Speech–Language Pathologists’ Perceptions of Their Competence in Managing Stuttering: A Systematic Review with Narrative Synthesis

ABSTRACT

Background

Stuttering can significantly impact an individual's quality of life and has the potential to affect social interactions, academic and career opportunities, and well‐being. Speech–language pathologists (SLPs) play a crucial role in the treatment of stuttering across the lifespan.

Aims

This systematic review aimed to describe (1) how competent SLPs perceive themselves to be in their management of stuttering and (2) the factors that influence SLPs’ perceived competence in managing stuttering.

Methods

A comprehensive search of eight electronic databases resulted in 13 studies that met the inclusion criteria. A narrative synthesis was completed on the extracted data.

Main Contribution

Competence was perceived to be lower in treatment than in assessment. Perceived competence was higher in SLPs who saw people who stutter more frequently and engaged in more continuing professional education in stuttering. Factors affecting SLPs’ perceived competence also included: the level of support to implement treatment, knowledge of stuttering, formal education in stuttering, years of experience as an SLP, experiences with stuttering, familiarity with people who stutter, previous treatment outcomes and the perceived complexity of stuttering. The available data were primarily focused on participants working in paediatric populations.

Conclusions

The review revealed diversity in perceived competence when managing stuttering, influenced by factors related to SLPs’ professional and personal experiences, the practice context and available evidence, with notable variation in competence across different settings and regions. Further research is required across the lifespan to better understand the relationships between factors and to guide future interventions for competence.

WHAT THIS PAPER ADDS

What is already known on the subject

• Research has identified gaps in SLPs’ knowledge, clinical experience and confidence in treating stuttering. These studies highlighted SLPs’ limited awareness of effective interventions, varying levels of perceived competence across different age groups, low preference for treating stuttering and difficulty applying clinical trial evidence. This study was needed to consolidate these findings and examine factors influencing SLPs’ perceived competence in stuttering management.

What this paper adds to the existing knowledge

• This review provides a synthesis of SLPs’ perceptions of their competency in managing stuttering and identifies key factors influencing competency. It details perceived competence of stuttering treatment across the lifespan, in assessment and treatment. Additionally, it explores factors such as experience with stuttering, level of support, the practice context, familiarity with people who stutter, the perceived complexity of stuttering and previous treatment outcomes. These findings have implications for stuttering treatment and guiding professional development.

What are the potential or actual clinical implications of this work?

• The findings of this review emphasise the importance of ongoing education and support for SLPs to enhance their clinical competence in stuttering management. Specifically, targeted professional development, supportive work environments and familiarity with people who stutter can positively impact SLPs’ confidence and proficiency. The results reinforced the need for SLPs whose caseloads include stuttering to prioritise ongoing education in stuttering, seek support to implement treatment where needed and pursue opportunities to gain experience with people who stutter. These insights can inform the development of guidelines and training programmes to improve SLPs’ competence and ultimately benefit people who stutter.

1. Introduction

Stuttering is experienced as a complex synthesis of behavioural, cognitive, emotional, and social factors (Tichenor and Yaruss 2019). Adults who stutter report the feeling of a loss of control and may experience various overt (repetitions, prolongations, blocks), covert (avoidance, hiding), and reactive behaviours (tension, struggle) (World Health Organization (WHO) 2016). These behaviours can become deeply ingrained due to past difficulties, leading to a cycle of thoughts, emotions and behaviours which influence each other (Bricker‐Katz et al. 2009; Tichenor and Yaruss 2019). Stuttering is also experienced as the impact on individuals’ quality of life and limitations of participation in daily activities (Craig et al. 2009). Stuttering impacts individuals across the lifespan, with an estimated prevalence of 0.72% of the population (Craig et al. 2002; Yairi and Ambrose 2013) and a cumulative incidence of stuttering in preschool children of 11.2% (Reilly et al. 2013). Early intervention by a speech–language pathologist (SLP¹) is recommended as best practice to reduce stuttering, as left untreated, the disorder can become chronic in nature (Onslow and O'Brian 2013). Early intervention is crucial to minimize the later impacts on the life of a person who stutters (Onslow and O'Brian 2013).

SLPs work with people who stutter, providing differential diagnosis, assessment of severity and frequency, and implementation of appropriate, evidence‐based intervention (American Speech–Language–Hearing Association (ASHA) 2016; Speech Pathology Association of Australia (SPAA) 2011). SLPs also must consider the impacts of stuttering on the quality of life and mental health and collaborate with other stakeholders such as educators, teachers and particularly psychologists for co‐occurring mental health difficulties (Royal College of Speech & Language Therapists (RCSLT) 2024; SPAA 2018; Tichenor et al. 2022). SLPs may treat stuttering across a variety of practice contexts, including private practice, schools, community health centres, hospitals, non‐government organizations, and university and research facilities (ASHA n.d.; SPAA 2002). Treatment methods for stuttering differ across the lifespan, with varying evidence and approaches for preschool children, school‐aged children, adolescents and adults (Laiho et al. 2022). Upon graduation, SLPs who are ready to enter the profession are expected to demonstrate competency in the clinical management of stuttering (ASHA 2018; SPAA 2017).

Competence is defined as an individual's ability to effectively apply their knowledge, understanding, skills and values within their scope of practice (Communicating Quality 3, RCSLT 2006; as cited in SPAA 2011). Competence is when an SLP provides services effectively, acts in a professional manner, and reflects critically on their practice, seeks mentorship and supervision, and accesses continuing professional development (ASHA 2016; SPAA 2011). Research exploring health professionals’ competence has used terms such as confidence, performance, skill, self‐efficacy and knowledge (Sears et al. 2014). SLPs’ perceived competence in stuttering has similarly been measured by the above terms, as well as success and comfort (Beita‐Ell and Boyle 2020; Brisk et al. 1997; Byrd et al. 2020). These terms seem to be used interchangeably in the literature and are typically measured on a continuum (Beita‐Ell and Boyle 2020; Brisk et al. 1997; Kelly et al. 2020), and have all been incorporated into the search terms for a robust review. The term competence has been found to be the most inclusive (Sears et al. 2014) and will be used in relation to SLPs’ perceived ability to effectively manage stuttering. Historically, literature has used self‐reported measures such as surveys rather than assessments of clinical practice skills, hence the term ‘perceived competence’.

Historical literature has identified cause for concern regarding SLPs’ knowledge of stuttering, its treatment, SLPs’ clinical experience and their reluctance to treat stuttering (Gabel 2013; Tellis et al. 2008; Yaruss 1999, 2017). Tellis et al. (2008) found that 78.2% of the SLPs surveyed in the United States had not heard of the Lidcombe Program, now considered a ‘gold standard’ approach for treating childhood stuttering (Jones et al. 2005; Laiho et al. 2022). The survey results also found that 75.1% did not know the prevalence of stuttering in the general population (Tellis et al. 2008). Research in the United States has identified an increased likelihood that students will graduate speech pathology university programmes without clinical experience in stuttering. A survey of university programmes that provided education in speech–language pathology showed that 59% of programmes in 1999 allowed students to graduate without any clinical experience in stuttering, which increased to 79.4% on surveys completed between 2013 and 2014 (Yaruss 1999; Yaruss et al. 2017). When asked to rank areas of practice by most to least preferred to treat, SLPs ranked stuttering as second to last (Gabel 2013). Stuttering was preferred over voice disorders and less preferred than language, articulation, reading/writing, autism, developmental apraxia/childhood apraxia of speech, hearing disorders, Alternative Augmentative Communication (AAC) areas of practice (Gabel 2013). Yaruss et al. (2002) found a strong positive correlation between the speech therapy satisfaction for adults who stutter and their judgments of the treating clinicians’ competence.

The contemporary landscape of speech–language pathology practice shows further challenges impacting SLPs’ ability to feel competent managing stuttering. Lack of guidance in workplaces is evident with 85% of SLPs in Norway reporting that their workplace did not have any guidelines for working with children who stutter (Kefalianos et al. 2022). The time spent waiting to access intervention has been felt to be ‘much too long’ by 41.8% of SLPs (McGill et al. 2021). Furthermore, SLPs face challenges translating evidence from clinical trials to their community caseloads, particularly with differences in participant motivation and commitment to treatment (Lowe et al. 2021; O'Brian et al. 2023). ‘Therapist drift’, when a treatment is not delivered according to the prescribed manual or as intended by the creators, is also becoming an issue in stuttering treatment due to the community pressures of healthcare delivery (O'Brian et al. 2023). These everyday challenges in clinical contexts may limit SLPs’ ability to provide timely, evidence‐based treatment and to feel that they are managing stuttering competently.

The impact of SLPs perceiving a lack of competence to treat stuttering has the potential to impact quality of care. In Australia, there is evidence of compromises to stuttering therapy such as offering short‐term treatment blocks rather than completing treatment and offering less frequent sessions (Koushik et al. 2019; Senate Community Affairs Committee 2014). It has been reported that the ‘current level of service provision cannot meet the clinical needs of this prevalent patient population, and immediate planning for adequate health care services is essential for this public health problem’ (Senate Community Affairs Committee 2014). A comprehensive understanding of the factors that influence SLPs’ ability to manage stuttering is needed to identify perceived limitations and highlight factors that reinforce competence. A synthesis of evidence is required to provide universities/colleges, governing speech–language pathology organizations, and employers with integrated information to better determine the education and support needs for SLPs to effectively manage stuttering.

This paper aims to extend the existing evidence base through a narrative synthesis. The research questions are to determine: (1) how competent do SLPs perceive themselves to be in the management of stuttering and (2) what factors influence SLPs’ perceived competence in managing stuttering.

2. Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines were used to inform the methodology for this review (Moher et al. 2015). Prior to undertaking the current review, it was registered with PROSPERO (ID number CRD42023291439), an international register of prospective systematic reviews.

2.1. Search Strategy

A systematic literature search was conducted using the following electronic databases: Cochrane, CINAHL, ERIC, Medline, ProQuest Education, PsycINFO, PubMed and Scopus to identify relevant studies that answered the above research questions. Search terms were devised in collaboration with librarians from The University of Queensland and the Sunshine Coast Health Institute. Keywords used in the searches included: (1) population terms: speech–language pathologist, speech therapist, clinician; (2) context terms: stutter, stammer, disfluency; and (3) outcome terms: perception, competence, confidence, self‐efficacy. The full list of search terms used for each database can be found in Appendix A. The search was limited to studies published since 2013. The aim of this research was to understand current perspectives of SLPs. There have been recent changes in perceptions towards stuttering and its treatment, such as shifts from focusing on fluency‐enhancing strategies to addressing communication effectiveness and the social–emotional aspects of stuttering (Byrd et al. 2022). Literature shows increasing consideration of neurodiversity, recognizing stuttering as a variation in communication rather than a deficit and empowering individuals who stutter to focus on self‐acceptance (Constantino 2018). Given these changes, this review focused on the last 10 years of data to accurately reflect recent perspectives to ensure that the findings are relevant to current management approaches (Meline 2006).

Papers identified from database searches were screened by the first author (E. A.) to determine whether they met the inclusion criteria by title and abstract, then by full paper. The same process was repeated on all papers by a second author. The second screening was distributed across the other authors (A. P., R. U., N. S.). The second reviewers were blinded to the first reviewer's selections. Disparities between selections were resolved by discussion with the reviewing team to determine whether the paper fit the inclusion criteria until consensus was achieved. Screening decisions were recorded using Covidence software. The electronic database searches were followed by manual reference list searching of all papers included at the full text screening stage.

2.2. Eligibility Criteria

Inclusion criteria were the following:

• Population: SLPs who have completed a university/college degree in speech–language pathology, including SLPs who may or may not be currently managing people who stutter or who manage stuttering that co‐occurs with other conditions.

• Context: Treatment of children with developmental stuttering and adolescents and adults with persistent developmental stuttering in any geographical area or clinical setting.

• Outcomes: Qualitative and/or quantitative primary research data of SLPs’ perceived competence in managing stuttering.

Exclusion criteria were the following:

• SLPs working only with neurogenic/acquired stuttering, cluttering, psychogenic stuttering and/or prosodic disorders.

• Papers published in a language other than English.

• Papers published before the year 2013.

• Papers which were not peer‐reviewed.

2.3. Quality Assessment

The Mixed Methods Appraisal Tool (MMAT) was used to appraise the methodological quality of the included articles (Hong et al. 2018). The MMAT is a tool designed for critical appraisal of mixed studies and for use during the appraisal stage of systematic reviews. The criteria allow for appraisal of the methodological quality of five categories to studies: qualitative research, randomized controlled trials, non‐randomized studies, quantitative descriptive studies, and mixed methods studies. Each criterion is rated as either ‘yes’, ‘no’ or ‘can't tell’. A percentage of ‘yes’ responses was calculated to determine the percentage of quality criteria met (Hong 2020). Information from the tool was also used to describe the quality of the paper and any risk of bias. The first author (E. A.) critically appraised each paper, followed by a second independent appraisal, which was distributed amongst the other authors (A. P., R. U., N. S.).

2.4. Data Extraction and Management

Qualitative, quantitative, and mixed methodologies that included data pertaining to one or both research questions were included. The following data were extracted from each paper: study characteristics (authors, year of publication, country of origin, study design), participant demographics (population description, number of participants, years of experience, other relevant information), and outcomes of interest (e.g., ratings or themes related to perceived competence, factors correlated with competence ratings, qualitative factors perceived as related to competence). Data extraction was completed by the first reviewer (E. A.) and was checked by a second reviewer (A. P.). An Excel spreadsheet was used to record and manage data extraction.

2.5. Data Analysis

A narrative synthesis approach was chosen due to the papers relevant to the research question being expected to contain heterogeneous data and to focus on reports of perceived competence, factors associated with perceived competence and participant characteristics. A narrative approach synthesizes evidence extracted from multiple studies to generate insights in a systematic and transparent manner (Mays et al. 2005). A narrative synthesis uses words to summarize and tell the story of the findings from the included studies (Popay et al. 2006). It involves developing a preliminary synthesis, exploring relationships amongst the findings and evaluating the robustness of the synthesis (Mays et al. 2005).

3. Results

3.1. Selection of Studies

Figure 1 shows the PRISMA flowchart and papers identified from each stage of the review process. After duplicates were removed, papers were screened by title and abstract, underwent full‐text review, and were found to meet the inclusion criteria. An additional six papers obtained through a manual search of the reference lists in the included papers were also screened, with one of these papers proceeding to full‐text review and being included. The MMAT results were used qualitatively to inform the robustness of the narrative synthesis, and no papers were excluded based on MMAT results. See the Supporting Information S1 for further outcomes of the critical appraisal. A total of 13 papers were included in the review.

FIGURE 1.

PRISMA flow diagram.

3.2. Results of Syntheses

A narrative synthesis of the extracted data is presented below in two parts according to the research questions: (1) how competent do SLPs perceive themselves to be in the management of stuttering and (2) what factors influence SLPs’ perceived competence in managing stuttering. Various constructs of competence have been investigated in the included papers. The constructs reported in the included papers are listed in Table 1. There was a range of diversity in the participants and settings of the included papers. Participants in 38.5% (n = 5) of the included papers were SLPs who worked with children in school settings. The remaining papers included participants who worked with children in a variety of settings or with both adults and children. No papers recruited participants who worked exclusively with adults or adolescents. The other settings in which the participants worked included private practice, community health clinics, hospitals, and universities. The majority of the included papers (n = 8) were from North America, with the remaining papers from Australia (n = 2), Netherlands (n = 1), Norway (n = 1) and Kuwait (n = 1). Survey methodology was utilized by 76.9% (n = 10) of the papers, with other studies utilizing either focus group or semi‐structured interview methods, and a single study included a clinical vignette (a response to a clinical case scenario) as a method of data collection. There was large variability in the number of participants, with a range of 13 to 444 participants. The mean years of experience ranged from 9.9 to 33.75 years; however, this measure was not reported by all papers. SLPs in most of the included papers had very few clients who stutter on their caseloads (range of 1.55–2.2 clients), with the exception of studies where participants were recruited directly from stuttering workshops (Erickson et al. 2023), intervention trials (de Sonneville‐Koedoot, Adams, et al. 2015) and targeted specialists (Boyle et al. 2021). Not all papers reported on the number of clients who stutter on SLPs’ caseloads.

TABLE 1.

Characteristics of included studies.

Reference	Participants	Population description	Study design	Data collection instrument	Data analysis method	Constructs	Mean years of experience as an SLP	PWS treated	MMAT quality criteria met
Al‐Khaledi et al. (2014)	63	SLPs in the Middle East	Quantitative	Survey	Descriptive statistics, χ 2 tests, ANOVA tests, Cronbach α coefficient	Confidence	Not reported	Not reported	100%
Beita‐Ell and Boyle (2020)	320	School‐based SLPs in the United States	Quantitative	Survey	Descriptive statistics, Pearson correlation coefficients	Self‐efficacy Self‐reported success Comfort	17.08 (SD = 10.50)	1.55 on current caseload 1.67 annually 13.36 throughout career	86%
Boyle et al. (2021)	66	SLPs who were board certified specialists a in fluency in the United States	Mixed methods	Survey	Descriptive statistics, Cronbach's α, Kendall's tau‐b (τb) correlation coefficients, thematic analysis	Self‐efficacy Self‐reported success Comfort	33.75 (SD = 1.30)	12.77 on current caseload 43.34 annually 550.74 throughout career	100%
Bridgman and Erickson (2023)	215	SLPs who were attendees at a paediatric stuttering workshop in Australia	Mixed methods	Survey	Ordinal logistic regression and content analysis	Confidence Self‐reported success	Not reported	70% treated < 5 children who stutter per year	65%
Briley (2018)	444	School‐based SLPs in North Carolina, USA	Quantitative	Survey	Descriptive statistics, Chi‐square tests	Confidence	16.1 (SD = 10.1)	2.2 on current caseload	71%
Byrd et al. (2020)	141	School‐based SLPs in the United States	Mixed methods	Clinical vignette	Two‐way repeated‐measures analysis of variance, thematic analysis	Comfort	16.13	Not reported	94%
de Sonneville‐Koedoot, Adams, et al. (2015)	13	Private practice SLPs in the Netherlands who participated in the RESTART study	Qualitative	Focus group	Creswell's (2003) 10 steps for qualitative data analysis	Competence	Not reported	Not reported	86%
Erickson et al. (2023)	18	SLPs in Australia who were attendees at a paediatric stuttering workshop	Qualitative	Semi‐structured interviews	Reflexive thematic analysis	Self‐efficacy Comfort Confidence	Not reported	44% treated 1–9 clients per year, 39% treated 10–20 clients per year, 11% treated > 21 clients per year	100%
Gabel (2013)	141	School‐based SLPs in Ohio, USA	Quantitative	Survey	Descriptive statistics	Self‐reported success Experiences	15.2 (SD = 9.3)	2 on current caseload	100%
Kirmess et al. (2023)	121	SLPs in Norway	Quantitative	Survey	Descriptive statistics and Spearman's rho correlations	Competence	9.9 (SD = 8.4)	6.2 children in the last 3 years	86%
Panico et al. (2021)	200	School‐based SLPs in the United States	Mixed methods	Survey	Descriptive statistics, nonparametric tests, constant comparison method	Self‐reported knowledge	Not reported	Not reported	76%
Santayana et al. (2021)	106	SLPs in the United States and Canada who delivered the Lidcombe Program via telepractice	Mixed methods	Survey	Descriptive statistics and categorization of comments	Confidence	Not reported	Not reported	71%
Singer and Kelly (2021)	87	SLPs in the United States	Quantitative	Survey	Descriptive statistics	Confidence Self‐reported knowledge	Not reported	Not reported	86%

Note: ^aA Board‐Certified Fluency Specialist (BCFS) is a SLP who has obtained additional training and certification in the area of fluency disorders, including stuttering. The BCFS certification is offered through a division of the American Board of Speech–Language Pathology and Audiology. ‘Specialist’ is not used to refer to speech pathologists with additional training in Australia.

3.2.1. How Competent Do SLPs Perceive Themselves to be in the Management of Stuttering?

The included papers explored SLPs’ perceived competence when working with people across the lifespan who stutter (i.e., with children, adolescents, and adults), including a variety of aspects of management.

3.2.1.1. Perceived Competence of SLPs Working With People Who Stutter Across the Lifespan

Perceived competence varied across studies, countries and participant groups. Only two studies explored perceived competence of SLPs’ management of people who stutter across all age groups. Gabel (2013) conducted a survey involving 141 school‐based SLPs in the United States to assess their perceived experience and success in treating stuttering. This was measured on a rating scale ranging from 1 to 5, with higher values indicating sufficient levels of experience or success. The results indicated that on average, the SLPs reported neutral levels of experience (m = 2.5) and success (m = 3). Gabel (2013) further explored SLPs’ perceived competence in managing stuttering by age groups. School‐based SLPs expressed the least confidence in treating adults (98% were not confident), followed by adolescents (88%) and preschool children (86%), whereas a relatively higher level of confidence was observed in treating school‐aged children (38%). Notably, 10% of SLPs indicated a lack of confidence in treating individuals who stutter across all age groups (Gabel 2013). Al‐Khaledi et al. (2014) found that 25.4% of the 63 surveyed SLPs in the Middle East did not feel very confident in delivering effective treatment for people who stutter across the lifespan.

3.2.1.2. Competence Working With Adults Who Stutter

Only one paper specifically explored SLPs’ competence in managing adults who stutter with Al‐Khaledi et al. (2014) finding that 22.2% of SLPs did not feel confident working with adults who stutter.

3.2.1.3. Competence Working With Children and Adolescents Who Stutter

SLPs’ perceived competence in working with children and adolescents who stutter was reported in five papers. Al‐Khaledi et al. (2014) identified that 17.5% of SLPs did not feel very confident that they had the necessary skills to evaluate and treat stuttering in children. Beita‐Ell and Boyle (2020) surveyed 320 school‐based SLPs in the United States about their self‐efficacy when working with school‐aged children. SLPs had an average self‐efficacy score of 6.86 on a scale of 0–10, with higher scores representing greater levels of self‐efficacy. SLPs reported similar levels of comfort and success when working with school‐aged children who stutter (6.37 and 6.16, respectively). In a follow‐up study by Boyle et al. (2021), the same questionnaire was used to explore the self‐efficacy of 66 SLPs who were ‘board certified specialists in fluency disorders’. As expected, these SLPs reported high levels of self‐efficacy across all domains of stuttering management with an average self‐efficacy score of 9.19. The ‘specialists’ also reported high levels of comfort and success in treating children who stutter, averaging 9.55 and 9.73, respectively. In a survey of 200 school‐based SLPs in the United States, Panico et al. (2021) found that the majority of SLPs either agreed or strongly agreed with the statement, ‘I am knowledgeable about preschoolers, school‐aged children, and adolescents who stutter’ (76%, 88%, and 74%, respectively for each age group). In contrast, interviews with 18 Australian SLPs revealed that they were less comfortable and had lower self‐efficacy with school‐aged children than with preschool children who stutter (Erickson et al. 2023).

3.2.1.4. Perceived Competence in Management of Stuttering Clients

Perceived competence in areas of management such as screening, assessing, providing treatment, working with families, and goal setting in stuttering was reported by six studies. Of the 444 school‐based SLPs in Briley's (2018) US‐based study, very few indicated that they were ‘not at all confident’ in screening and assessing for the presence of stuttering in children (1.8% and 4.3%, respectively). Similar results were also reported by Singer and Kelly (2021), who identified that 1% of the 87 SLPs felt ‘very unconfident’ and 12% felt ‘somewhat unconfident’ treating children who stutter. When comparing perceived confidence in treating stuttering versus the assessment of stuttering, Briley (2018) found that 16.9% of the school‐based US SLPs indicated that they were ‘not at all confident’ in treating children who stutter, much higher than their findings regarding screening and assessment. Panico et al. (2021) found comparable results with 200 school‐based SLPs in the United States who were less likely to strongly agree that they were confident when treating stuttering compared with when assessing stuttering, particularly in preschool children and adolescents. In addition, their perceived confidence in working with families during stuttering treatment was rated considerably lower than both stuttering treatment and assessment.

A survey of Norwegian SLPs reported that 40% felt that they were not able to offer treatment as frequently as they would like to, and that 9% of the respondents felt that this was due to their competency in providing stuttering treatment (Kirmess et al. 2023). Byrd et al. (2020) measured the comfort level of SLPs in the United States when diagnosing stuttering in a clinical vignette, and participants rated their comfort level on a scale of 0 to 100, with higher values equating to increased comfort levels. Participants rated a median score of 74 if the child was present and 80 if the child was absent. These median comfort levels were significantly lower for stuttering than other areas of practice, which all received a median score of 90 or higher if the child was present and 100 if the child was absent. When investigating specific treatment methods, Santayana et al. (2021) surveyed 106 SLPs in the United States and Canada who were trained to deliver the Lidcombe Program and found that they were confident or extremely confident in providing treatment with the Lidcombe Program. Other treatments options were not explored in this study.

3.2.2. What Factors Influence SLPs’ Perceived Competence in Managing Stuttering?

Ten of the included studies reported on data which answered the second research question. Factors reported in reference to influencing SLPs’ perceived competence in managing stuttering are as follows (with n equalling the number of studies which reported the factor): continuing professional education (n = 5), number of people who stutter on an SLP's caseload (n = 4), support to implement treatment (n = 3), knowledge of stuttering (n = 3), formal education (n = 3), years of experience as an SLP (n = 3), experiences with stuttering (n = 3), familiarity with people who stutter (n = 3), previous treatment outcomes (n = 3), the perceived complexity of stuttering (n = 2), addressing the social–emotional impacts of stuttering (n = 2), clinical skills in managing stuttering (n = 1), evidence for treating stuttering with co‐morbidities (n = 1), and the practice context (n = 1).

3.2.2.1. Continuing Professional Education

Surveys by Gabel (2013) of SLPs in the United States reported that 70% of SLPs felt that they had achieved their present level of competence with clients who stutter through continued professional education. Beita‐Ell and Boyle (2020) also surveyed SLPs in the United States and found that cognitive self‐efficacy and total self‐efficacy (i.e., self‐efficacy in management of speech‐related, cognitive, social, and emotional variables associated with stuttering) scores were significantly positively correlated with the average number of hours of continuing professional education in stuttering within a 3‐year period. The semi‐structured interviews with SLPs in Australia by Erickson et al. (2023) identified that SLPs perceived professional development strengthened their self‐efficacy in the management of stuttering.

Professional education, specifically in the Lidcombe Program, was explored by two papers. SLPs surveyed by Santayana et al. (2021) in the United States and Canada were highly confident delivering stuttering treatment with the Lidcombe Program and 93% had attended a 2‐day Lidcombe Program workshop. Similarly, Australian SLPs who completed Lidcombe Program training reported significantly higher confidence in their ability to deliver education to clients and families, deliver Stage 1 and Stage 2 of the Lidcombe Program, and had higher self‐reported success rates compared with those who had not completed Lidcombe Program training (Bridgman and Erickson 2023). No studies explored the impact of continuing professional development in other treatment methods on SLPs’ perceived competence.

3.2.2.2. Number of People Who Stutter on an SLP's Caseload

In a study conducted by Beita‐Ell and Boyle (2020) of SLPs in the United States, it was found that SLPs with higher total self‐efficacy scores had an increased number of children who stutter on their caseload and had treated a higher number of children who stutter throughout their career. In a follow‐up study, Boyle et al. (2021) found a significantly higher number of children who stutter on the caseload of ‘fluency specialists’ (m = 12.77) with high average self‐efficacy, in contrast to the average number of children (m = 1.55) who stutter on the caseload of school‐based SLPs who reported lower self‐efficacy (Beita‐Ell and Boyle 2020). A third of SLPs in the United States and Canada who were surveyed by Santayana et al. (2021) spent more than 25% of their time treating stuttering. These SLPs reported being highly confident delivering stuttering treatment with the Lidcombe Program. An Australian study found similar results with Bridgman and Erickson (2023) reporting significant relationships between the number of children who stutter treated by SLPs and their confidence levels in delivering both stages of the Lidcombe Program, their confidence to deliver education to families, and their self‐reported success rate in completing Stage 1 of the Lidcombe Program. This was significantly higher in SLPs who treated over 20 children who stutter each year. No papers investigated the influence of the number of adults or adolescents who stutter on an SLP's caseload.

3.2.2.3. Support to Implement Treatment

In a survey study by Gabel (2013), 72% of US SLPs believed that their level of competence with clients who stutter was achieved through collaboration with other SLPs. The study conducted by de Sonneville‐Koedoot, Adams, et al. (2015) involved a focus group of 13 SLPs from the Netherlands who participated in the RESTART study comparing the Lidcombe Program with RESTART‐DCM treatment, a treatment based on the Demands and Capacities Model, which focuses on reducing demands on the child who stutters and strengthening their capacities to improve fluency (de Sonneville‐Koedoot, Stolk, et al. 2015). These SLPs reported perceiving increased competence to deliver stuttering treatment with the Lidcombe Program and RESTART‐DCM treatment following opportunities to regularly discuss cases, having access to treatment protocols, and exchanging experiences with colleagues (de Sonneville‐Koedoot, Adams, et al. 2015). In a qualitative study by Erickson et al. (2023), a related theme of engaging in professional collaboration strengthened Australian SLPs’ perceived self‐efficacy when working with children who stutter.

3.2.2.4. Knowledge of Stuttering

All papers that reported on this factor included participants who worked in the United States. SLPs surveyed by Gabel (2013) rated knowledge of stuttering as a factor that contributed to their level of comfort treating people who stutter and specifically that 47% of SLPs felt that lack of knowledge hindered their ability to provide treatment to people who stutter. Qualitative themes reported by Byrd et al. (2020) identified limited knowledge of stuttering as a negative factor in comfort levels to diagnose stuttering. Further, limited knowledge was also identified as a negative factor by Singer and Kelly (2021), who found that 72% of SLPs reported lacking knowledge of factors that contribute to persistence when assessing stuttering.

3.2.2.5. Formal Education

The influence of university‐level education on the perceived competence of SLPs in the management of stuttering was variable. According to Gabel's (2013) findings, approximately 82% of US SLPs attributed their current level of competence in working with clients who stutter to their formal education. In contrast, Byrd et al. (2020) conducted a survey involving 141 school‐based SLPs in the United States and determined that undergraduate and graduate clinical experience with stuttering did not significantly predict SLPs’ comfort in diagnosing stuttering. In a study conducted by Erickson et al. (2023), the influence of university education on 18 Australian SLPs was investigated and found that their experiences with stuttering through general and stuttering‐specific placements positively influenced perceived competence. Similarly, SLPs who did not have undergraduate placement experiences in stuttering were more likely to avoid working with this population later in their career (Erickson et al. 2023).

3.2.2.6. Years of Experience as an SLP

This factor was reported by three studies with participants in the United States. Briley (2018) found that SLPs who were extremely confident in screening and assessing stuttering in children was greatest in SLPs with over 20 years of experience. However, there was no significant difference when comparing SLPs’ years of experience with their confidence level in treating children who stutter. Beita‐Ell and Boyle (2020) found that SLPs’ perceptions of their self‐efficacy in addressing speech‐related aspects of stuttering were higher in SLPs with more years of experience as an SLP. Other investigated areas of self‐efficacy such as cognitive, emotional and social were not significantly correlated with years of experience. Byrd et al. (2020) also found that years of experience was not a significant predictor variable for comfort level stating the diagnostic term ‘stuttering’.

3.2.2.7. Experiences With Stuttering

SLPs in the United States surveyed by Gabel (2013) rated experience with stuttering as a factor contributing to their level of comfort in treating people who stutter. A total of 81% of SLPs believed they achieved their present level of competence through experience with clients who stutter, yet 65% felt that their lack of experience hindered their ability to provide treatment to people who stutter (Gabel 2013). Byrd et al. (2020) found that a theme of limited experience with stuttering was the most frequent negative response (32/127 responses) by US SLPs in clinical vignettes, whereas only one positive experience with stuttering was reported.

3.2.2.8. Familiarity With People Who Stutter

SLPs in the United States surveyed by Gabel (2013) rated exposure to stuttering as a factor that contributed to their level of comfort in treating people who stutter. It was reported that 27% felt that a lack of exposure hindered their ability to provide treatment to people who stutter. In a similar manner, Beita‐Ell and Boyle (2020) found that US SLPs’ with higher self‐efficacy scores in managing the cognitive, social and emotional components of stuttering treatment more likely to have attended a self‐help/support group meeting for people who stutter. Knowing a person who stutters was reported to be the only significant predictor variable for school‐based SLPs in the United States to feel comfortable using the diagnostic term ‘stuttering’ (Byrd et al. 2020). Attendance at a stuttering support group was not found to be a significant predictor for SLPs’ comfort level when diagnosing stuttering.

3.2.2.9. Previous Treatment Outcomes

The only studies that reported on the impact of previous treatment outcomes included participants who worked in the United States. SLPs surveyed by Gabel (2013) rated treatment success as a factor that contributed to their level of comfort in treating people who stutter. Lack of success for 24% of SLPs in their ability to provide treatment was perceived to have hindered their comfort levels in the management of stuttering. Higher total self‐efficacy scores reported by Beita‐Ell and Boyle (2020) were significantly correlated with SLPs’ reported levels of success when working with children who stutter. This finding was consistent with specialist SLPs, where the largest correlations were between their self‐efficacy scores and their self‐rated success in helping clients who stutter (Boyle et al. 2021).

3.2.2.10. Perceived Complexity of Stuttering

The perceived complexity of stuttering as a disorder was reported as a factor which negatively influenced SLPs’ perceived competence (Byrd et al. 2020; Erickson et al. 2023). Stuttering was rated by US SLPs as an area of practice in which SLPs felt less comfortable diagnosing, were challenged by ‘dealing with emotional components of stuttering’ and believed that ‘stuttering was difficult to explain’ (Byrd et al. 2020). In a qualitative study with a smaller number of Australian SLPs, a primary theme identified by Erickson et al. (2023) was that SLPs felt that ‘a stronger sense of self‐efficacy was needed in stuttering management compared with other areas of clinical practice’.

3.2.2.11. Addressing Social–Emotional–Cognitive Impacts of Stuttering

SLPs and fluency specialists who perceived a greater importance of addressing social–emotional–cognitive impacts during treatment, were more likely to have higher cognitive self‐efficacy and total self‐efficacy scores (Beita‐Ell and Boyle 2020; Boyle et al. 2021).

3.2.2.12. Clinical Skills in Managing Stuttering

Only one paper identified difficulties with clinical skills as a factor impacting perceived competence. Qualitative themes reported by Byrd et al. (2020) identified a negative factor of having ‘difficulty assessing stuttering’. Specifically, differentiating between typical disfluencies versus true stuttering, for example, ‘I feel less comfortable deciphering a few stumbles from a stutter sometimes if I don't really know the child’.

3.2.2.13. Evidence for Treating Stuttering With Co‐Morbidities

Semi‐structured interviews with Australian SLPs by Erickson et al. (2023) revealed that SLPs expressed less confidence in treating complex cases or those with co‐morbidities due to the lack of a prescriptive approach and absence of a ‘right way’ or ‘gold standard’ treatment.

3.2.2.14. Practice Context

Semi‐structured interviews with 18 SLPs in Australia qualitatively explored the impact of the practice context on SLPs’ perceived competence (Erickson et al. 2023). It was found that the practice context could enhance or undermine SLPs’ sense of self‐efficacy, particularly for those working in private practices due to the cost of treatment sessions. The cost precluded families from attending frequent, ongoing treatment sessions, impacted on client outcomes and led to negative perceptions of competence in managing stuttering. In schools and community health contexts, the availability of parents to attend treatment sessions and SLPs’ caseload sizes were factors reported to negatively impact self‐efficacy. In contrast, the practice context of sole clinicians or private practice owners had a positive influence on their self‐efficacy where they had autonomy of service delivery and were confident to deliver treatments with fidelity (Erickson et al. 2023).

3.2.2.15. Other Factors

The factors outlined below were described briefly and by only one of the 10 papers that reported factors influencing SLPs’ perceived competence in managing stuttering. Gabel (2013) reported that 40% of SLPs indicated a lack of time and 14% reported a lack of interest as hindering their ability to provide treatment to people who stutter. Beita‐Ell and Boyle (2020) found that SLPs with greater empathy scores also had higher self‐efficacy in managing the cognitive aspects of stuttering treatment. It was also found that higher self‐efficacy in addressing emotional aspects of stuttering was significantly correlated with the SLP having been taught by a faculty member specializing in fluency disorders. Briley (2018) reported increased levels of confidence in treating stuttering in SLPs who assessed for covert stuttering behaviours. Bridgman and Erickson (2023) found that Australian SLPs who had read the Speech Pathology Australia clinical practice guidelines on stuttering treatment reported higher confidence levels when providing education about preschool‐aged stuttering.

4. Discussion

This systematic literature review aimed to synthesize SLPs’ perceptions of their competency in the clinical management of stuttering and to describe factors influencing this competency. The literature described varying levels of perceived competency when working with individuals who stutter across the lifespan. Competency was influenced by a range of factors including education, experience, knowledge, and skills in managing stuttering, peer support and the practice context. Additionally, geographical location appeared to play a role in this variability.

The studies that measured perceived competence predominantly utilized survey methodology and considered constructs such as confidence, self‐efficacy, comfort, self‐reported success and experience. SLPs’ lack of perceived competence was primarily associated with the treatment aspects of managing stuttering, as they felt more confident in their ability to assess and screen for stuttering (Briley 2018; Panico et al. 2021; Singer and Kelly 2021). This finding was only reported when managing children who stutter in the United States. No studies measured this in adults or in other regions. The only SLPs who reported high levels of competence in providing treatment were those in the United States who identified as being stuttering specialists (Boyle et al. 2021) and those who reported their confidence in the Lidcombe Program (Santayana et al. 2021). It is acknowledged that many countries outside of the United States may not identify ‘fluency specialists’. The key factors of the participants in the Boyle et al. (2021) and Santayana et al. (2021) studies were that they had large caseloads of people who stutter and reported more training in stuttering, for example, Lidcombe programme workshop training and specialist training. These findings underscored the importance of university/college settings addressing these factors early in an SLP's career through more education focused on treatment programmes and opportunities to treat stuttering during undergraduate studies. This further emphasized the importance of SLPs accessing continuing professional education to enhance SLPs’ feeling of competence in stuttering treatment.

It is unclear whether there is a relationship between continuing professional education in stuttering and improvements in actual competence, or only perceived competence. There are no known measures of this relationship in the field of stuttering, and there are variable findings in other areas of speech–language pathology. For example, Squires et al. (2023) measured changes in competence and perceived competence in 24 SLPs working in Australia who participated in a phonetic transcription course. Results found that feelings of confidence significantly increased, however transcription accuracy was high pre training and did not significantly improve. The longer term effect of targeted professional development has been studied with SLPs working in literacy. Mahowald and Rentmeester‐Disher (2019) reported improved literacy practices following professional development, with maintenance of these after 1 year and a flow‐on effect to client outcomes. Other areas of speech pathology practice where SLPs report higher competence, such as language, have focussed training programmes or frameworks to guide practice (Gabel 2013; The Hanen Centre 2024). Bridgman and Erickson (2023) proposed that engaging in any form of professional development may generally improve a feeling of confidence. Further research is required to understand the relationship between continuing professional education in stuttering and improvements in competence.

Only one paper reported on perceptions across the lifespan with school‐based SLPs in the United States feeling least confident working with adults, followed by adolescents and preschool children, and most confident with school‐aged children (Gabel 2013). It is noted that the participants’ work setting was likely to have influenced this. Interestingly, the school‐age population has the smallest body of evidence in clinical trials compared with treating stuttering in other age groups (Laiho et al. 2022). In contrast to this finding was the Australian study which reported lower perceived competence with school‐aged children compared with preschool children (Erickson et al. 2023). The difference between the Erickson et al. (2023) and Gabel (2013) findings may be due to considerable differences in the population size, year of the study and the country. Of the eight US studies included in this review, five recruited solely participants who worked in schools and all included school‐based SLPs. More than half of SLPs in the United States work in schools (ASHA n.d.). Whereas in Australia, the majority are reported to work in private practice settings and not all Australian states have school‐based SLPs (Senate Community Affairs Committee 2014). This may impact the transferability of US studies to other populations.

The findings of this review illustrated that there were many factors which contributed to SLPs’ perceived competence in managing stuttering. A key finding was that having a larger caseload of people who stutter was a factor associated with reporting higher perceived competence in both generalist SLPs and ‘fluency specialists’. This finding has been reported in other areas of SLP practice. For example, O'Donoghue and Dean‐Claytor (2008) found that SLPs who had current paediatric dysphagia clients on their caseloads had significantly higher self‐confidence to treat paediatric dysphagia than those who did not. These findings may suggest a correlation between the diversity and complexity of caseloads and the perceived competence of clinicians. SLPs who regularly work with individuals who stutter may be exposed to a wider range of stuttering severities and treatment challenges, providing them with opportunities for managing diverse stuttering presentations, and positively influencing SLPs’ confidence in their abilities. The positive correlation between caseload and perceived competence may suggest that SLPs who approach their work with a greater sense of self‐assuredness, are more likely to accept stuttering referrals. Further research is required to determine whether factors related to competence, the practice context, socioeconomic area, existing caseload sizes, or other factors influence the ability to accept stuttering referrals and thereby the number of people who stutter on an SLP's caseload.

Another interesting finding was that non‐clinical factors such as support to implement treatment and familiarity with people who stutter were reported to have a positive influence on perceived competence. These findings highlighted the significance of a supportive work environment and the potential need for more communities of practice or similar support groups to bolster confidence and competence. This was evidenced where SLPs who participated in an aphasia community of practice group were found to have increased knowledge of clinical tools, reflective practice experiences, and changes in their practice towards client‐centred participation goals (Alary Gauvreau et al. 2019). Interestingly, only one study reported a perceived lack of clinical skills to manage stuttering and years working as an SLP was largely not found to impact perceived competence in treatment. This emphasized the importance of a holistic approach to the professional development of SLPs by cultivating non‐clinical factors to enhance the perceived competence of SLPs.

The perceived complexity of stuttering, particularly when paired with co‐morbidities, was identified in this review; yet it was unclear why SLPs perceived that stuttering was ‘difficult to explain’ or required ‘a stronger sense of self‐efficacy’ (Byrd et al. 2020; Erickson et al. 2023). Factors such as diversity in presentation, variability in treatment options, lower prevalence, limited funding options and an unclear cause of stuttering may be theorized, along with many other factors, to influence the perception of complexity. Aspects of stuttering treatment protocols can be challenging to replicate in typical practice contexts, and caseload characteristics in clinical trials often differ from those encountered in everyday practice (Bridgman et al. 2019; O'Brian et al. 2013). This may impact perceived competence when striving for similar treatment outcomes. Furthermore, uncertainty regarding the best treatment approach is often found among clinicians when treating communication disorders co‐occurring with stuttering in community settings (Unicomb et al. 2013). Further research is required to determine where perceived gaps in knowledge, skill, support, or otherwise exist for SLPs in comparison with other areas of practice.

This review found limited research on SLPs’ perceptions of working with adults and adolescents. Many of the included papers reported on treatment using the Lidcombe Program, and there was little exploration of treatment methods for older age groups. The reason for this was unclear, however a few potential factors include: a focus on early intervention (Onslow and O'Brian 2013), adults who stutter may only choose to seek help if their stuttering is severe (Iverach et al. 2019), or that there may be fewer SLPs who treat adults who stutter due to changing perceptions towards stuttering (Constantino 2018; Ong et al. 2024). Further research is needed to better understand perceived competence in treatment with adolescents and adults more broadly.

Interventions for increasing perceived competence have been explored in other areas of clinical practice, such as in paediatric feeding. Surveys in 2013 and 2023 showed that SLPs perceived having limited‐to‐average knowledge in paediatric feeding therapy. Similar to the findings of this review, higher confidence was correlated with increased frequency of service provision and perceived success in therapy (Marshall et al. 2013; Raatz, Marshall, et al. 2023). Follow‐up intervention studies focused on increasing competence in paediatric feeding through the use of virtual, interprofessional, and cased‐based peer‐learning sessions, with pre‐post‐learning outcomes demonstrating significant improvements in SLPs’ self‐reported confidence and reduction in requests for support (Raatz, Ward, et al. 2023). Further research is required in stuttering to better understand the support needs of SLPs and to guide interventions to increase competence and confidence, thereby improving the quality and access to support for people who stutter.

5. Limitations

The authors recognize the limitations of this review such as the searches did not include grey literature or any papers published from the date of the final search. A limitation of the findings is the small number of studies globally that met the inclusion criteria and therefore the generalizability of these findings. This small number of contemporary studies reflects the need for further research in this area. A limitation of the evidence included in this review was that many studies recruited participants from stuttering workshops, intervention trials or stuttering special interest groups, which may not be reflective of the overall population and may also be impacted by response bias. The factors which were associated with SLPs’ perceived competence were often prespecified in survey questions by the authors. Whilst some of the studies explored research questions that aligned with the aims of the current study, many of the papers explored competence to an extent but the research questions were not directly in alignment with the scope of the current paper. These papers were therefore explored only for data related to the research questions of this study. The generalizability of the findings may be limited by the participants in the included papers working predominantly in the United States, and the remaining participants working in a variety of countries and workplaces. There may be considerable differences in treatment methods, service settings, access to resources and training across the participants groups that were studied.

It is acknowledged that perceived competence and actual competence are likely to vary significantly and may have differing impacts on treatment. This review used the term perceived competence due to the existing literature which entirely used self‐report measures. There are no known papers which measured actual competence through an assessment of the SLP's knowledge or clinical skills. The existing literature relies on SLPs’ self‐awareness and ability to reflect on their clinical practice in the context of evidence‐based practice. Previous studies may have chosen not to assess actual competence due to competency‐based standards already having been met on entry to the profession.

6. Conclusions

This review synthesized the existing literature concerning SLPs’ perceived competence in the clinical management of stuttering and the factors which influence perceived competence. The review revealed diversity in perceived competence when managing stuttering, influenced by factors related to SLPs’ professional and personal experiences, the practice context and available evidence, with notable variation in competence across different settings and regions. Overall, SLPs’ ratings of their own competence were lower in treatment than assessment, and higher in SLPs who saw people who stutter more frequently and had more training in stuttering. Further research is required across the lifespan, to better understand the relationships between factors, and to guide future interventions for competence.

The results identified the need for university/college settings and workplaces to provide comprehensive teaching for students and SLPs, access to ongoing professional education, practice contexts which enable delivery of evidence‐based treatment approaches, opportunities to gain more experience treating and associating with people who stutter to ensure that people who stutter receive effective and appropriate treatment from SLPs. The results also reinforced the need for SLPs to prioritize continuing professional education in stuttering, seek support to implement treatment where needed, and pursue opportunities to work with and gain familiarity with people who stutter.

Conflicts of Interest

The authors report no conflicts of interest.

Supporting information

Supporting Information S1 – Mixed Methods Appraisal Tool (MMAT)

APPENDIX A.

A.1.

Search Terms

Database	Search terms
Cochrane Library	MeSH terms	Keywords
Concept 1	Speech therapy Speech–language pathology Language therapy	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) NEAR/3 (therap* OR pathology* OR clinician*)
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐concept	Confiden* OR self‐confiden* OR ‘self‐perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐efficacy
	Professional competence
	Clinical competence
	Attitude of health personnel
	Achievement
	Aptitude
Other filters	Published after 1 January 2013

CINAHL Complete (EBSCO Host)	Subject headings	Keywords
Concept 1	Speech therapy Language therapy Speech–language pathology	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) N3 (therap* OR pathology* OR clinician*)
Concept 2	Fluency disorders	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐concept	Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐efficacy
	Self‐assessment
	Professional competence
	Clinical competence
	Competency assessment
	Skill acquisition
	Skill retention
	Achievement
	Aptitude
	Speech–language pathologist attitudes
	Attitude of health personnel
Other filters	Published after January 2013

ERIC (ProQuest)	Subject headings	Keywords
Concept 1	Speech therapy Allied health personnel Speech language pathology	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) NEAR/3 (therap* OR pathology* OR clinician*)
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐concept	Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐efficacy
	Self‐evaluation (Individuals)
	Perception
	Attitudes
	Competence
	Ability
	Aptitude
	Skill development
Other filters	Published after 1 January 2013

Medline (EBSCO Host)	MeSH terms	Keywords
Concept 1	Speech therapy Language therapy Speech–language pathology	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) N3 (therap* OR pathology* OR clinician*)
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐concept	Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐efficacy
	Self‐assessment
	Attitude of health personnel
	Clinical competence
	Professional competence
	Achievement
	Aptitude
Other filters	Published after January 2013

ProQuest Education Database	Subject headings	Keywords
Concept 1	Speech therapy Speech therapists Medical personnel	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) NEAR/3 (therap* OR pathology* OR clinician*)
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐evaluation	Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Confidence
	Employee attitude
	Attitudes
	Clinical competence
	Skills
	Aptitudes
	Skill development
Other filters	Published after 1 January 2013

APA PsycINFO	Index terms	Keywords
Concept 1	Speech therapists Speech therapy Language therapy Speech language pathology	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist* (speech OR language) N3 (therap* OR pathology* OR clinician*)
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐evaluation	Confiden* OR self‐confiden* OR ‘self‐perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐confidence
	Self‐efficacy
	Self‐perception
	Self‐monitoring
	Professional competence
	Competence
	Achievement
	Aptitude
	Therapist attitudes
	Self‐concept
Other filters	Published after January 2013

PubMed	MeSH terms	Keywords
Concept 1	Speech therapy Language therapy Speech–language pathology	‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist*
Concept 2	Stuttering	Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3	Self‐concept	Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
	Self‐efficacy
	Self‐assessment
	Attitude of health personnel
	Clinical competence
	Professional competence
	Achievement
	Aptitude
Other filters	Published after 2013

Scopus		Keywords
Concept 1		‘speech therap*’ OR ‘language therap*’ OR ‘speech patholog*’ OR ‘speech language therap*’ OR ‘speech‐language therap*’ OR ‘speech‐language patholog*’ OR ‘language patholog*’ OR clinician* OR therapist*
		(speech OR language) W/3 (therap* OR pathology* OR clinician*)
Concept 2		Stutter* OR stammer* OR fluenc* OR dysfluenc* OR disfluenc*
Concept 3		Confiden* OR self‐confiden* OR ‘self perception’ OR ‘self efficacy’ OR self‐efficacy OR competen* OR skill*
Other filters	Published after 2013

Data Availability Statement

The data for this paper are available on request.