Public attitudes toward stuttering in Poland

INT J LANG COMMUN DISORD, NOVEMBER–DECEMBER 2013,VOL. 48, NO. 6, 703–714

Research Report

Public attitudes toward stuttering in Poland

Aneta M. Przepiorka†, Agata Blachnio†, Kenneth O. St. Louis‡ and Tomasz Wozniak§†Institute of Psychology, The John Paul II Catholic University of Lublin, Poland‡West Virginia University, Morgantown, WV, USA§Maria Curie-Sklodowska University, Poland

(Received March 2013; accepted June 2013)

Abstract

Background: People who stutter often experience negative judgments and reactions to their stuttering from thenonstuttering majority. Many are stigmatized because of their stuttering and threatened with social exclusion,placing them at risk for compromised quality of life.Aims: The purpose of this investigation was to measure public attitudes toward stuttering in Poland.Methods & Procedures: A sample of 268 respondents (mean age = 29 years; range = 15–60 years) from numerousdifferent geographic and urban-rural settings in Poland filled out a Polish translation of the Public Opinion Surveyof Human Attributes–Stuttering (POSHA–S).Outcomes & Results: Polish respondents displayed attitudes toward stuttering and people who stutter that weregenerally similar or “average” in comparison with other samples around the world from the POSHA–S database.Conclusions & Implications: Although generally typical of other Western societies studied, attitudes of adolescentsand adults from Poland were notably different in some ways, such as in the beliefs that emotional trauma or virusesand disease can cause stuttering as well as in the self reaction that they would feel uncomfortable speaking with astuttering person. Overall, social exclusion and stigma are as likely among Poles who stutter as among most otherpopulations studied.

Keywords: stuttering, attitudes, Poland, POSHA–S.

What this paper adds?What is already known on this subject?Previous studies have suggested that people who stutter, regardless of their age, are likely to be negatively affected bystereotypes, stigma, and social exclusion. Stuttering affects social relationships, impedes functioning in society, andhas detrimental influence on their quality of life.

What this study adds?This study contributes to the knowledge on the attitudes towards people who stutter primarily as a result of usinga standard measure, the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S). Using a new Polishtranslation of the POSHA–S, a broadly-selected sample of Polish adults was compared with previous samples usingthe instrument. Attitudes towards stuttering in the Polish society were generally similar to other samples around theworld. Nevertheless, their attitudes were still far from positive and showed much the same stereotypes and potentialstigma reported previously, thus very likely affecting the lives of people who stutter in Poland.

Introduction

Stuttering is not only a speech fluency disorder: it alsohas a social dimension, potentially impeding the indi-vidual’s functioning in society seriously and potentiallylowering the quality of a person’s life (Craig, Blumgart,

Address correspondence to: Aneta Malgorzata Przepiorka, Institute of Psychology, The John Paul II Catholic University of Lublin, Al. Raclawickie14, PL 20–950 Lublin, Poland; e-mail: [email protected]

& Tran, 2009). In the literature, stuttering is viewed asa complex and multifaceted speech disorder (Wozniak,2008), which is manifest as symptoms not only atlinguistic, emotional, or physical levels, but in termssocial consequences. This disorder has impact on the

International Journal of Language & Communication DisordersISSN 1368-2822 print/ISSN 1460-6984 online C© 2013 Royal College of Speech and Language Therapists

DOI: 10.1111/1460-6984.12041

704 Aneta M. Przepiorka et al.

functioning of person who stutters in society, especiallyon the way the person is perceived. A so-called “stutter-ing stereotype” has been shown to exist in the nonstut-tering majority, wherein people who stutter are assumedto be quiet, taciturn, evasive, introverted, reserved, pas-sive, limited worth, fearful, tense, distrustful, nervous,withdrawn, and timid (Williams, 2006). Such negativestereotypes often result in a stigmatization of these peo-ple, which in turn, can affect their lives dramatically(Blood & Blood, 2007).

Negative social consequences of stuttering have beenwidely reported in the literature. Children and ado-lescents who stutter are negatively evaluated, becomethe object of jokes and ridicule from their peers, meetwith limited acceptance from colleagues and strangers,and are less often perceived as leaders (Blood, Blood,Tellis, & Gabel, 2003; Blood, Blood, Tramontana,Sylvia, Boyle, & Motzko, 2011; Davis, Howell,& Cooke, 2002; Franck, Jackson, Pimentel, &Greenwood, 2003; Langevin & Hagler, 2004; Langevin,Kleitman, Packman, & Onslow, 2009). For example,Langevin et al. (2009) found that about one-fifth ofCanadian 3rd to 6th graders held negative attitudes to-wards their peers who stutter. In Poland, school-age chil-dren and adolescents (aged 8–25 years) were more dis-liked than their fluent peers (Kulas, 1990).

Similarly, adults who stutter are viewed negatively,stigmatized, and discriminated against, and stereotyp-ing seems to be omnipresent regardless of educationor culture. For example, speech-language clinicians andrespondents from the general public (17–81 years) at-tributed characteristics to people who stutter that wereprimarily negative, e.g., shy, introverted, tense, reticent,and withdrawn (Woods & Williams, 1976). Teachersfrom Kuwait surveyed by Abdalla and St. Louis (2012)held similar negative attitude towards people who stut-ter. As in other studies, the teachers’ knowledge about thecause of stuttering was highly variable and typically notaccurate. Hughes, Gabel, Irani, and Schlagheck (2010)studied university students and documented clear neg-ative effects of stuttering on lives of those who stutterand about the possible difficulties they would encounterwhen they stuttered. In interviews, stuttering partici-pants identified more problems and barriers as a resultof their stuttering than positive aspects. Gabel, Blood,Tellis, and Althouse (2004) reported that employers haveclear ideas about what stuttering workers can and can-not do, thus “entrapping” them in certain roles or jobs.Even in close-knit rural communities, adults judged ahypothetical person who stuttered more negatively thanthey judged a person who did not stutter, even though85% of the participants declared that they knew a per-son who stuttered and 39% were related to such a person(Doody, Kalinowski, Armson, & Stuart, 1993). We mayconclude that even being acquainted with a person who

stutters does not necessarily prevent from stereotyping,although one study did show better attitudes towardknown stuttering individuals (Klassen, 2001).

Results of a study in Poland by Blachnio (in press)showed that fluent speakers strongly experience emo-tions of helplessness and care when listening to personswho stutter. Another Polish study documented nega-tive stereotype attribution to people who stutter, es-pecially the belief that they are fearful or distrustful(Grzybowska, Łapinska, & Michalska, 1991).

The concept of ostracism, a term which is often usedinterchangeably with social exclusion and rejection, hasbearing on the results of research on attitudes towardsstuttering (Oaten, Williams, Jones, & Zadro, 2008).Studies of Polish respondents by Tarkowski (2008) indi-cate that fluent speakers may be divided into two groupswith regard to their stereotypes concerning people whostutter. One group believes that people who stutter donot have a disordered personality but merely suffer froma peculiar speech dysfunction. The other group believesthat stuttering is a speech neurosis and is connected withneuroticism; these people consider those who stutter tobe fearful, sensitive, shy, and taciturn. Tarkowski stressedthat the negative reactions of fluent speakers to stutter-ing stem from a lack of knowledge concerning what theinterlocutor who stutters is experiencing.

Studies on ostracism demonstrate that being re-jected has negative influence on individuals, their self-esteem, and their sense of meaning in life (e.g., Leary,Kowalski, Smith, & Phillips, 2003). Williams, Cheung,and Choi (2000) advanced the position that ostracismposes a threat to four human needs: (a) the need tobelong, (b) the need for control, (c) the need for self-esteem, and (d) the need for meaning in life. Ostracisminduces negative emotions in a rejected person and trig-gers a sense of loss. The person’s reaction will dependon which of the needs cannot be fulfilled. Turnbull(2006) points out that negative stereotyping of chil-dren who stutter may have negative impact on their de-gree of interaction in school as well as their self-esteem.She highlighted the beneficial effect of a class presenta-tion delivered to children with speech difficulties thatwas associated with positive changes in their attitudes.Similarly, Murphy, Yaruss, and Quesal (2007) identifiednegative reactions that children who stutter experiencefrom peers who tease them and emphasized that educa-tion about stuttering can foster reductions in negativesocietal opinions.

Other research shows that social exclusion has neg-ative influences on self-regulation and that these in-fluences are more lasting in people with high levelsof social anxiety (Oaten, Williams, Jones, & Zadro,2008). Although not entirely accepted, recent researchhas also shown that people who stutter may have ele-vated social anxiety (Blumgart, Tran, & Craig, 2010).

Polish stuttering attitudes 705

Being somewhat different from others may limit normalfunctioning in society, which depends to a great extenton the social perception of people with one’s differences.The evidence is clear that lack of tolerance for differencesin others can lead to many negative sequelae for thoseidentified as different (Abbey, Charbonneau, Tranulis,Moss, Baici, Dabby et al. 2011). Stuttering can generatestigma in society that reduces “a whole and usual personto a tainted, discounted one” (Goffman, 1963, p. 3).

Although negative attitudes toward people who stut-ter have been commonly reported, because most researchstudies have used different strategies and measures, theresults are not easily comparable. To address this issue,St. Louis and his colleagues inaugurated the Interna-tional Project on Attitudes Toward Human Attributes(IPATHA), an international project for research on at-titudes toward people with various stigmatizing humanconditions that would employ standard measures. Mostnotably, they developed the Public Opinion Survey of Hu-man Attributes–Stuttering (POSHA–S) (St. Louis, 2011),which permits inter-sample comparisons of attitudes.

The POSHA–S contains a demographic section; ageneral section comparing stuttering to four other “an-chor” attributes, i.e., intelligent, left handed, mentallyill, and obese; and a detailed stuttering section (St. Louis,2011). The general section asks for ratings of the five at-tributes on 5-point Likert scales while the detailed stut-tering section ask for “yes,” “no,” and “not sure” ratingsthat are later converted to 3-point scales where “no” = 1,“not sure” = 2, and “yes” = 3. All attitude ratings arethen converted to a -100 to +100 scale where 0 is neu-tral, with scores for some items reversed such that higherscores reflect more accurate and sensitive attitudes, andvice versa. The −100 to +100 conversion is carried outafter mean values for each item are calculated, permit-ting comparison of the two rating scales on the samescale.

In the demographic section following an instructionpage, participants are requested to fill in demographiccharacteristics and to make self-ratings of their physicalhealth, mental health, speaking ability, and learning abil-ity. Additionally, respondents rate various life priorities(e.g., being safe and secure, helping the less fortunate,earning money, and doing my jobs or my duty) as po-tential future predictors of attitudes. Next, respondentsfill out the general section wherein they provide theiropinions of stuttering in comparison to four other hu-man attributes ranging from positive (i.e., intelligent),to neutral (i.e., left handed), to negative (i.e., obese, andmentally ill). The purpose of this section is to providethe potential to differentiate samples according not onlyto attitudes toward stuttering but also to the contextsinto which they occur. Finally, respondents rate hypo-thetical stuttering/people who stutter on a wide varietyof items that can be divided according to beliefs about

the disorder that do not involve the respondent consid-ering his or her own reactions or behaviour versus selfreactions or responses that do involve the respondent’sactions and emotions. Using the converted scores, thePOSHA–S is scored such that clusters of various itemsform components, various components form subscores,and the two subscores for stuttering (Beliefs and SelfReactions) form an Overall Stuttering Score.

The IPATHA initiative has generated a database ofrespondents from dozens of studies using the POSHA–S(St. Louis, 2011, 2012c). The database consisted of 6957respondents representing in 15 different languages and23 countries. The POSHA–S has been carefully evalu-ated for reliability; validity; internal consistency; user-friendliness; translatability; different modes of adminis-tration; and sensitivity to attempts to change attitudes,intercultural differences, generational differences, anddifferent types of sampling (e.g., Flynn & St. Louis,2011; St. Louis, 2012c, 2012c; St. Louis, Reichel,Yaruss, & Lubker, 2009; St. Louis & Roberts, 2010).

Research using the POSHA–S has shown importantdifferences between countries and cultures, cf. reviewin St. Louis (2012c). Three examples serve to illustrate.St. Louis & Roberts showed that attitudes toward stut-tering in Cameroon were markedly less positive thanattitudes in Canada and the USA, regardless of whetherthe POSHA–S was administered in English or French.Ozdemir, St. Louis, and Topbas (2011a, 2011b) demon-strated that public attitudes toward stuttering in Turkeywere not as positive as previous samples taken from the“West” and that attitudes of 6th grade schoolchildrenwere remarkably similar to the attitudes of their parents,grandparents (or adult relatives), and neighbours. In ad-dition, attitudes of adult respondents from Hong Kongand adjacent Mainland China were much more similarthan different but, as a group, were less positive thanmost of the samples in the POSHA–S database takenfrom North America and Western Europe (Ip, St. Louis,Myers, & An Xue, 2012).

Several POSHA–S investigations have also begun toexplore predictors of more versus less positive publicattitudes. Information about stuttering from an enter-taining talk to high school students about stuttering by ayoung adult male with rather severe stuttering or a pro-fessionally developed video for teens featuring the samespeaker (plus two other females who stuttered) resultedin significant short-term positive changes in attitudes(Flynn & St. Louis, 2011). One study showed that maleand female respondents selected randomly but equallyfrom 50 different samples around the world resultedin virtually identical POSHA–S measured attitudes (St.Louis, 2012a).

The need exists to broaden the database to publicsamples in other countries, especially in areas that haverelatively recently undergone dramatic political changes,


such as in Eastern European nations previously partof the Soviet Union. Poland is one such country. Thepurposes, therefore, of the current study were two-fold:(a) to describe the attitudes toward people who stutterthat are held by adolescent and adult Poles, and (b)to compare the Polish attitudes to those from samplesprevious analyzed in the POSHA–S database.

Method

Survey instrument

This study was conducted according to procedures ap-proved by the research ethics committee. The currentstudy used a Polish version of the POSHA–S. The firsttwo authors who are native speakers of Polish trans-lated separately the POSHA–S into Polish. Next, theycompared the two drafts of their translations in termsof ambiguity and adequacy and jointly chose the mostappropriate translation. Following that, their Polish ver-sion was verified by a committee of three experts in aspeech therapy (one practitioner and two researchers inthe field) for correct terminology. Next, the approvedPolish version was translated back into English by aprofessional English translator, and the original Englishversus back-translated English version were compared.The two English versions, though not worded exactlythe same, had no important differences in meaning. Thefinal version of POSHA–S was verified for readability byadministering it to a group of ten students to assesswhether any inconsistencies or misunderstandings arosefor the respondents. They did not report any problemsin understanding the items or in the survey procedure.As will be seen below, it is important to note that therespondents knew that the term for stuttering “jakanie”meant the disorder of stuttering and not normal disflu-ency “niepłynnosc.”

Participants

The data were collected in different places in Poland,i.e., the provinces of Kielce, Lublin, Poznan, Rzeszow,Warsaw, and Wrocław. Even though we used conve-nience sampling, our goal was to generate a reasonablyrepresentative sample of Poles by recruiting respondentsfrom different cities and at different age and educationlevels across Poland: 15% from rural areas, 14% fromsmall towns (≤20,000 inhabitants), 26% from medium-sized towns (20,000–99,000 inhabitants), 22% fromlarge towns (100,000–500,000 inhabitants), and 23%from cities (≥500,000 inhabitants). The question-naires were administered to respondents who volun-tarily agreed to participate. They were informed thatthe goal of this project was to explore public opinionabout a number of human attributes and characteristics

and were asked to share their honest opinions about thefive different human attributes. Respondents receivedno financial compensation but were thanked for theirparticipation and reassured about anonymity of theirratings.

Data analysis

Data were analyzed according to procedures used inseveral recent studies (e.g., Ip et al. 2012; Ozdemiret al. 2011a, 2011b; St. Louis, 2011; St. Louis, 2012a,2012b, 2012c). These involved reporting convertedmeans (ranging from most negative [−100] to most pos-itive [+100]) for each of the items, components (clustersof items), subscores (clusters of components), and theOverall Stuttering Score (mean of the two stutteringsubscores). A radial graph provides a visual display ofthe components and subscores along with a numericalOverall Stuttering Score. The radial graph shows themiddle (median) mean rating of 98 different samplesanalyzed to data in the POSHA–S database. At the timeof this writing (circa January, 2013), the 98 differentsamples came from single administrations of the instru-ment or the first of multiple administrations (e.g., pre-and post-test designs) representing 6957 respondentsfrom 23 countries taking the POSHA–S in 15 differentlanguages. Additionally, the radial graph shows the high-est (most positive) mean rating observed to date for eachcomparison as well as the lowest (least positive) in orderthat the sample(s) in question can be compared with theextremes and with the median or average sample rating.

To provide a more precise sample comparison, per-centiles relative to the 98 database means were gener-ated for the means of the Polish sample and divided intoquartiles. The percent of all of the Polish mean ratings inthe 1st or lowest quartile (0–25th percentile [%ile]), theinterquartile range (25th–75th%ile or 2nd and 3rd quar-tiles), and the 4th or highest quartile (75th–100th%ile)were then calculated. If the large majority of them werein the interquartile range, then it could be assumed thatthe Polish attitudes were about average. If a substantialpercentage were in the lowest or highest quartiles, thenthe implication would be that the Polish samples hadlower or higher attitudes, respectively, than average.

Although the POSHA–S database is not yet suffi-ciently broad and large to make accurate predictions ofthe relative positivity or negativity of attitudes in mostplaces of the world, the current study went one step fur-ther to search for predictors in this Polish sample. Wedivided the total sample in half based on their OverallStuttering Scores, a number that is influenced by all ofthe stuttering items. The highest half was then comparedto the lowest half so that we could inspect demographicvariables to determine which, if any, of them were


significantly different for the half with the “best” versusthe half with the “worst” attitudes toward stuttering.

Results

Demographic information

Demographic information is provided in column 2 ofTable 1 for the 268 Polish respondents who took part inthe study. The Table also compares these results to meansof the 98 samples in the POSHA–S database. The me-dian or middle sample mean from the database is shownin column 3. Column 4 shows percentiles for the Polishmeans generated from the 98 database means. Womenconstituted 60% of participants, and men, 40%. Re-spondents’ mean age was 29.2 yr, and they had an av-erage of 12.8 years of formal schooling. Twenty-sevenpercent were married, and 30% were parents. Thirty-nine percent were students, 34% were working while19% were not, and 8% were retired. Only 22% iden-tified themselves as intelligent (21st percentile [%ile]),and, surprisingly, 11% and 20% identified themselvesas stuttering and mentally ill, which placed them rel-ative to the POSHA–S database at the 91st%ile and99th%ile, respectively. Percentages (and percentiles rel-ative to the POSHA–S database) of the Polish samplereporting knowing no people who stuttered or who werementally ill were 35% (68th%ile) and 21% (40th%ile),respectively, but were above the 98th%iles for know-ing no one who was intelligent, left handed, or obese.Health and abilities were all rated lower than average,with physical health, mental health, and ability to learnall rated in the lowest quartile (0–25th%iles). This ado-lescent and adult sample of Poles were also somewhatatypical of the samples analyzed previously in that theywere in the 4th quartile (75–100th%ile) for wanting tobe free and desiring exciting but potentially dangerousexperiences but in the 1st quartile for wanting to attendsocial events, helping the less fortunate, doing their jobor duty, and getting things done.

Polish attitudes toward stuttering

Table 2 lists the 60 POSHA–S standard ratings: items,components, subscores, and Overall Stuttering Score,along with database median and generated Polish per-centiles as is Table 1. Figure 1 displays the Polish datagraphically in the standard POSHA–S graph formatcomparing them to the highest, lowest, and mediansample means observed to date (St. Louis, 2011). Thesolid tracing for the Polish data in Figure 1 are veryclose to the finely dotted median tracing, indicatinggenerally average Polish attitudes. Nevertheless, the Pol-ish means were lower or less positive than the databasemedian values for the Who Should Help (Help) com-

ponent, but sometimes more positive for the Knowl-edge/Experience (Knowledge) and Knowledge Source(Source) components. The Polish Overall StutteringScore of 18 (52nd%ile) is slightly above the mediandatabase score of 15.

By quartile, more than three-fourths (78%) the Pol-ish percentiles (Table 2, column 4) for the POSHA–Sratings were in the interquartile range, which is whatwould be expected if the Polish sample were generallyabout average. Eleven percent of the ratings were withinthe 1st quartile and 11% were within the 4th quartile.

Beliefs about stuttering reflect impressions andthoughts about stuttering that do not involve the re-spondent personally. Poles were less likely than averageto reject the belief that a person who stutters is “shy orfearful” (69th%ile) than to reject “nervous or excitable”(30th%ile). Nevertheless, the relatively low scores onthe −100 to + 100 range for both items reflect thewell-known “stuttering stereotype” (Woods & Williams,1976). Beliefs that were less positive or less accurate thanaverage included component ratings of who should helpa person who stutters (22nd%ile), accepting that speechand language therapist should help (7th%ile), and re-jecting that a medical doctor should help (7th%ile). Bycontrast, the Polish respondents held the more posi-tive than average belief that other people who stuttershould help a stuttering person (80th%ile). Regardingetiology, Poles failed to reject as much as average sam-ples that stuttering is due to a very frightening event(13th%ile) or a virus or disease (11th%ile). Although thePoles thought a person who stutters can lead a normallife (70th%ile), they did not believe the person could doany job he or she wanted (8th%ile). Fewer respondentsthan average indicated that they would feel comfortablearound a person stuttering (23rd%ile).

Self-Reactions are items associated with respon-dents’ self-appraisals of their own behavior, reactions,or knowledge. Although the mean was about neutral(i.e., 3), Polish respondents indicated more commonlythan average that they, themselves, should help a personwho stutters (81st%ile). Although within the interquar-tile range, the respondents were less likely to reject fillingin a stuttering person’s words than telling him or her to“slow down” or “relax.” They, like most samples, weremore likely to reject making a joke about stuttering.Respondents rated their comfort level with a stutteringperson lower than average. Otherwise, items related tothe Social Distance/Sympathy component were close toor slightly above average.

Although low in terms of the mean ratings, the Polesindicated higher sources of knowledge about stutteringthan average (76th%ile), especially relative to stutteringpersons known personally (83rd%ile). Poles’ sources of


Table 1. Demographic characteristics: POSHA–S mean ratings of Polish respondents, median values from the POSHA-S databasesamples (98 samples circa January, 2013 reflecting first or only POSHA-S administrations for 6957 respondents), and percentiles of

those means relative the POSHA-S database

Demographic Polish Database Median Polish SampleVariable Respondents (50th Percentile) Percentile

Number in sample 268 55 97Age: Mean (yr) 29.2 yr 34.9 yr 34Total schooling: Mean (yr) 12.8 yr 14.7 yr 18Sex: Males / females (% total) 40% / 60% 35% / 65% 68 / 32Student (% total) 38% 17% 60Working (% total) 34% 61% 18Unemployed or not working (% total) 19% 6% 78Retired (% total) 8% 3% 81Married (% of total) 27% 46% 27Parent (% of total) 30% 53% 34Polish as native language (% total) 100% — —Self-Identification (% responding)

Stuttering 11% 0% 91Mentally ill 20% 1% 99Obese 14% 8% 75Left handed 8% 7% 60Intelligent 22% 41% 21

No Persons Known (% responding)Stuttering 35% 25% 68Mentally ill 21% 23% 40Obese 35% 5% 98Left handed 29% 3% 99Intelligent 26% 1% 99

Self-Ratings for Health and Abilities (Mean: -100 to +100)Physical health 32 47 13Mental health 43 58 6Ability to learn 50 62 19Speaking ability 61 62 40

Self-Ratings for Life Priorities (Mean: -100 to +100)Be Safe/Secure 74 80 32Be Free 69 65 77Spend Time Alone 32 34 47Attend Social Events 7 16 23Imagine New Things 37 33 58Help Less Fortunate 40 55 19Have Exciting by Potentially Dangerous Experiences -6 -23 79Practice My Religion 12 24 33Earn Money 58 64 33Do Job/Duty 63 77 11Get Things Done 66 77 21Solve Big Problems 72 70 58

Completion time: Mean (min) 8.8 min 10.6 min 14

knowledge were higher than average from television,radio, and films as well as from the Internet, 79th%ileand 90th%ile, respectively.

For the attributes of obesity and mental illness, thePolish sample had a higher than average overall impres-sion of obese people (85th%ile), and although within theinterquartile ranges, their desire to be obese or amountknown about obesity were more positive than parallelratings for mental illness.

In the preliminary attempt to identify demographicfactors related to stuttering attitudes, we sorted the Pol-ish sample sorted according to the Overall Stuttering

Score into the highest and lowest halves. Predictably,mean ratings for the “best” half versus the “worst” halfwere higher for all the stuttering attitude ratings. Thispattern was also true for all the obesity and mental illnessitems. We ran t tests for independent samples between allpair-wise “best” versus “worst” means, with a Bonferronicorrected alpha level of (p ≤ .05/12 or .00417) to re-duce the likelihood of Type I errors. This specific alphalevel used in numerous previous sample comparisonsand has provided a satisfactory balance between avoid-ing Type I errors with solid correction but also avoidingType II errors with a too-strict correction (e.g., Flynn &


Table 2. Attitudes: POSHA–S mean ratings of Polish respondents, median values from the POSHA-S database samples (98 samplescirca January, 2013 reflecting first or only POSHA-S administrations for 6957 respondents), and percentiles of those means relative

the POSHA-S database

Polish Database Median Polish SamplePOSHA-S Variable Respondents (50th Percentile) Percentile

OVERALL STUTTERING SCORE 18 16 52Beliefs About Persons Who Stutter 31 34 39Traits / Personality 25 18 62

Have themselves to blamea 81 82 47Nervous or excitablea 17 7 69Shy or fearfula −22 −4 30

Stuttering Should Be Helped by . . . 16 26 22Speech and language therapist 85 89 7Other people who stutter 28 11 80Medical doctora −65 −15 9

Stuttering is Caused by . . . 29 34 36Genetic inheritance 22 15 67Learning or habitsa 33 18 66A very frightening eventa −48 3 13An act of Goda 68 63 62A virus or diseasea 20 53 11Ghosts, demons, spiritsa 80 89 31

Potential 55 61 31Can make friends 92 93 44Can lead normal lives 91 84 70Can do any job they want 11 51 8Should have jobs requiring good judgment 25 40 29

Self-Reactions to People Who Stutter 4 −2 66Accommodating / Helping 40 49 31

Try to act like the person was talking normally 81 77 57Person like me 3 −21 81Fill in the person’s wordsa 36 51 31Tell the person to “slow down” or “relax”a −20 28 27Make joke about stutteringa 78 88 28Should try to hide their stutteringa 62 69 33

Social Distance / Sympathy 9 4 57Feel comfortable or relaxed −2 18 23Feel pitya 21 22 48Feel impatient (not want to wait while the person stutters)a 54 58 44Concern about my doctora 43 29 57Concern about my neighbora 73 67 59Concern about my brother or sistera −11 −31 66Concern about mea −42 −50 63Impression of person who stutters 8 1 62Want to have stuttering −66 −71 68

Knowledge/Experience −25 −38 76Amount known about stuttering −12 −20 62Persons who stutter known −76 −85 83Personal experience (me, my family, friends) 12 −9 67

Knowledge Source −8 −23 66Television, radio, films 21 −12 79Magazines, newspapers, books −8 −13 60Internet 6 −49 90School −19 −24 53Doctors, nurses, other specialists −40 −35 48

Obesity/Mental Illness Subscore −32 −32 59Overall Impression −13 −15 65

Obese −9 −23 85Mentally ill −17 −9 34

Want to be −81 −83 60Obese −78 −82 65Mentally ill −84 −85 54

Amount Known about −1 2 43Obese 15 11 62Mentally ill −17 −10 35

aThe signs of the mean ratings for this item are reversed so that higher scores reflect “better” attitudes and lower scores, “worse” attitudes.


Figure 1. Summary POSHA-S graph for the Polish sample.

St. Louis, 2011; Ip et al. 2012, Ozdemir et al. 2011a,2011b; St. Louis 2012a, 2012c). Sixty-eight percent (41)of these comparisons statistically favored the “best” half,but in this preliminary predictor analysis those itemsthat did not discriminate the “best” versus “worst” atti-tudes would be especially interesting. Differences werenot significant for 32% (19) of the comparisons: impres-sions of obese persons, wanting to be obese or mentallyill (items and the combined component), and amountknown about mental illness. Non-significant stutteringratings included: help for stuttering by a medical doc-tor; genetic, learning, emotional trauma, act of God, andvirus/disease etiology; leading a normal life (with stut-tering); being suited for jobs requiring good judgement;telling a stuttering person to “relax” or “slow down; jok-ing about stuttering; being concerned if a neighbourstuttered; number of stuttering persons known; and in-formation about stuttering from television/radio/filmsor from the Internet. Unlike the attitude ratings, nonethe demographic variables were significant except thatthe “best” half indicated a significantly higher life prior-ity for “getting things done.” The variables of age, educa-tion, income, sex ratio, self-ratings of physical or mentalhealth, self-ratings of abilities to learn or speak, and 11other life priorities did not differentiate the two halves.General section ratings for intelligence and left handed-ness do not influence POSHA–S summary scores. Some-

what surprisingly, however, ratings for amount knownabout these two attributes were significantly different(as was the amount known about obesity and stutteringwhich were included in the summary scores).

Discussion

This investigation constitutes an important contribu-tion to the literature in that stuttering attitudes of abroad-based sample of the public from Poland are com-pared with other public samples around the world. Themost important finding of the study was that the EasternEuropean sample of Polish respondents held attitudes to-ward stuttering similar to the average of previous conve-nience and probability samples around the world. Fully78% of the POSHA–S items, components, subscores,and Overall Stuttering Score were within the interquar-tile range (25th%ile to 75th%ile) relative to samples of 98first-time respondents (circa January, 2013) within thePOSHA–S database. Average scores would be expectedto fall within this range. By contrast, a few significantdifferences are worth highlighting among the 11% ofratings falling in either the 1st quartile and the 11% inthe 4th quartiles. One previous report on Polish attitudestoward stuttering carried out in the period of transitionfrom communism to capitalism wherein the process ofglobalization has started postulated that their attitudes


were generally less positive than those observed in manyother countries, for example the USA (Grzybowska et al.1991).

The items relating to sources of help for people whostutter were noteworthy. Below average ratings for thebeliefs that either speech and language therapists andmedical doctors should help people who stutter are con-sistent with the result of a Polish report on confidencein doctors and therapists, which reveals that one outof ten Poles do not trust their doctors or therapists(Report Polpharma, 2010). On the other hand, the factthat Poles were relatively more optimistic than averageabout people who stutter helping others with the sameproblem bodes well for the potential of self-help groupsin Poland.

Compared to other samples, the Polish respondentswere more likely to accept genetic inheritance as a causeof stuttering and to reject learning or habits and anact of God. They were somewhat to substantially lesslikely than average to reject emotional trauma, virusesor disease, and ghosts, demons, or spirits. A possibledisconnect was observed between the belief that thosewho stutter can lead normal lives but uncertainty aboutwhether or not they can do any job they want or do a jobrequiring good judgment. This finding may be relatedto the fact that rising unemployment characterized thePolish work market at the time of this writing (ReportMPiPS, 2013).

Comparing the Poles to other samples around theworld, we noted a few slight differences in Self-Reactionsto people who stutter. The Poles were less likely to re-ject the option to “Tell the person to slow down orrelax” than average. They were more likely to indicatethat they should help a stuttering person, much moreso than average. Other differences occurred in SocialDistance and Sympathy components. For example, thePoles were more likely than average to indicate ‘no’ inresponse to the question of whether they would feelcomfortable and relaxed when talking to a stutteringperson. They were about average in other responses re-lated to social distance, i.e., concern about examples ofother people who stutter (doctor, neighbour, siblings,and themselves). In the area of knowledge and experi-ence, they assessed their knowledge about stuttering andtheir personal experience higher than other samples did.They also reported television, radio, films, the Internet,and school more highly as sources of their stutteringknowledge.

As noted, it is premature to calculate the predic-tive value of various descriptors and self-ratings in thedemographic section shown in Table 1 on stuttering at-titudes. Such predictions will require that the POSHA–Sdatabase grow considerably, especially among main-stream populations around the world, so that regression

analysis can be performed on these and other items to de-termine which items, or which combination of items, ifany, are predictive of more positive or negative attitudestoward stuttering. Nevertheless, comparing the “best”versus the “worst” halves of the Polish data according totheir Overall Stuttering Scores revealed some interestingresults. First, mental illness and obesity attitudes weremore positive, and some significantly so, when the datawere sorted according to stuttering attitudes alone. Ap-parently, there is some “carry over” of positive attitudestoward stuttering to positive attitudes toward other stig-matizing attributes. This is consistent with a preliminarystudy by St. Louis and Rogers (2011a) who analyzed thePOSHA–S database, then containing 3750 respondents.However, the failure of such socio-economic variablesas education and income to predict the “best” versus“worst” attitudes was not consistent with a companionpreliminary study of the 3750 respondents (St. Louis &Rogers, 2011b). In fact, none of expected demographicvariables made a significant difference in the prelimi-nary analyses reported in this study (Table 1). We can-not explain why only respondents’ priority for “gettingthings done” and knowledge of left handedness and in-telligence did discriminate between the two halves. Tobe able to offer some meaningful interpretation of thatfinding would require many more “normal” samples ofrespondents around the world, not just those that are atthe positive and negative extremes.

Looking at differences for the total Polish sam-ple (Table 1) for life priorities indicates that Polesrated themselves quite positively on desire for freedom(77th%ile) and for exciting but potentially “dangerous”experiences (79th%ile). We speculate that this may bepartly related to their age, since the majority of respon-dents were young adults. At that age, excitement andfreedom may be important (Erikson, 1968). We specu-late further that it might also be related to the historyof Poland, a country that was under occupation anddeprived of independence for a long time. This situa-tion may have affected Polish citizens’ way of thinking.In communism, people with different disabilities werefrequently pushed to the margin of society, so that inthose years, disabled people were not commonly seen inthe streets of Poland, and people who stutter were fre-quently absent from social life. In a study by Cieciuchand Zaleski (2009) using the Schwartz Portrait ValueQuestionnaire, freedom and the sense of security werefound to be important for Poles as they attempt to com-pensate for the lack of these in their recent history. Thisbeing said, the POSHA–S database is still expandingas new samples are added so that the percentiles maystill change. Additionally, we emphasize that this studyexamined a convenience sample that may not be repre-sentative of the Polish population.


As noted, the results provide evidence that the atti-tudes of Poles are generally similar to those of other adultsamples of the public around the world. Nevertheless, itis important to bear in mind that many ratings were stillnegative, and much more negative than the most posi-tive attitudes obtained so far from leaders in the self-helpmovement for stuttering or from speech and languagetherapists who were specialists in fluency disorders, whohave been advanced as generating a “gold standard” tar-get (St. Louis & George, 2008). Accordingly, the socialproblems, stigma, and ostracism reviewed in the intro-duction can also be similarly attributed to people whostutter in Poland, confirming results of other Polish stud-ies (e.g. Grzybowska et al. 1991; Kulas, 1990). The lowratings for people who stutter being nervous, excitable,shy, or fearful are widely regarded symptoms of the “stut-tering stereotype” (Blood & Blood, 2007; Woods &Williams, 1976). The social concern about other peo-ple who stutter, such as neighbours, reported by somePolish respondents suggests that even something as in-nocuous as a stuttering neighbour creates a threat. IfTarkowski (2008) is correct, it is possible that those whoare concerned about a neighbour who stutters are morelikely those who view stuttering as a symptom of neuro-sis. More obvious and in accordance with Blachnio’ (inpress) findings, the Polish respondents reported feelinguncomfortable while talking with a person who stutters.In similar vein to aforementioned research (e.g. Gabelet al. 2004; Klein & Hood, 2004), the failure of Polishrespondents to agree that people who stutter can do anyjob they want suggests that vocational role entrapmentdoes occur in Poland and could easily deprive them ofjob opportunities and/or hinder desired promotions.

We were somewhat surprised at the high levels ofself-identification of stuttering and mental illness ob-tained in the Polish sample. During the translation pro-cess, no misinterpretation of the experts in the termfor the disorder of stuttering occurred. “Jakanie” doesnot mean “normal disfluency.” Even so, 11% of the re-spondents self-identified themselves as stuttering. Highself-identification of stuttering could be influenced byseveral factors. For example, in colloquial Polish, thereis an expression meaning “do not stutter,” used in or-der to reprimand a person for speaking unclearly andincoherently, regardless of whether they really stutteredor not. This is similar to the English use of the termin some colloquial use. It is possible that, by iden-tifying themselves as people who stutter, respondentsmeant that they sometimes happen to stutter, e.g., dur-ing stressful situations, in which case “stuttering” oc-curs as an incident but is not a fluency disorder. Onthe other hand and although we cannot be certain,it is possible that the percentages reflect an unusuallyhigh prevalence of stuttering in the sample studied. ThePolish sample percentage self-identifying themselves as

intelligent was surprisingly low (21st%ile), and we can-not imagine that respondents misunderstood that termespecially since they were at the 58th%ile for their rat-ing of the amount known about intelligence. Eightpercent identified themselves as left handed, which isabout average (60th%ile). Fourteen percent indicatedthat they were obese (75th%ile), which is consistentwith a recent report of obesity in Poland (Milewicz,Jedrzejuk, Lwow, Białynicka, Łopatynski, Mardarowicz,& Zahorska-Markiewicz, 2005). Twenty percent of Pol-ish respondents identified themselves as mentally ill,which may well stem from a misunderstanding of theterm. Affective disorders such as depression or even per-sonal crises might be interpreted by the respondents tofall under the term “mental illness,” which might beconsistent with their 7th%ile self-identification meanrating for mental health. We believe the misinterpreta-tion explanation, though tentative, to be a more plausi-ble explanation of the high prevalence of stuttering andmental illness, although only further research, especiallymixed method research, could more satisfactorily answerthe question.

The obtained results validate the Polish translationof POSHA–S and indicate that the instrument mea-sures attitudes in Polish very similarly to the way itdoes in other languages. This is consistent with studiesusing translations into many other languages such asFrench, Simplified Chinese, and Turkish (Ip et al. 2012;Ozdemir et al. 2011a; St. Louis & Roberts, 2010).

Finally, the data have clinical implications for Polishspeech and language therapists as well. The mean rat-ings have potential usefulness in targeting areas whereinpeople who stutter may be stigmatized and where thedanger of stereotyping is the highest. Also, since stutter-ing therapy often involves family and friends, educatingthem about negative public attitudes could be helpfulin modifying clients’ environments. Hopefully, such ef-forts would result in more positive views and kindertreatment of stutterers based on information consistentwith the true nature of this disorder rather than on mis-guided knowledge, beliefs, and reactions.

Future Research

Clearly, there is much to be done and changed in orderto build a society more friendly to people who stutter.These results are a first step in making Polish societymore familiar with stuttering itself. A logical next stepwould be to compare the attitudes of people on the streetwith those who are or will be charged with treating peo-ple who stutter, such as speech and language therapistsor psychologists or students training to do so. Addi-tionally, future studies should be focused on changingthe perception of the public toward people who stutter


through direct contact with stutterers and informationabout stuttering.

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Public attitudes toward stuttering in Poland