Search conference	All participants undertook a collaborative workshop, known as a search conference to cooperatively develop bespoke voice support strategies. Search conferences are an inquiry orientated, collaborative, systems (re)design approach [70]. Stakeholders generate potential future actions by exploring experiences, common needs, and shared goals [71, 72].
		a. Preliminary analysis feedback	The SME provided coaches with feedback on preliminary stage analysis, including individualised written feedback and discussion of feedback common to all coaches. Findings were grouped based on a systems approach, including recognition of facilitators and barriers to vocally reliant coaching participation [73]. This stimulated participant discussions and support coaches’ awareness of voice.
		b. Vocal ergonomics briefing	The SME briefed coaches on pertinent voice related information to support later parts of the search conference. This was informed by the broader scientific literature and the preliminary stage. Information included voice production and safe voice use patterns to avoid phonotrauma [12 , 61], occupational vocal health [1 , 14], and vocal ergonomic factors [4 , 64].
			This stimulated participant discussions and support coaches’ awareness of voice.
		c. Semi-structured discussion for strategy development	Participants brainstormed strategies for supporting coaches’ voices during the tournament. This was based on coaches’ experiences and preferences, preliminary stage findings, SME’s practice led recommendations, and recommendations relevant to vocal ergonomics within the research literature [4 , 64]. Participants then selected strategies for implementation.
Implementation: Across competition	Trial strategies	Strategy implementation	Coaches and the SME implemented 4 strategies.
		a. Player insights on coaches’ voice use	The SME gained players insights on coaches’ voice use. Included 1 meeting with players and SME, 1 coach-briefing for discussion points, and 1 team-based follow-up meeting.
		b. Ongoing feedback discussions	The SME and coaches engaged in 16 ongoing discussions to support broader strategy implementation and continued considerations of voice. Occurred at 12 brief period-end coach meetings and 4 longer day-end coach meetings.
		c. Increased movement and postural change	Coaches used pedometers to stimulate increased movement and avoidance of sitting during 4 games.
		d. Specific task adaptation	Additional whiteboards were accessible for coaches during 4 games. This was done to support coaches’ auxiliary communication and reduce coaches’ vocal demands.
		Observations	The SME continued observe coaches across implementation of strategies during 4 games and associated coaching duties, game briefings, other coaching tasks during the tournament.
Evaluation: Post game 4	Evaluate the action inquiry	Semi-structured focus group	Participants discussed their evaluative experiential insights regarding undertaking vocal ergonomics approaches and the programme overall [1]. Coaches made recommendations for future programmes.

Note. SME = Subject Matter Expert. The vocal ergonomist undertook this role as they facilitated the cooperative action inquiry with coaches.

Voice symptoms are negative personal experiences of vocal health, typically associated with voice production and use []. For example, someone may experience pain, negative sensations, altered voice quality, or diminished voice performance due to decreased vocal health status [74]. The presence of voice symptoms is not specifically indicative of any voice problem [60, 73].

Voice problems are health-related difficulties with voice use that limit a voice user’s undertaking of activities and participation in their life domains [].

References

Vilkman

. A survey on the occupational safety and health arrangement for voice and speech professionals in Europe. In: Dejonckere PH, editor. Occupational voice: Care and cure. The Hague, The Netherlands: Kugler. 2001;129–137.

Verdolini

, Ramig

. Review: Occupational risks for voice problems. Logop Phoniatr Vocology. 2001;26(1):37–46.

Titze

, Lemke

, Montequin

. Populations in the U.S. workforce who rely on voice as a primary tool of trade: A preliminary report. J Voice. 1997;11(3):254–9.

Vilkman

. Occupational safety and health aspects of voice and speech professions. Folia Phoniatr Logop. 2004;56(4):220–53.

Fritzell

. Voice disorders and occupations. Logop Phoniatr Vocology. 1996;21(1):7–12.

Eurofound, International Labour Organization. Working conditions in a global perspective. Luxembourg and Geneva, Switzerland: Publications Office of the European Union and International Labour Organization, 2019.

Morawska

, Niebudek-Bogusz

. Risk factors and prevalence of voice disorders in different occupational groups –A review of literature. Otorynolaryngologia. 2017;16(3):94–102.

Munier

, Brockmann-Bauser

, Laukkanen

A-M

, Ilomäki

, Kankare

, Geneid

. Relationship between laryngeal signs and symptoms, acoustic measures, and quality of life in Finnish primary and kindergarten school teachers. J Voice. 2019)1–13.

Fuentes-López

, Fuente

, Contreras

K V

. Inadequate vocalhygiene habits associated with the presence of self-reported voicesymptoms in telemarketers. Logop Phoniatr Vocology. 2019;44(3):105–14.

10.

Antunes Rezende

, Natali Silva Abreu

, Avila Assunção

, Mesquita de Medeiros

. Factors associated with the limitation at work because of the voice: Study with teachers of basic education in Brazil. J Voice. Forthcoming:[13].

11.

Buckley

, O’Halloran

, Oates

. Occupational vocal health of elite sports coaches: An exploratory pilot study of football coaches. J Voice. 2015;29(4):476–83.

12.

Porcaro

, Howery

, Suhandron

, Gollery

. Impact of vocal hygiene training on teachers’ willingness to change vocal behaviors. J Voice. Forthcoming:[11].

13.

da Rocha

, de Lima Bach

, do Amaral

, Behlau

, de Mattos Souza

. Risk factors for the incidence of perceived voice disorders in elementary and middle school teachers. J Voice. 2017;31(2):258.e7–12.

14.

McAleavy

, Adamson

, Hazlett

, Donegan

, Livesey

. Modelling determinants of the vocal health of teachers in Northern Ireland: Implications for educational policy and practice. Public Health. 2008;122(7):691–9.

15.

Rantala

, Sala

, Kankare

. Teachers’ working postures and their effects on the voice. Folia Phoniatr Logop. 2018;70:24–36.

16.

Ferreira de Brito Mota

, Pimentel Pinto Giannini

, Bittante de Oliveira

, Paparelli

, Dornelas

, Piccolotto Ferreira

. Voice disorder and burnout syndrome in teachers. J Voice. 2019;33(4):581.e7–16.

17.

Aiken

, Rumbach

. Keeping the voice fit in the group fitness industry: A qualitative study to determine what instructors want in a voice education program. J Voice. 2018;32(2):256.e25–34.

18.

Devadas

, Bellur

, Maruthy

. Prevalence and risk factors of voice problems among primary school teachers in India. J Voice. 2017;31(1):117.e1–10.

19.

Sala

, Rantala

. Acoustics and activity noise in school classrooms in Finland. Appl Acoust. 2016;114:252–9.

20.

Fellman

, Simberg

. Prevalence and risk factors for voice problems among soccer coaches. J Voice. 2017;31(1):121.e9–15.

21.

O’Neill

, McMenamin

. Voice use in professional soccer management. Logop Phoniatr Vocology. 2014;39(4):169–78.

22.

Penteado

, da Silva

. Voice and work conditions of soccercoaches and physical trainers. Distúrbios da Comun. 2014;26(4):790–9.

23.

Penteado

, da Silva

, Calçada

MLM

, de Lima Montebello

. Vocal discomfort, signs and symptoms in soccer coaches and physicaltrainers. Disturbios Comun, Sao Paulo. 2015;27(4):778–88.

24.

Bridger

. Introduction to ergonomics. New York, NY: McGraw-Hill; 1995.

25.

Dul

, Bruder

, Buckle

, Carayon

, Falzon

, Marras

, et al. A strategy for human factors/ergonomics: Developing the discipline and profession. Ergonomics. 2012;55(4):377–95.

26.

International Ergonomics Association. Human factors/ergonomics (HF/E) definition and applications [Internet]. Geneava, Switzerland: IEA; 2020 [cited 2020 Oct 20]. Available from: http://iea.cc/whats/index.html

27.

Wickens

, Lee

, Liu

, Gordon Becker

. An introduction to human factors engineering. 2nd ed. Upper Saddle River, NJ: Person Education; 2004.

28.

Sala

, Rantala

. Voice ergonomics: Occupational and professional voice care. Newcastle upon Tyne, England: Cambridge Scholars; 2019.

29.

Bazilinskyy

, de Winter

JCF

. Analyzing crowdsourced ratings of speech-based take-over requests for automated driving. Appl Ergon. 2017;64:56–64.

30.

Durup

, Dance

, Shield

, O’Sullivab

, Gomez-Agustina

. How classroom acoustics affect the vocal load of teachers. Energy Procedia. 2015;78:3084–3089.

31.

Sauer

, Sonderegger

, Schmutz

. Usability, user experience and accessibility: Towards an integrative model. Ergonomics. 2020;63(10):1207–20.

32.

Rantala

, Hakala

, Holmqvist

, Sala

. Connections between voice ergonomic risk factors and voice symptoms, voice handicap, and respiratory tract diseases. J Voice. 2012;26(6):819.e13–20.

33.

Phyland

, Miles

. Occupational voice is a work in progress: Active risk management, habilitation and rehabilitation. Laryngol Bronchoesophagol. 2019;27(6):439–47.

34.

Ahlin

, Österman

, Osvalder

A-L

, Hemphälä

, Glimne

, Hägg

, et al. Strategies to develop and strengthen human factors and ergonomics knowledge among stakeholders in Sweden. In: Proceedings of the 19th Triennial Congress of the IEA; 2015 Aug 9–14; Melbourne, Australia. International Ergonomics Association, 2015.

35.

Judon

, Galey

, Saint-Dizier de Almeida

, Garrigou

. Contributions of participatory ergonomics to the involvement of workers in chemical risk prevention projects. Work. 2019;64:651–660.

36.

Punchihewa

HKG

, Gyi

. Reducing work-related musculoskeletal disorders (MSDs) through design: Views of ergonomics and design practitioners. Work. 2016;53:127–142.

37.

Kee

, Haslam

. Prevalence of work-related musculoskeletal disorders in agriculture workers in Korea and preventative interventions. Work. 2019;64:763–775.

38.

Burgess-Limerick

. Participatory ergonomics: Evidence and implementation lessons. Appl Ergon. 2018;68:289–93.

39.

Cervai

, Polo

. The impact of a participatory ergonomics intervention: The value of involvement. Theor Issues Ergon Sci. 2018;19(1):55–73.

40.

Mokarami

, Varmazyar

, Kazemi

, Taghavi

, Stallones

, Marioryad

, et al. Low cost ergonomic interventions to reduce risk factors for work related musculoskeletal disorders during dairy farming. Work. 2019;64:195–201.

41.

Lehto

. A case study: Resting, loading and recovery of the floorball player [degree thesis]. Pori, Finland: Satakunta University of Applied Sciences; 2013.

42.

IFF. This is floorball [Internet]. Zurich, Switzerland: International Floorball Federation (IFF); 2019 [cited 2020 Sep 30]. Available from: https://floorball.sport/this-is-floorball/

43.

Heron

, Reason

. A participatory inquiry paradigm. Qual Inq. 1997;3(3):274–94.

44.

Braun

, Clarke

. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2020:[26].

45.

Stake

. Multiple case study analysis. New York, NY: The Guilford Press; 2006.

46.

Reason

, Bradbury

. In: Reason P, Bradbury H, editors. The Sage handbook of action research. 2nd ed. London, England: Sage. 2008;1–10.

47.

McNiff

, Whitehead

. All you need to know about action research. 2nd ed. London, England: Sage; 2012.

48.

Fishman

. The case for pragmatic psychology. New York, NY: University Press; 1999.

49.

Torre

, Fine

, Stoudt

, Fox

. Critical participatory action research as public science. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, editors. APA handbook of research methods in psychology, Vol 2. Washington, DC: American Psychological Association. 2012; 71–84.

50.

Caronia

. How “at home” is an ethnographer at home? Territories of knowledge and the making of ethnographic understanding. J Organ Ethnogr. 2018;7(2):114–34.

51.

Berger

. Now i see it, now I don’t: Researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219–34.

52.

Tracy

. Qualitative quality: Eight big-tent” criteria for excellent qualitative research. Qual Inq. 2010;16(10):837–51.

53.

Smith

, McGannon

. Developing rigor in qualitative research: Problems and opportunities within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2017:[22].

54.

Stake

. The art of case study research. Thousand Oakes, CA: Sage; 1995.

55.

Braun

, Clarke

. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Heal. 2019;11(4):589–97.

56.

Vertanen-Greis

, Löttyniemi

, Uitti

. Voice disorders are associated with stress among teachers: A cross-sectional study in Finland. J Voice. 2020;34(3):488.e1–8.

57.

Sathyanarayan

, Boominathan

, Nallamuthu

. Vocal health practices among school teachers:Astudy from Chennai, India. J Voice. Forthcoming:[7].

58.

Arya

, Bagwan

, Relekar

. Vocal fatigue in school teachers and its relation to the acoustic analysis of voice. Indian J Otolaryngol Head Neck Surg. 2020:[10].

59.

Allison

, Sandage

, Weaver

. Vocal dose for rhythm-based indoor cycling instructors: With and without amplification. J Voice. 2020;34(6):963e23–31.

60.

Russell

. Voice problems in teachers: Prevalence and predictions [dissertation]. Melbourne, Australia: La Trobe University; 1999.

61.

Ozgur Pinarbasli

, Kaya

, Ozudogru

, Kezban Gurbuz

, Colak

, Akif Aksoy

, et al. Acoustic analysis of soccer fans in acute phonotrauma after the match. J Voice. 2017;33(2):129–34.

62.

Penteado

, da Silva

, de Lima Montebello

. Voice, stress, work and quality of life of soccer coaches and physical trainers. CoDAS. 2015;27(6):588–97.

63.

Vaz Masson

, de Araújo

. Protective strategies againstdysphonia in teachers: Preliminary results comparing voiceamplification and 0.9% NaCl nebulization. J Voice. 2018;32(2):257.e1–10.

64.

Vintturi

, Alku

, Lauri

, Sala

, Sihvo

, Vilkman

. Objective analysis of vocal warm-up with special reference to ergonomic factors. J Voice. 2001;15(1):36–53.

65.

Sandage

, Rahn

A K

, Smith

. Vocal ergonomics in the workplace: Heating, ventilation, and air-conditioning method influences on vocal comfort and function. J Speech, Lang Hear Res. 2017;60(2):355–63.

66.

Haddad

, O’Connor

, Burns

. The decision to adopt a formal athlete leadership group: Qualitative insights from professional football coaches. Psychol Sport Exerc. 2021;52: Article 101803 [10].

67.

Macquet

A-C

, Stanton

. Do the coach and athlete have the same “picture” of the situation? Distributed situation awareness in an elite sport context. Appl Ergon. 2014;45:724–33.

68.

Madden

. Being ethnographic. A guide to the theory and practice of ethnography. London, England: Sage; 2010.

69.

Dean

, Bundon

. ‘You’re only falling into water!’: exploringsurfers’ understandings of concussion in Canadian surf culture. QualRes Sport Exerc Heal. 2020;12(4):579–96.

70.

Large

. Using the search conference for planning a merger participatively. Career Dev Int. 1998;3(2):Article 62 [7].

71.

Varney

, Rumbold

, Sampson

. Evidence in a different form: The search conference process. J Appl Arts Heal. 2014;5(2):169–78.

72.

Fenner

, Allen

. The participatory installation –Forming theevidence of experience. J Appl Arts Heal. 2014;5(2):179–87.

73.

World Health Organization. International classification of functioning, disability and health: ICF. Geneva, Switzerland: World Health Organization; 2001.

74.

Colton

, Casper

, Leonard

. Understanding voice problems: A physiological perspective of diagnosis and treatment. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.

Strategy	Rationale	Approach and Evaluation
1. Gaining players’ insights on coaches’ voices	Athletes are coaches’ primary communication partners. This may afford athletes novel insights into coaches’ voice use.	Semi-structured, non-audio recorded meeting between player group and the Subject Matter Expert (SME). This occurred prior to competition, to facilitate implementation of relevant recommendations across the tournament.
		Athletes indicated speech intelligibility considerations in coaches’ voice use. These included hard to distinguish terms in the heavy background noise of play (e.g. sub for player substitution and push up for move forward).
		Athletes noted supportive attributes of coaches’ voice use (e.g. word repetition, close proximity).
		SME provided coaches with summary of meeting. Coaches then addressed these considerations with players at a subsequent team meeting, agreeing to keyword changes and focusing on louder instructions during games.
		Coaches deemed this strategy useful in clarifying effective voice use practices for this team.
		Coaches recommended earlier timing of player consultation in future programmes.
2. Ongoing feedback discussions	Ongoing discussions aimed to facilitate continued sharing from all participants to support sustained action inquiry. This included recognising the novelty of this programme, supporting broader strategy implementation, and to further explore coaches’ vocally reliant participation across this tournament.	Participants engaged in 16 discussion sessions across the tournament. These discussions occurred during scheduled coaching meetings (i.e. briefly at period ends, in-depth at end-of-day).
		Participants explored facilitators and barriers for coaches’ voices during these discussions.
		Recognised facilitators included supportive coaching behaviours (e.g. shared vocal demands, reduced proximity to players for critical voice use, non-vocal communication) and supportive player behaviours (e.g. repeating coaches’ keywords, requesting instruction clarification).
		Commonly discussed barriers included players’ performance errors and adverse environmental noise. These recognised barriers often required loud, effortful voice use to support team performance and were too challenging to directly eliminate within the tournament context.
		Coaches reported that feedback discussions supported their ongoing attention to voice. As Lars noted: “We have more to think on than the voice, so you are our reminder.” (Lars, focus group).
		Coaches recommended increased focus on vocal health during these discussions in future. However, participants recognised that tournament time pressures limited opportunities for in-depth health discussions.
3. Increased movement and postural change	Coaches’ voices were adversely affected by far distances between communication partners and static, seated postures.	Coaches wore pedometers during competition games.
		Coaches reported that while steps were a good indicator of how much they had moved, the pedometers did not promote behavioural change during games. As Lars noted, coaches often forgot they were wearing pedometers during competition times. He suggested that physical stimuli may be more successful in reminding coaches to engage dynamic postures and move closer to athletes, stating “I didn’t think to look. Perhaps if it buzzed?” (Lars, focus group).
4. Specific task adaptation to reduce vocal demands	Coaches’ used drawing on the whiteboard while instructing athletes on movement sequences (aka plays). Having access to additional whiteboards may promote this auxiliary communication channel and reduce coaches’ effortful voice use across games.	Four additional whiteboards were introduced for tournament games (i.e. five whiteboards available in total).
		All coaches utilised whiteboards when discussing plays with athletes during the tournament, particularly in the locker-room. However, they only intermittently used whiteboards during competition periods. While drawing, coaches often sustained loud talking to overcome noise and maintain players’ attention.
		Athletes often used whiteboards to explain plays to each other during games. While this may have somewhat reduced coaches’ need to explain or clarify instructions, it was unclear if coaches’ vocal demands lowered during competition play. As Kristian noted: “There was always something to tell the girls (athletes).” (Kristian, focus group).
		Coaches identified that presence of additional barriers impaired success of this strategy by necessitating coaches’ continued engagement in demanding voice use (e.g. ongoing player performance errors, communication breakdowns, lack of team familiarity).