Configurations of self-identity formations of adults who stutter

The aims of this paper are twofold: Firstly, to describe the configuration of self-identity formations evident across and within research stories of adults living with stuttering; and secondly, to discuss the clinical implications of these findings. The study on which this paper is based used life history narratives to describe the types, processes and configurations of self-identity formations of adults who stuttered since childhood. Through open-ended, in-depth interviews 7 participants shared their experiences of living with stuttering. The interviews were analysed at a first level using narrative analysis and at a second level to further describe the types, processes and configurations of self-identity formations evident in the stories. The findings on configurations of self-identity formations were that the two types of self-identity formations Able and DisOther were present in singular and dual configurations. The dual self-identity formations occurred in co-existing, competing and coalescing relationships within particular time periods in their stories. The clinical implications of the findings are discussed

Life histories of people who stutter : on becoming someone.

Thesis (Ph.D.) - University of Durban-Westville, 2003.This study explores participants' experiences of stuttering in their lifeworlds over time through the lens of self-identity formations. The critical questions raised are: How do participants form their self-identities in their lifeworlds over time in relation to stuttering? In the context of their self-identity formations, how do they negotiate stuttering? A narrative life history methodology was used with intention to access personal, temporal and social dimensions of experience. Seven adult participants, two female and five male participants, with histories of living with stuttering since childhood, were invited to share their stories. Their personal experiences are embedded in diverse lifeworlds in KwaZulu-Natal, South Africa, a context making a sociopolitical transition from apartheid to democracy. The data was produced through retrospective accounts of their experiences via a series of dialogical interviews. Issues of empathy, power, and positioning and quality in the research process are problematised. The data was analysed at three levels. The first level of analysis entailed a narrative analysis of interview data, represented as seven individual research stories. The second level of analysis is a cross-case analysis using the seven research stories for the purposes of theorising. The outcomes of the third level of analysis are abstractions and explanatory concepts which respond to the critical questions in a general way. The genesis of two self-identity trajectories, self-identity as DisOther and self-identity as Able/Potential are traced over time. The biographical, contextual and social forces shaping self-identity formations and participants' actions in negotiating stuttering are illuminated. The self-identity trajectories are unique in the context of each biography. However, the relative prominence of self-identity formation as DisOther across cases in school years was evident. In contrast, self-identity as Able/Potential became prominent, during adulthood, for some participants. The experience is rendered as complex and fluid through a set of abstractions and explanatory concepts. These concepts foreground the changing and multiple relationships between self-identity formations, the influence of social forces shaping self-identity, the impact critical catalysts shaping self-identity formations, and strategic manipulation of self-identity in negotiating stuttering. In particular, the strategies to negotiate stuttering successfully are examined. The limitations of the study and potential application of this theoretical offering in the research, educational and clinical domains of Speech-Language Pathology are discussed

'It’s not just the learner, it's the system!' Teachers’ perspectives on written language difficulties: Implications for speech-language therapy

The failure to achieve academic outcomes in linguistically diverse classrooms in poor areas of the Western Cape, South Africa, is well documented. A major contributing factor is the written language communication difficulties experienced in these classrooms. This paper describes the views of intermediate-phase teachers on why written language difficulties are experienced by learners and ways in which these difficulties might be overcome. A series of interviews were conducted with two class teachers in one urban school from which there had been a high number of referrals for speech-language therapy. The teachers were individually interviewed using an in-depth, semi-structured format. Teachers reported that 50 - 70% of learners in their classes were not meeting grade level academic outcomes. They were asked to explain the difficulties experienced with regard to written language, and the challenges and solutions linked to these. The findings suggest that there are barriers and opportunities at the school system, individual learner and home/social community levels. Major challenges identified at the school system level included limited training and lack of support for teachers, poor foundation skills in learners and difficulties with language. The current opportunities for the development of written language were insufficient and teachers identified further opportunities to promote the learners’ written language development. These included training and support for teachers, clear and consistent assessment guidelines, remedial assistance for learners and safe, nurturing home environments. There is a need to look beyond the learner as the site of the problem; a systemic approach is essential. In the light of these findings, suggestions are made for the role of the speech-language therapist

Life histories of people who stutter : on becoming someone.

Thesis (Ph.D.) - University of Durban-Westville, 2003.This study explores participants' experiences of stuttering in their lifeworlds over time through the lens of self-identity formations. The critical questions raised are: How do participants form their self-identities in their lifeworlds over time in relation to stuttering? In the context of their self-identity formations, how do they negotiate stuttering? A narrative life history methodology was used with intention to access personal, temporal and social dimensions of experience. Seven adult participants, two female and five male participants, with histories of living with stuttering since childhood, were invited to share their stories. Their personal experiences are embedded in diverse lifeworlds in KwaZulu-Natal, South Africa, a context making a sociopolitical transition from apartheid to democracy. The data was produced through retrospective accounts of their experiences via a series of dialogical interviews. Issues of empathy, power, and positioning and quality in the research process are problematised. The data was analysed at three levels. The first level of analysis entailed a narrative analysis of interview data, represented as seven individual research stories. The second level of analysis is a cross-case analysis using the seven research stories for the purposes of theorising. The outcomes of the third level of analysis are abstractions and explanatory concepts which respond to the critical questions in a general way. The genesis of two self-identity trajectories, self-identity as DisOther and self-identity as Able/Potential are traced over time. The biographical, contextual and social forces shaping self-identity formations and participants' actions in negotiating stuttering are illuminated. The self-identity trajectories are unique in the context of each biography. However, the relative prominence of self-identity formation as DisOther across cases in school years was evident. In contrast, self-identity as Able/Potential became prominent, during adulthood, for some participants. The experience is rendered as complex and fluid through a set of abstractions and explanatory concepts. These concepts foreground the changing and multiple relationships between self-identity formations, the influence of social forces shaping self-identity, the impact critical catalysts shaping self-identity formations, and strategic manipulation of self-identity in negotiating stuttering. In particular, the strategies to negotiate stuttering successfully are examined. The limitations of the study and potential application of this theoretical offering in the research, educational and clinical domains of Speech-Language Pathology are discussed

Debate: Why should gender-affirming health care be included in health science curricula?

Background Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care. Main body Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions. Conclusion There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future

The internal and external consistency of a speech reception threshold test for isiZulu speakers with normal hearing sensitivity

Background and objectives: This study investigated reliability, particularly the internal and external consistency, of a new isiZulu speech reception threshold (SRT) test. Methods: To examine internal consistency, 21 adult isiZulu speakers with normal hearing sensitivity completed the SRT test using the first and second halves of the SRT wordlist in the same test session. To examine external consistency, a separate 23 adult isiZulu speakers with normal hearing sensitivity completed the SRT test, using the whole word list on two occasions 4 weeks apart. Consistency of SRT test scores in these test conditions was measured using intraclass correlation coefficient analyses (a measure of the consistency or reproducibility of different observations of the same quantity) and Bland and Altman analyses of agreement (a comparison of measurement error with the expected variation amongst subjects). Results: Intraclass correlation coefficient values ranged from 0.69 to 0.79, showing the isiZulu test scores were highly consistent between the test and retest conditions used in this study. Bland and Altman analyses showed that isiZulu speakers with normal hearing sensitivity can be expected to return isiZulu SRT test scores that differ by no more than 7.5 dB HL - 8.7 dB HL between original and repeat assessments. Conclusion: The isiZulu SRT test was reliable, showing high internal and external consistency, when used to assess first-language speakers of isiZulu with normal hearing sensitivity. These findings warrant continued development of the isiZulu SRT test for eventual clinical use. This development should include validating this test on first-language speakers of isiZulu with and without hearing loss

Configurations of self-identity formations of adults who stutter

The aims of this paper are twofold: Firstly, to describe the configuration of self-identity formations evident across and within research stories of adults living with stuttering; and secondly, to discuss the clinical implications of these findings. The study on which this paper is based used life history narratives to describe the types, processes and configurations of self-identity formations of adults who stuttered since childhood. Through open-ended, in-depth interviews 7 participants shared their experiences of living with stuttering. The interviews were analysed at a first level using narrative analysis and at a second level to further describe the types, processes and configurations of self-identity formations evident in the stories. The findings on configurations of self-identity formations were that the two types of self-identity formations Able and DisOther were present in singular and dual configurations. The dual self-identity formations occurred in co-existing, competing and coalescing relationships within particular time periods in their stories. The clinical implications of the findings are discussed

Clinical educators’ experiences of facilitating learning when speaking a different language from both the student and client

Background: Worldwide there is an increasing responsibility for clinical educators to help students from different language backgrounds to develop the necessary skills to provide health care services to a linguistically diverse client base. This study describes the experiences of clinical educators who facilitate learning in contexts where they are not familiar with the language spoken between students and their clients. A part of the qualitative component of a larger mixed methods study is the focus of this paper. Semi-structured interviews were conducted with eight participants recruited from all audiology university programmes in South Africa. Thematic analysis allowed for an in depth exploration of the research question. Member checking was used to enhance credibility. It is hoped that the findings will inform training programmes and in so doing, optimize the learning of diverse students who may better be able to provide appropriate services to the linguistically diverse population they serve. Results: Participants experienced challenges with fair assessment of students and with ensuring appropriate client care when they were unable to speak the language shared between the client and the student. In the absence of formal guidelines, clinical educators developed unique coping strategies that they used on a case-by-case basis to assess students and ensure adequate client management when they experienced such language barriers while supervising. Coping strategies included engaging other students as interpreters, having students role-play parts of a session in English in advance and requesting real-time translations from the student during the session. They expressed concern about the fairness and efficacy of the coping strategies used. Conclusions: While clinical educators use unique strategies to assess students and to ensure suitable client care, dilemmas remain regarding the fairness of assessment and the ability to ensure the quality of client care

Primary school teachers’ opinions and attitudes towards stuttering in two South African urban education districts

Background: As teachers form an important part of the intervention process with children who stutter in primary school, the primary aim was to describe primary school teachers’ attitudes in South Africa. The secondary aim was to compare teachers’ attitudes towards stuttering in South Africa with those from a pooled group of respondents in the Public Opinion Survey of Human Attributes–Stuttering (POSHA-S) database from different countries collected in 2009–2014. Method: A quantitative, cross-sectional survey research design was used. Primary schools in two education districts in Western Cape, South Africa, were sampled. The POSHA-S, a selfadministered questionnaire, was completed by a cluster sample of 469 participants. Results: Overall positive attitudes towards stuttering were found, specifically related to the potential of people who stutter, although the result should be interpreted with caution as the sample was not homogenously positive. Teachers still had misconceptions about personality stereotypes and the cause of stuttering. The attitudes of the South African sample were slightly more positive compared with the samples in the current POSHA-S database. Conclusion: When developing stuttering intervention strategies, there are a number of key considerations to take into account. The study provides a basis for speech-language therapists to think about intervention with teachers and which areas of stuttering to consider

The Classroom Communication Resource (CCR) intervention to change peer’s attitudes towards children who stutter (CWS): study protocol for a randomised controlled trial

Background: Children who stutter (CWS) are at a high-risk of being teased and bullied in primary school because of negative peer attitudes and perceptions towards stuttering. There is little evidence to determine if classroom-based interventions are effective in changing peer attitudes towards stuttering. The primary objective is to determine the effect of the Classroom Communication Resource (CCR) intervention versus usual practice, measured using the Stuttering Resource Outcomes Measure (SROM) 6-months post-intervention among grade 7 students. The secondary objective is to investigate attitude changes towards stuttering among grade participants on the SROM subscales. Methods: A cluster randomised controlled trial (RCT) will be conducted with schools as the unit of randomization. Schools will be stratified into quintile groups, and then randomized to receive the CCR intervention or usual practice. Quintile stratification will be conducted in accordance to the Western Cape Department of Education classification of schools according to geographical location, fee per school and allocation of resources and funding. Participants will include primary schools in the lower (second and third) and higher (fourth and fifth) quintiles and children aged 11 years or older in grade 7 will be included. The study will consist of the CCR intervention program or usual practice as a no-CCR control. The CCR is a classroom-based, teacher led intervention tool including a story, role-play and discussion. The grade 7 teachers allocated to the CCR intervention, will be trained and will administer the intervention. The analysis will follow intention-to-treat (ITT) principle and generalized estimating equations (GEE) to compare groups on the global SROM and its subscales to account for possible clustering within schools. The subgroup hypothesis will be tested by adding an interaction term of quintile group x intervention. Discussion: This study is designed to assess whether the CCR intervention versus usual practice in schools will lead to positive shift in attitudes about stuttering at 6-months post-intervention among grade 7 participants. Trial registration: The trial number is NCT03111524. It was registered with clinical trials.gov Protocol registration and results system (PRS) retrospectively on 9 March 2017