2003 IFA Congress: Montreal, Canada

Public Attitudes Toward Stuttering and Other Human Attributes in Brazil

Kenneth O. St. Louis1 and Claudia Regina F Urquim De Andrade2
1Department Of Speech Pathology and Audiology, West Virginia University, PO Box 6122, Morgantown, WV26506-6I22, USA
2Department of Physiotherapy, Speech-Language-Hearing Sciences and Occupational Therapy, Sao Paulo University, Sao Paulo, Brazil


As part of the International Project on Attitudes Toward Stuttering (IPATS), 188 questionnaires were analyzed from university students and other adults living in Brazil from the state and city of S510 Paulo and from Minas Gerais, an adjacent state. The questionnaires were Brazilian Portuguese translations of a slightly modified version of the Public Opinion Survey of Human Attributes-EXperimental Edition (POSHA-E) (St. Louis, et al., 2001). The two states differed significantly on some questionnaire items, although the overall sample was similar to previous research using the POSHA-E in English and other languages.

  1. Introduction
In numerous areas around the world, studies have found that the general public appears to hold negative, erroneous, and even discriminatory reactions, beliefs, and feelings about people who stutter (e.g., Craig et al., 2001; Klassen, 2002; Turnbaugh et al., 1979). Numerous reports have documented a stuttering “stereotype.” Yet, aside from some isolated efforts (e.g., Jin 2001; Van Borsel, et al., 1999), there has been little research that has attempted to compare attitudes on the same measures cross-culturally. Accordingly, it is impossible to determine which communities, regions, or societies are more or less knowledgeable about stuttering or punitive toward individuals who stutter. It is also not possible to determine whether or not some cultures tend to stigmatize persons who stutter more than other cultures do. St. Louis et al., (2001) described an initiative called the International Project on Attitudes Toward Stuttering (IPATS) to carry out such comparisons. They reported similarities and differences in attitudes among small “convenience” samples of adults from the USA, Canada, Denmark, Bulgaria, and South Africa.

The current study was undertaken to extend those comparisons to two states in the South American country of Brazil. Furthermore, the study was carried out to compare the attitudes of adults who were university students versus those who were not.

  1. Method
This investigation used an adaptation of the experimental prototype of the instrument entitled the “Public Opinion Survey of Human Attributes-Experimental Edition” [POSHA-E]) described by St. Louis, et al._ (2001). The POSHA-E is a paper-and-pencil questionnaire designed to measure attitudes toward stuttering, including: knowledge, beliefs, reactions, and feelings as well as comparative attitudes toward several other human conditions hypothesized to be desirable, neutral, or undesirable. These other conditions, termed “anchors,” included: mental illness, wheelchair use, overweight, old, left handed, good talker, multilingual, and intelligent. The second author translated the POSHA-E into Brazilian Portuguese and then had a colleague “back translate” it to English to assure minimize errors in translation.

In the St. Louis, et al. (2001) report, respondents drew Vertical lines on “continuous” scales following each questionnaire item that were later converted to numbers from O to 100. Each POSHA-E contained a general section that asked three questions about all nine attributes, a longer section on stuttering, and a demographic section. The primary differences between the procedures in this study and the earlier pilot study reports by St. Louis, et al. is that the respondents in Brazil were not asked to list who they knew with each attribute (general section) and each respondent received a detailed section on stuttering only. (In the earlier study, respondents were asked to respond to a detailed section on stuttering as well as for two other anchors.)

Twenty-five students in a class on fluency disorders at the Sao Paulo University distributed POSHA-Es to classmates, family members, and acquaintances both at the university and in their hometowns and villages. Each student handed out approximately 10 questionnaires for a total of 250. Respondents returned the questionnaires to students, who then measured the lines used to mark scaled ratings on transparent rulers in order to determine a number from 0 to 100. These numbers were transferred to charts provided for each student. It should be noted that nearly all (97.1%) of the responses were rounded to the nearest ten, e.g., “0,” “10,”  “20,” “30,” etc. when “read” by the students.

  1. Results and Discussion
The overall return rate for the questionnaire was approximately 75% (188/250). Of the total sample, 35% were male and 65% were female. The mean education level was 13.5 years of school. Of 184 individuals who identified their race: 58% were “white” or European, 23% were Latino/ Latin American, 15% were Asian/Oriental, 2% were “negro,” and 1% was Arabic. Seventy-three percent of the respondents listed “Catholic” as their religion (with 179 responding to the item). The remaining 27% were distributed as follows: 11% Protestant and other Christian, 8% Spiritualist, 6% atheist/agnostic/other, and 2% Buddhist. Respondents were classified according to residence in two Brazilian states, Sao Paulo and the adjacent state of Minas Gerais (See Table 1.) Within the state of Sao Paulo, respondents were further subdivided into those from the city of Sao Paulo versus those from other cities. Table 1 shows these subgroups as well as classification of respondents from both states in terms of their status as students or non-students. Mean or percent data for each subgroup of demographic data for respondents from SE10 Paulo versus Minas Gerais, students versus non- students, and the total group of 188. Means (but not percentages) of respondents from Sao Paulo versus Minas Gerais, and from students versus nonstudents, were compared by using multiple t tests comparisons, using the Bonferroni correction to minimize Type I errors. The .05 alpha level was divided by 124 (the number of questionnaire items in all three sections of the POSHA-E whose means were subjected to t tests) to yield a cutoff or statistical significance of .00043.


Table 1. Demographic data.

Table 2 summarizes the results for the general section of the POSHA-E, requesting ratings for “overall impression,” â_ Wanting (or not wanting) to be...,” and “amoun; known about” stuttering and eight other anchors. Even with the conservative statistical procedure described earlier, overall impressions of respondents from Sao Paulo were significantly more positive than those of the comparison group in Minas Gerais for all but mental illness. There were no significant differences between students and non-students. Somewhat surprisingly, the overall impressions for being old and left handed, found to be 5-10 points above 50 or “neutral” in the comparison sample (St. Louis, et al., 2001) were more positive among the large Sao Paulo sample, 85 and 91, respectively. (These ratings also heavily influenced student, non-student, and overall means.) The Minas Gerais sample had lower than neutral ratings for old and left handed. When asked if they “wanted to be” the attribute in question, respondents in all groups showed dramatic negative shifts for the undesirable attributes of stuttering, mental illness, wheelchair use, and overweight, a finding consistent with earlier comparisons (e.g., St. Louis, et al., 2001). There was also a positive shift for the desiraale attributes of good talking, multilingualism, and intelligence. The differences between Sao Paulo and Minas Gerais were significant for stuttering, old, left handed, and multilingual. Asked how much they knew about each attribute, Sao Paulo respondents reported significantly less knowledge for stuttering than Minas Gerais respondents did but significantly more knowledge for overweight, old and left handed (and approaching significance for intelligent). Students reported significantly higher knowledge ratings for stuttering than non-students (and nearly significantly higher ratings for mental illness).


Table 2. Ratings (0-100) for stuttering and eight other human attributes.

Table 3 portrays ratings for the detailed section on stuttering with few significant differences between either Sao Paulo versus Minas Gerais respondents or between students and non-students. Using the same cutoff of .00043, the Sao Paulo group reported significantly less certainty that stuttering was either caused by parents overreacting_ to their children’s speech or imitating other people, more certainty that stutterers should be helped by medical doctors or pediatricians or physical/occupational therapists, and very little - but significantly less - likelihood of experiencing surprise or embarrassment upon talking with a stutterer. The only significant difference between students and non-students was for source of their information on stuttering from schoolteachers, 44 for students versus 21 for non-students, (not shown in Table 3).

Respondents in the combined sample from Brazil, like previous samples, showed considerable ambiguity about the cause of stuttering, tending to rate many items close to the “neutra “ or “unsure” level. Although rated low, Brazilian respondents rated causes of “a virus or disease,” â_ an act of God,” and “ghosts, demons, or spirits” somewhat higher than the combined subject group from St. Louis et al. (2001).

The results for who should help a person who stutters were unremarkable and quite similar to comparison data. In terms of what the respondent would do when confronted with a stutterer, Brazilian respondents were likely to report respectful reactions, similar to the comparison group, with mean scores of 61 for ignoring the stuttering, 66 for waiting patiently during the stuttering, and less than 5 for telling the person to stop stuttering, making a joke about or imitating stuttering, walking away, and so on. Like the comparison group, none of the listed emotions that would be felt while talking to a person who stutters reached the midway point between “no” and “yes.” Unlike the comparison group in which “comfortable or relaxed” was tied for highest (48) however, Brazilians rated this choice at a mean level of 26, the same as for “pity.” â_ Impatient” was rated at 33, and “curious to know more about stuttering” at 42, the highest rating.

The hierarchy of concern about contact with people who might stutter was similar to, but slightly more divergent, than the comparison group. Respondents were relatively unconcerned about stuttering among neighbors (25) and their younger or older child’s teachers (23 and 24), (the latter pair being lower than those in the comparison group [52 and 48]). Progressing toward more concern, Brazilian respondents listed their religious leader (34), their doctor (39), their younger or older children’s friends (42 and 44), their spouse (81), their son or daughter (90 each), and finally themselves (92).

Ratings for a number of items showed the same apparent contradictions that have been reported previously using the POSHA-E (St. Louis, Schiffbauer, Phillips, Sedlock, Hriblan & Dayton, 2000; St. Louis et al., 2001). On the positive side, stutterers were viewed as not having lower-than-average intelligence (5), not having any need to hide their stuttering (9), seeming no different than anyone else (76), being pleasant to be around (62), being able to do any job they wanted to (70), and being able to lead normal lives (85 ). Even so, they were regarded as being generally nervous or excitable (59), shy or fearful (58), and not well suited for jobs requiring good judgment (37) or lots of talking (20). Ratings for the effect of stuttering on a person’s ability to do a variety of activities, such as doing well in school (46), making friends (51), or interacting with people socially (60), were generally higher than the comparison group, but still lower than the above-mentioned item wherein respondents believed that people who stutter can lead normal lives (85).



 Table 3. Selected ratings (1 -1 00) for stuttering attitudes.

Overall, the results of this field test of the POSHA-3 indicated that the Brazilian Portuguese version is sensitive to similar attitudes shown in earlier English and Bulgarian versions (e.g., St. Louis, et al., 2000; St. Louis et al., 2001). Furthermore the investigation revealed a number of differences within the Brazil sample. With the caution that sub-sample sizes were not equally representative of the groups represented; the following tentative conclusions emerged. College students versus non-students, with similar total educational levels, held quite similar attitudes toward stuttering and the other eight attributes, in spite of a 14-year age difference, dissimilar marital status, and different proportions of males and females. Predictably, the students reported more knowledge about stuttering, however. Much greater differences emerged between residents of Sao Paulo and Minas Gerais, even though they were less divergent in age, sex, and marital status than students versus non-students. The largest differences occurred in comparisons among all nine human attributes. For the ratings of “overall impression” and “wanting to be,” the Minas Gerais respondents rated most attributes lower - and Sao Paulo respondents rated them higher - than a composite sample of respondents from the USA, Canada, Denmark, Bulgaria, and South Africa (St. Louis, et al., 2001). Differences between the two Brazilian states were less pronounced for the detailed stuttering section, although there was an uneven trend of less informed and slightly less sensitive reactions to stuttering and stuttering people by the Minas Gerais subgroup. For this section, there were some subtle differences between the overall Brazil sample and the comparison group; yet, overall, similarities outweighed these differences.

Craig, A., Hancock, K, Tran, Y, & Craig, M. (2001). Prevalence and stereotypes of stuttering in the community. In H-. G. Bosshardt, J. S. Yaruss, & H. F. M. Peters (Eds.), Fluency disorders: Theory, research, treatment, and self-help, Proceedings of the Third World Congress on Fluency Disorders in Nyborg, Denmark (pp. 588-592). Nijmegen, The Netherlands, N ijmegen University Press.

Jin, X. (2001). Public awareness of stuttering in China. Paper presented at the 6” World Congress for People Who Stutter / 3”â  International Stuttering Association Conference. Ghent, Belgium

Klassen, T. R. (2002). Social distance and the negative stereotype of people who stutter. Journal of Speech-Language Pathology and Audiology. 26, 90-99.

St. Louis, K. 0., Schiffbauer, J. D., Phillips, C. I., Sedlock, A. B., Hriblan, l. _J., & Dayton, R. M. (2000). The public environment where attitudes develop: Stuttering versus mental illness and intelligence. Paper presented at the 3rd International Stuttering Awareness Day On-Line Conference. http://www.mankato.msus.edu/dept/comdis/ISAD3/isadcon3.html

St. Louis, K. 0., Yaruss, J. S., Lubker, B. B., Pill, J., & Diggs, C. C. (2001). An international public opinion survey of stuttering: Pilot results. In H.-G. Bosshardt, J. S. Yaruss & H. F. M. Peters (Eds.). Fluency disorders: Theory, research, treatment and self-help. Proceedings of the Third World Congress on Fluency Disorders in Nyborg, Denmark. International Fluency Association, 581-587.

Turnbaugh, K. R., Guitar, B. E., & Hoffman, P. R. (1979). Speech clinicians’ attribution of personality traits as a function of stuttering severity. Journal of Speech and Hearing Research, 22, 37-45.

Van Borsel, J., Vemiers, 1., & Bouvry, S. (1999). Public awareness of stuttering. Folia Phoniatrica et Logopaedica, 5], 124-132.
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