Understanding the Concept of Fluency in Stuttering: A Grounded-Theory Study

Purpose: Fluency is a widely used concept in stuttering research and clinical practice and has traditionally been approached through observable speech characteristics. Although theoretical and clinical perspectives have acknowledged internal aspects of fluency, the perspectives of people who stutter themselves remain largely unexplored. The purpose of this study was to examine how adults who stutter define fluency and experience it in their daily lives. Method: Ten adults who stutter participated in individual interviews guided by an evolved grounded theory approach. Interviews began with the question, “What does fluency mean to you in the context of stuttering?” and follow-up questions were guided by participants' responses. Recruitment continued until saturation was reached. Interviews were audio-recorded, transcribed, and analyzed using grounded-theory analysis. Results: Participants described fluency as a dynamic construct shaped by the interaction between observable speech and internal experience, dimensions that are not always aligned. Fluent-sounding speech could involve substantial monitoring or tension and not feel fluent, whereas observable stuttering could be experienced as easy and comfortable and feel fluent. In that regard, observably disfluent speech can feel more fluent than observably fluent speech. This interaction was linked to different consequences, including changes in confidence, anxiety, relief, or happiness, and was influenced by emotional, cognitive, social, and therapy-related factors. Conclusions: Fluency in stuttering cannot be fully understood based only on external speech. Considering both observable and internal aspects of fluency, as well as their consequences, may support more person-centered research and clinical practice.