Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part I. Scale Development

Abstract

Purpose This article is the first in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. In this article, we describe the process of developing measures to assess stage of change (SOC) by defining behaviors of stuttering management, as well as the two primary cognitive constructs that underlie one's readiness to make behavioral change: decisional balance (DB) and situational self-efficacy (SSE). This work hinges on the ability to develop an operational definition of what it means to successfully manage or do something positive about one's stuttering. Method We used an iterative process to develop the three scales. Through qualitative analysis of key informant interview and focus group transcripts with 24 adolescents who stutter and 26 clinicians specializing in stuttering, we developed stuttering-specific SOC, DB, and SSE scales. The drafted scales were cognitively tested with nine adolescents who stutter. Results Thematic analysis yielded a three-part definition of successful stuttering management that formed the basis for the SOC scale: (a) learning and using strategies to modify speech or stuttering, (b) changing negative thoughts and attitudes regarding stuttering, and (c) talking without avoiding sounds, words, or situations. Results from this analysis support a broader view of successful stuttering management; that is, it is likely that doing so requires more than just behavior change, which has long been considered the main objective of stuttering treatment. Additional analyses yielded pros and cons of managing stuttering (62 items for the DB scale) and situations in which it is difficult to manage stuttering (39 items for the SSE scale). Conclusions Qualitative analyses provided a three-part definition of “stuttering management” and a comprehensive pool of items that would allow measurement of DB and SSE that underlie readiness to manage stuttering among adolescents. In the companion article in this two-part series, we describe the next step in scale development: exploratory scale validation of the drafted SOC, DB, and SSE scales.

Meet Them Where They're At: Maximizing Adolescents' Engagement in Stuttering Therapy

“…This was a challenging pursuit, as “change” for people who stutter is multidimensional and highly personal. Through thematic analysis of interviews with dozens of adolescents who stutter and speech therapists who specialize in stuttering therapy, we developed a three-part definition of what it means for adolescents who stutter to manage how they live with stuttering (listed in no order of importance) 17 :…”

“…This was a challenging pursuit, as "change" for people who stutter is multidimensional and highly personal. Through thematic analysis of interviews with dozens of adolescents who stutter and speech therapists who specialize in stuttering therapy, we developed a three-part definition of what it means for adolescents who stutter to manage how they live with stuttering (listed in no order of importance) 17 Once presented with the definition, we asked adolescents who stutter to "stage" themselves by indicating how ready they are to manage stuttering globally, and then how ready they are to address each of the three domains of change. The options were: A. I am not thinking about doing this in the next 6 months (aligns with Precontemplation).…”

Identifying perspectives of adults who stutter on therapeutic alliance in stuttering intervention

“…Some researchers have advocated for the influential role of factors outside the specific intervention technique on treatment outcomes. Such factors include TA, or person-related variables such as a client's readiness for change or a clinician's empathy (Botterill, 2011;Connery et al, 2022;Ebert & Kohnert, 2010;Grencavage & Norcross, 1990;Manning, 2000;Rodgers et al, 2021;Zebrowski et al, 2021). This prompts us to consider whether the intervention technique is the primary effective component of stuttering intervention or whether there are other factors that play a role (Connery et al, 2022).…”