Improving Public Attitudes

In a recent blog, Jaan Pill, who is affiliated with the Canadian Stuttering Association wrote wrote a piece entitled, “How effective are public education campaigns, directed at changing people’s opinions about stuttering?  How can the outcomes of such efforts be measured?

Had I known about it, I would have encouraged him to submit it as a paper for this conference. Obviously, since he cited my work, I agree with him, but my question is this: How can we show empirically the impact of interventions designed to improve public attitudes on the quality of life of people who stutter?

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Improving Public Attitudes — 7 Comments

  1. Hi,
    I’m going to use your question to make a comment related to the influence we allow others to have on us and expand briefly on Eleanor Roosevelt ‘s statement, “No one can make you feel inferior without your consent.” What we think of ourselves ultimately matters more than what others think of us. A good, life-long use of our time is to follow the advice inscribed on the wall of Apollo’s Temple in Ancient Greece, which is, “Know Thyself.” The greatest gift any of us can give to ourselves and ultimately others is to know and live who and what we are.

    – Ellen-Marie Silverman

  2. As I’m sure we all agree, such evidence needs to be gathered at two levels:
    Level 1. The recipients of the awareness program
    Level 2. The persons who stutter within this larger population
    Speaking of the first level, all public education programs for stuttering have not shown equally positive outcomes. One way to maximize outcomes of such efforts, in my opinion, is to cover small and very specific points in the program , and to have a short, 4-5 item questionnaire to assess if a change has come about in the audience’s knowledge of these specific points.
    This brings me to our second level of evidence- “outcomes in terms of improvement in quality of life of persons who stutter”. For this, maybe PWS within this target population that we sensitized could be given an impact assessment tool just before, and perhaps a few weeks after the public education program, to see if the impact on their quality of life has improved.

    However, I feel despite extremely positive outcomes at level 1, we would still not get commensurately positive outcomes at level 2. This is because a larger part of this impact would depend on how PWS themselves perceive life events; their self talk based on their own belief systems.

    • Dr. Kelkar,
      Poignantly st ated “improvement in quality of life of persons who stutter” “we would still not get commensurately positive outcome” because “this impact would depend on how PWS themselves perceive life events, their self-talk based on their belief systems.
      In my opinion, it is the responsibility of the SLP or other professional to adjust the PWS attitudes. belliefs, and emotions. Two books that can help in that are “SOS Help for Your Emotions” by Lynn Clark and “From Stuttering to Fluency: Manage your emotions and live life more fully” by Neiders
      I am sure there are other ways how the client can be convinced that with or without stuttering life not awful, he or she can well learn to stand the frustration that accompanies stuttering, that the habit of self-deprecation is without merit and should be stopped, and that recovery from stuttering is possible even though at the start the changes might be incremental.
      In summary, stuttering therapy that does not deal with beliefs and emotions will probably fail in the long run and that a person, while undergoing self- or formal therapy and still stuttering can have dignity and self-respect.

  3. JJaan Pill et al,
    As a practicing clinical psychologist who specializes in recovery from stuttering, I tend to focus on the individual and what they can do to improve themselves and the society around them. Before I encourage people to focus on some as yet undefined public education campaign I ask, “What have you done yourself to improve people’s opinions about stuttering.”
    The first issue that we handle is to differentiate between what we and the public mean by the terms they use. There is a big difference between stuttering, the act, and the person who stutters.
    Stuttering, the act, has many dimensions. A few of them are: 1) the associated fear; 2) the associated shame; 3) the discomfort when encountering a disfluency; 4) the self deprecation due to the dysfluency; 5) the severity/forcing of the sounds (the disfluency itself; 6) the concomitant (secondary) behaviors such as snapping of the fingers, avoiding eye contact, etc.; 7) the avoidances of feared sounds; 8) the avoidances of the feared situations, etc.
    (Before I proceed I would like to say an aside: The first order of recovery is to work on minimizing the associated unhealthy feelings about stuttering and working on eliminating the severity of the harmful behaviors.}
    In talking to the general public, the PWS and I have found little discrepancy about how they evaluated these items. For example, the severe forcing of sounds is bad; the associated fear of speaking, if possible, should be minimized,…
    There are two main areas that both some PWS and some members of public differ. One, rather cute aspect, is that a slight stutter if often found by the general public to be endearing. The other is that some people in the public and, unfortunately, many PWS believe that disfluencies and stuttering should be hidden. This is not so. But the topic of covert stuttering and the useless effort to hide stuttering is discussed elsewhere.
    Where PWS and general public run into difficulty is in the evaluation of a person (as a whole) using stuttering as the determining factor. This is where the public needs to be educated. And this is where most, if not all PWS’s and even a significant number of SLP’s have to be educated. The best arguments against evaluation of a person as a whole because of one characteristic, usually a negative one, are found in Rational Emotive Behavior Therapy and General Semantics. Simply put, we all, whether we stutter or not, have thousands of characteristics, thousands of deeds we have done in the past, and potential of doing thousands more. It is unscientific, illogical, and self-defeating to evaluate us by one characteristic. This is silly. It is outright stupid.
    This is where I focus at first on educating my clients. I really focus on showing them that it is totally arbitrary and even frivolous to define themselves as children of a lesser god just because they stutter. They are just as worthwhile, they can accomplish just as much (look at Charles Darwin, vice president Joe Biden (see American Institute for Stuttering website where he talks about his stuttering), Bruce Willis, Jack Welch etc.) as any person who does not stutter. As you can read in my book you can live life to the fullest even though you stutter.
    Once I have helped the PWS to live life more fully, I encourage the PWS through their behaviors convince the general public that they can have productive and live enjoyable lives even though they stutter. I have also participated in projects that tried to inform the public that the PWS are just as worthy human beings as the people without disfluencies.
    The questions I have asked after my education of the public were simple:
    1. Do you believe that a person who stutters is as worthwhile as persons who do not stutter?
    2. Would you want to have a friend who stutters?
    3. Would you want to know more about the challenges and triumphs of a person who stutters?
    It has been encouraging to me that I have received positive answers.

    • Hi Gunars,

      Re: the problems with evaluating people (who are complicated) by a single characteristic, I think of what I’ve learned from Kristin Chmela about developing a healthy mindset surrounding communication. A favorite saying is, “My challenges do not define me or determine whether or not I am OK.” This has really been resonating with me lately, both in terms of how I think about myself as an evolving communicator, and how I relate to my students as evolving communicators. Best,

      Rob Dellinger

  4. Effectiveness of public awareness is tough to prove. I spent a few minutes looking at the effectiveness of other campaigns that attempt to educate and raise public awareness of a condition/difference/disorder/disease/problem. Many of the “before and after” type studies I read resulted in improved public awareness that was considered “slight” or a “little more than slight.” If attempting to design a study to evaluate the effectiveness of programs, I would look to literature in other fields of study to find an appropriate design. Separating awareness from actual change in perception and/or behavior is difficult as well. Increased awareness may not be a reflection of changes in attitudes.

    As was mentioned above, facilitating attitudinal change within yourself is highly valuable and a critical part of living your best life. For those participating in or providing speech therapy, reframing negative thinking patterns is vital for change. With that being said, public awareness campaigns should not be tossed aside because it is tough to prove their effectiveness. (I mean… think about what public awareness has done for decreasing smoking rates over the past 50 years… while there were a lot of factors that went into cutting down the smoking, public awareness was critical. Especially for youth.)

    Sometimes I think I would like to compare 2 college dorms. Flood one with stuttering awareness posters and media. Then have another with no public awareness campaign. See if there is a difference in knowledge, awareness, perceptions, etc.

    This is such a great question. I hope we have more suggestions!!! I would love to hear some.


  5. Thank you to everyone who has responded to my question. I believe Trisha’s suggestion of different interventions in two opposing dorms would be one way to go, but maybe in different universities where the students in one would be highly unlikely to interact with students in the other. I’ve thought about using different schools in the same general region for children’s attitude. Suffice to say, if all the work others and I have done in documenting and improving negative attitudes among the public, it would be of little use if it did not impact the lives of those who stutter.

    Clearly, to respond to Gunar and Ellen-Marie, speech therapists and others need to deal with their stuttering clients’ reactions to public reactions and beliefs. That, however, has been the way we have dealt with the problem of stereotypes and stigma in public attitudes. But this by passes the vast majority of stutterers who never darken the door of a speech clinic. Of course, many of them learn on their own that they do not need to internalize what others think; yet, many do. Mary Weidner and I have shown that these negative attitudes among the nonstuttering majority start (and are likely strongest) in very young children. It is there, we believe, that interventions with nonstuttering children need to be carried out.

    Another issue is that providing information is not necessarily going to change public attitudes as Pallavi points out. Research is now being directed at identifying what seems to work and what does not.

    To return to my question, if we could change public attitudes, which fortunately for stuttering appear to be relatively fluid (as opposed, for example, to political attitudes), the quality of lives of children and adults who stutter would likely be greatly improved. Of course, they would still stutter, but stuttering would be seen, as Robert Kroll once said, simply “part of the normal human condition.”

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