title: The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences.
abstract: BACKGROUND
  A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions.
  
  
  OBJECTIVE
  To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency.
  
  
  METHODS
  We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out.
  
  
  RESULTS
  Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes.
  
  
  CONCLUSIONS
  A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Maxine
authors.initials: M
authors.lastname: Johnson
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Baxter
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Blank
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Cantrell
authors.affiliation: Department of Human Communication Sciences, University of Sheffield, Sheffield, UK.
authors.forename: Shelagh
authors.initials: S
authors.lastname: Brumfitt
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Enderby
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goyder
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D009629:Person-Centered Psychotherapy; D036301:Qualitative Research; D012917:Social Adjustment; D013070:Speech Therapy; D013342:Stuttering / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult
keywords: qualitative evidence synthesis; stammering; stuttering; systematic review