The Pennsylvania State University The Graduate School Department of Communication Sciences and Disorders SELF-STIGMA OF STUTTERING: IMPLICATIONS FOR SELF-ESTEEM, SELF-EFFICACY, AND LIFE SATISFACTION A Dissertation in Communication Sciences and Disorders by Michael P. Boyle 2012 Michael P. Boyle Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy August 2012 ii The dissertation of Michael P. Boyle was reviewed and approved* by the following: Gordon W. Blood Professor and Department Head Dissertation Advisor Chair of Committee Ingrid M. Blood Professor of Communication Sciences and Disorders Robert A. Prosek Professor of Communication Sciences and Disorders James T. Herbert Professor of Counselor Education Kathryn D. R. Drager Associate Professor of Communication Sciences and Disorders Professor-in-Charge of the Graduate Program *Signatures are on file in the Graduate School iii ABSTRACT Stuttering is a communication disorder that is often stigmatized in our society and people who stutter may internalize this stigma. Although research has been conducted regarding stigma associated with stuttering, no research to date has analyzed different theoretical levels of stigma and how these relate to aspects of psychological well-being among adults who stutter. The purpose of this study was to create a psychometrically sound scale that measured different levels of internalized stigma (i.e., self-stigma) and analyze their relationships to self-esteem, self-efficacy, and life satisfaction. It was hypothesized that the experimental scale would demonstrate acceptable psychometric properties and that stigma self-concurrence would be negatively related to self-esteem, self-efficacy, and satisfaction with life among adults who stutter. Participants were 291 adults who stutter (ages 18 or older) recruited from the National Stuttering Association, as well as Board Recognized Specialists in Fluency Disorders. A Web-based survey including the Rosenberg Self-Esteem Scale, the General Self-Efficacy Scale, the Satisfaction With Life Scale, and the Perceived Stuttering Severity Scale was given to participants along with an experimental scale called the Self-Stigma of Stuttering Scale, or 4S, intended to measure self-stigma of people who stutter. The 4S demonstrated adequate reliability and signs of initial construct validity. Factor analysis revealed underlying components supportive of the hypothesized multidimensional model of stigma. Stigma self-concurrence, and to a lesser extent stereotype agreement, were negatively correlated with self-esteem, self-efficacy, and life satisfaction, even beyond perceived stuttering severity. Stigma self-concurrence was a significant predictor of self- iv esteem, self-efficacy, and life satisfaction among people who stutter, above and beyond demographic and stuttering-related variables. It is concluded that many people who stutter are resilient and can buffer self-esteem, self-efficacy, and life satisfaction even in the face of public stigma. However, those who internalize stigma and apply stigmatizing attitudes to themselves experience lower levels of psychological well-being. Speech- language pathologists should value and prioritize identification and modification of self- stigma in their adult clients who stutter. v TABLE OF CONTENTS LIST OF FIGURES ................................................................................................................. vii LIST OF TABLES ................................................................................................................... viii ACKNOWLEDGMENTS ....................................................................................................... ix Chapter 1 Introduction ............................................................................................................. 1 What is Stigma? ............................................................................................................... 1 Public Stigma and Self-Stigma ........................................................................................ 3 A Multi-Level Model of Stigma ...................................................................................... 9 The Impact of Stigma on the Self .................................................................................... 11 Stuttering and Stigma ....................................................................................................... 15 Stuttering and public stigma ..................................................................................... 15 Stuttering and self-stigma ......................................................................................... 24 Connections Between Stuttering, Stigma, and Well-Being ............................................. 26 Purpose of the Current Study ........................................................................................... 29 Research Questions and Hypotheses ................................................................................ 31 Chapter 2 Methods ................................................................................................................... 33 Participants ....................................................................................................................... 33 Survey Mode .................................................................................................................... 34 Recruitment of Participants .............................................................................................. 35 Procedure ......................................................................................................................... 37 Instruments ....................................................................................................................... 39 The Self-Stigma of Stuttering Scale (4S) ................................................................. 39 Literature review .............................................................................................. 41 Interviews and discussions with PWS .............................................................. 42 Expert review ................................................................................................... 43 Pilot study ......................................................................................................... 44 Rosenberg Self-Esteem Scale (RSES) ..................................................................... 47 Satisfaction With Life Scale (SWLS) ...................................................................... 48 The General Self-Efficacy Scale (GSES) ................................................................. 48 Perceived Stuttering Severity ................................................................................... 49 Demographic and stuttering-related information ..................................................... 51 Data Analysis ................................................................................................................... 51 Research Question 1 ................................................................................................. 52 Research Question 2 ................................................................................................. 53 Secondary research questions ................................................................................... 54 Chapter 3 Results ..................................................................................................................... 55 Qualitative Analysis ......................................................................................................... 55 Exploratory Data Analysis ............................................................................................... 58 vi Participant characteristics ......................................................................................... 58 Normative data and scale scores .............................................................................. 62 Associations between dependent variables and demographic/stuttering related variables............................................................................................................ 66 Research Question 1 ......................................................................................................... 69 Factor analysis .......................................................................................................... 69 Step 1 ................................................................................................................ 70 Step 2 ................................................................................................................ 74 Step 3 ................................................................................................................ 75 Step 4 ................................................................................................................ 78 Step 5 ................................................................................................................ 81 Step 6 ................................................................................................................ 85 Relationships among subscales ................................................................................ 86 Reliability: Internal consistency and temporal stability ........................................... 87 Content Validity ......................................................................................................