How effective are public education campaigns, directed at changing people’s opinions about stuttering? How can the outcomes of such efforts be measured?

Update: The subject matter is different at this update, but the underlying dynamics are in certain respects similar to the main topic of the current post. The task, broadly stated, involves the effective communication of fact-based information about any topic. I refer by way of an update to an Oct. 23, 2019 BMC Public Health article entitled: “How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation.”

An excerpt reads:



Vaccination misinformation is associated with serious public health consequences, such as a decrease in vaccination rates and a risk of disease outbreaks. Although social media offers organisations promoting vaccination unparalleled opportunities to promote evidence and counterbalance misinformation, we know relatively little about their internal workings. The aim of this paper is to explore the strategies, perspectives and experiences of communicators working within such organisations as they promote vaccination and respond to misinformation on social media.


Using qualitative methods, we purposively sampled 21 participants responsible for routine social media activity and strategy from Australian organisations actively promoting vaccination on social media, including government health departments, local health services, advocacy groups, professional associations and technical/scientific organisations. We conducted semi-structured, in-depth interviews to explore their perspectives and practices. Applying Risk Communication principles as a lens, we used Framework Analysis to explore the data both inductively and deductively.


Organisations promoting vaccination face multiple challenges on social media, including misinformation, anti-science sentiment, a complex vaccination narrative and anti-vaccine activists. They developed a range of sophisticated strategies in response, including communicating with openness in an evidence-informed way; creating safe spaces to encourage audience dialogue; fostering community partnerships; and countering misinformation with care.


We recommend that communicators consider directly countering misinformation because of the potential influence on their silent audience, i.e. those observing but not openly commenting, liking or sharing posts. Refutations should be straightforward, succinct and avoid emphasizing misinformation. Communicators should consider pairing scientific evidence with stories that speak to audience beliefs and values. Finally, organisations could enhance vaccine promotion and their own credibility on social media by forming strong links with organisations sharing similar values and goals.


Many attempts have been made to change public attitudes about stuttering.

Such attempts have included talks, media interviews, and videos which seek to inform the public about stuttering.

As a volunteer, I’ve shared my life story as a stutterer with countless classes of elementary students. I’ve appeared in media interviews, given talks at service organizations, and assisted with documentaries about stuttering. I’ve received feedback especially from children that my message has gotten through. However, I’ve never conducted a survey.

With regard to all such information-sharing efforts, a question naturally comes to mind.

The question is: How would we know whether a given attempt to change public attitudes about stuttering, or any other condition, actually works?

In this article, I will discuss the current state of the art (or more precisely, the current status of survey design and statistical analysis) as it relates to measuring the effectiveness of projects seeking to change (for the better) public attitudes about stuttering.

Personal connection

First, why does the topic interest me? I stuttered severely, from age 6 until I was 41. Sometimes, I could not get out any words at all. In 1987, I attended a three-week ISTAR speech therapy clinic in Edmonton, which enabled me to relearn how to speak. I’ve learned fluency as a second language.

After the clinic, I spent several years consciously applying, in everyday speaking situations, the fluency skills that I had learned in Edmonton. I have at times heard, at stuttering conferences and in print, that it’s impossible for a person to formulate sentences while at the same time applying fluency skills as they are speaking.

However, I found a way, that has worked fine for me. These many years later, I apply my fluency skills automatically. What I learned at the clinic has changed the trajectory of my life, for the better.

Research indicates that many stutterers can benefit from such a relearning process. However, a minority of stutterers will not be helped. This is not a matter of how hard a person works, in applying fluency skills. Instead, it has to do, most of all, with how a person’s brain is wired for speech production.

I also want to underline that the Canadian Stuttering Association provides an impartial forum for sharing information about stuttering. The only restriction is that it does not provide a platform for scam artists to promote ‘cures’ for stuttering. In discussing the approach to stuttering that has worked for me, I take care to desist from promoting it as the one way that will work for everybody. Each of us can approach stuttering however we please.

Public education

After attending a speech clinic in 1987, I became active as a volunteer on behalf of people who stutter. In the 1990s, I helped to set up several nonprofit organizations, locally, nationally, and internationally, dealing with stuttering. Among the organizations I have helped to launch is the Canadian Stuttering Association (CSA).

In 1999, in my role at the time as a leader of the worldwide stuttering self-help movement, I attended a weekend meeting of an invited task force in Morgantown, West Virginia. The meeting launched a new initiative called the International Project on Attitudes Toward Human Attributes (IPATHA). That’s when I became interested in how to go about measuring attempts to counter stereotypes about stuttering.

For 15 years, my volunteer work was focused on stuttering. Since then, my attention has been elsewhere, but I serve as member of an advisory board of the Canadian Stuttering Association. I do not have a vote, but occasionally I make comments.

Recently, the CSA board has been discussing the STAMMA campaign designed by an advertising agency on behalf of the British Stammering Association, which seeks to challenge existing misconceptions connected with stuttering.

The CSA board has discussed starting such an initiative in Canada. My comment has been that it would be helpful to have a means in place, whereby the actual results of such an effort would be measured, using a robust survey methodology.

A most valuable resource, for anybody with an interest in research, about how best to go about measuring efforts aimed at changing public opinions, is a study entitled: Stuttering Meets Stereotype, Stigma, and Discrimination (2015).

The study describes (p. 9) the launch, 20 years ago in 1999 by Ken St. Louis and colleagues, of an international initiative focusing on public opinion surveys of conditions such as stuttering.

The initiative has developed a survey instrument, which I believe would be feasible for stuttering organizations such as CSA to use, when measuring the effectiveness of their public education projects.

I encourage anyone, with an interest in use of the survey instrument, the Public Opinion Survey of Human Attributes – Stuttering (POSHA-S), to read Stuttering Meets Stereotype (2015). The instrument is described as capable of being used by stuttering organizations to good effect.

For laypersons, it takes some effort to read the book, which features dense, academic language and long paragraphs. In my estimation, however, the close study of such a book is well worth the effort. The current article seeks to share some highlights from it, in plain English.

What are some commonly held opinions regarding stuttering?

The above-noted study is edited by Ken St. Louis of West Virginia University.

A public opinion survey instrument, developed by Ken St. Louis and colleagues starting 20 years ago, offers one way to determine if efforts such as the STAMMA initiative will actually change public attitudes about stuttering.

Changing such attitudes is a daunting task but with the right approach, progress can be made. In this article, I will highlight what we are up against, when we seek to change firmly held stereotypes.

In Chapter 1 of the above-noted text, “Epidemiology of Public Attitudes Toward Stuttering,” Ken St. Louis notes (p. 8) that, “It is widely accepted that most cases of stuttering are due to genetically based, sex-linked physiological differences that affect the coordination and timing of neuromotor aspects of speaking.” Such a view, based on decades of research regarding the causes of stuttering, stands in contrast to what public perception of stuttering entails.

In Chapter 2, “Stigma and Stuttering,” Michael Boyle and Gordon Blood note (p. 47) that:

“Extensive research collected over decades indicates that people who stutter are perceived as having undesirable personality attributes such as being introverted, shy, anxious, nervous, quiet, tense, guarded, fearful, embarrassed, and frustrated.”

The authors also cite research that indicates that “university students perceive preschool and kindergarten children who stutter as more guarded, nervous, shy, self-conscious, tense, withdrawn, avoiding, afraid, insecure, self-derogatory, and quiet compared to controls who do not stutter.”

Such beliefs about the characteristics of people who stutter have been observed, in worldwide research, among the general public, special educators, health care professionals, employers, vocational rehabilitation counsellors, and speech-language pathologists.

Boyle and Gordon also share some helpful caveats.

They refer, for example, to recent findings that teachers’ and speech-language pathologists’ stereotypical views of stuttering people may not be as strong as in the past. That said, they also add that some evidence has been reported indicating that teachers’ stereotypes regarding stuttering are no better than those of the general public.

The authors also note that negative reactions toward stuttering can begin at a young age. They cite research in which preschool-age children have been observed to react negatively to stuttering. One research project, they note, “observed preschool children who stutter interacting with peers during play and found that in some cases they were interrupted, ignored, or mocked” (p. 50).

Research concerned with changing of attitudes about stuttering

In Chapter 5, “”Changing Attitudes Toward Stuttering,” Fauzia Abdalla notes (p. 106) that, “Although research on stuttering attitudes has been the subject of intense inquiry, only a handful of studies have documented ways to increase awareness and improve stuttering attitudes.”

The chapter is worth a close read, as it discusses the strengths and shortcomings of the relatively small number of studies that have been conducted to date, regarding efforts to change attitudes about stuttering.

A key highlight that stays in mind is the finding that not all videos that deal with stuttering are the same, in their effects on audiences. Some lead to more positive attitudes about stuttering whereas others serve to reinforce negative stereotypes.

[An additional more recent point, underlined at a recent comment (please see comments section at the end of the current post) is that, as Ken St. Louis notes, “interventions must be carefully matched to the audience, just as in any public awareness or public relations campaign. Information alone does not do the job.”]

In some studies the link, between a specified approach to changing attitudes, and the outcome is clearly defined. In other cases, the link that is sought is presented in a way that is vague or confusing.

In some cases, survey design and interpretation of the results is based on a sophisticated knowledge of statistical analysis, whereas in other cases such knowledge is not readily evident.

An approach that has shown promise

Both Chapter 1 and Chapter 5 refer to “a study in which an attempt was made to improve high school students’ attitudes toward stuttering by listening to a humorous talk by an adult who stuttered, a video presentation featuring this adult (along with others), or both (p. 24).”

The overview in Chapter 1 notes that:

“The study had two groups of students, one who heard the speaker only (ORAL) between pre- and post-POSHA-Ss, and the other with the video (VIDEO) between pre- and post-POSHA-Ss followed by a shortened talk (VIDEO + ORAL) and a third POSHA-S. Thirty-seven percent of the corrected POSHA-S comparisons were significantly improved in the study after the ORAL condition only and 35% after the VIDEO condition.”

From what I can gather, oral presentations, with inclusion of a bit of humour, are among the optimal ways to change attitudes about stuttering among high school students.


The survey instrument developed by Ken St. Louis and colleagues looks to me like a valid means, available to nonprofits such as CSA, to measure outcomes of public education efforts such as BSA’s STAMMA initiative.

However, some requisite skills would have to be in place. In order to organize a ‘before’ and ‘after’ evaluation of a given project aimed at attitude change, I believe you would need at least one volunteer with skills in survey methods and statistical analysis. We had such a volunteer in the years during which CSA was being developed. It served us really well.

I have the sense that people with skills in such areas can serve as a great resource, as volunteers on behalf of nonprofits such as CSA, when they are students and at the start of their professional careers. However, as they get launched in their careers, they will understandably need to focus on professional responsibilities, and thus are not likely to be able to devote much time to volunteer work.

A volunteer, with the skillset that I have described, would be a necessity, in the event that CSA or a similar nonprofit were to have an interest in determining whether or not their efforts to change public attitudes, about a condition such as stuttering, are effective or not.

Please note: I originally wrote this article for the newsletter of the Canadian Stuttering Association, where it is entitled: Public Education Campaigns about Stuttering: Measuring Success. The version at my website is slightly longer than the text, of about 1,500 words, prepared for the newsletter.

Countering COVID-19 rumours and misinformation

The topics discussed above are part of the larger topic of how misinformation spreads in general.

In this context, a March 10, 2020 Undark article is entitled: “Opinion: Don’t Just Debunk Covid-19 Myths. Learn From Them: The tactic of simply throwing facts at the misinformation problem can be ineffective, and even counterproductive.”

Instead of viewing rumors and myths as misperceptions that can be suppressed with accurate information, we should treat them as opportunities to understand — and respond to — the legitimate anxieties of the people who adopt and share them. In other words, we should look at them as valuable feedback that can help improve our own reporting and messaging.

5 replies
  1. Ken St. Louis
    Ken St. Louis says:

    Thank you for the excellent post. You are right. We need to measure the success–or lack thereof–of interventions designed to help the public adopt more accurate, sensitive beliefs and reactions to stuttering. A good number of investigators have done so using the POSHA-S, pre and post intervention. Most have shown improved attitudes overall, but some have not. We don’t yet know what makes the difference. It appears that we have overlooked the obvious: interventions must be carefully matched to the audience, just as in any public awareness or public relations campaign. Information alone does not do the job.

    With colleagues, I’m trying to sort this out further. Stay tuned.

    Ken St. Louis

    • Jaan Pill
      Jaan Pill says:

      It’s most interesting to read your comment, Ken. I’m pleased that I’ve had the opportunity to study your book more closely, as part of working on this post.

      That’s most interesting – the importance of matching interventions to the audience, as with any public awareness or public relations campaign.

      Erving Goffman’s concepts of impression management and definition of the situation come to mind, as I think about attitude-change strategies.

      I’m also reminded that Goffman played a key role in development of the concepts of stigma and stigmatization. Through refinement of the latter concepts, he increased their utility in increasing public understanding of what negative stereotyping entails.

      I much admire the insistence, in Stuttering Meets Stereotype (2015), on top-quality survey design and top-quality statistical analysis. In all aspects of life, excellence matters.


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