Reducing Adolescent Sexual Risk: A Theoretical - ETR Associates

suggests this may be an important factor for multiplegroups of teens.Finally, 14 studies measured the impact of self-efficacyto use condoms on actual condom use; 13 of the14 studies found that it increased actual condom use(Table 7-3). This is very strong and consistent evidencethat self-efficacy to use condoms does increaseactual condom use for most groups of teens. Fewother risk or protective factors were so consistentlyand significantly related to condom use. Notably, inthese studies, the assessment of self-efficacy to usecondoms or contraception included self-efficacy toobtain condoms or contraception.Can we increase self-efficacy?A review of studies of sexual behavior and HIVeducation programs found that out of 43 attemptsto increase self-efficacy in different areas, programssignificantly increased self-efficacy or skills in 23 (orabout half) of them (Table 7-4) (Kirby 2007). Thesestudies demonstrate clearly that not all programssignificantly increase self-efficacy, but a majoritydoes so. Moreover, it is possible to increase selfefficacyto refuse sexual activity, to use condoms orcontraception and to avoid STD/HIV risk behaviorsmore generally.The review did not distinguish between self-efficacyto avoid situations that might lead to undesired,unintended or unprotected sex and self-efficacy torefuse sexual activity. However, half the programs(7 out of 14) increased self-efficacy to refuse sexualactivity.Only two studies measured impact on ability toobtain condoms and one of these increased selfefficacyto obtain condoms. Even with a smallsample size, this suggests that it is at least possible toincrease self-efficacy to obtain condoms.Thirteen studies measured program impact on selfefficacyto use condoms and a majority (8 out of 13)increased that self-efficacy, indicating that programscan increase self-efficacy to use condoms given currentcurriculum activities. Only two studies measuredimpact on skills to use condoms properly andone study was effective.Table7-3Self-efficacy to actuallyuse condoms or contraceptives(N=14)Table7-4Number of Studies Reporting Effectsof Self-Efficacy to Actually Use Condomsor Contraceptives on Teens’ OwnCondom or Contraceptive UseIncreased Useof Condomsor OtherContraceptivesNoSignificantEffectsReduced Useof Condomsor OtherContraceptives13 1 0Number of Programs Having Effects onSelf-Efficacy and Skills to Perform ProtectiveBehaviorsSelf-efficacy and skillsSelf-efficacy to refusesex (N=14)Self-efficacy to obtaincondoms (N=2)Self-efficacy to use condoms(N=13)Had aPositiveEffectNoSignificantEffectsHad aNegativeEffect7 7 01 1 08 5 0Condom use skills (N=2) 1 1 0Self-efficacy to avoidSTD/HIV risk and riskbehaviors (e.g., toengage in sexual activitiesor engage in unprotectedsex) (N=12)6 5 1Total 23 19 1How do we increase self-efficacy and improveskills?Given Bandura’s theory on improving self-efficacy,the following general principles should be built intoactivities to increase self-efficacy and skills amongteens.1. If appropriate, activities should use more thanone method to increase teens’ self-efficacy (mastery,vicarious experiences, social persuasionand improvements in physical and emotionalassociations).2. Activities should first increase teens’ self-efficacythrough practice of skills that teens will learnmore easily. Activities should then make the86 Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs