The present study examined, among adolescents in Uganda, the predictors of the intention to delay sexual intercourse (for virgins), the intention to secondary abstinence (for non-virgins) and the intention to use a condom the next time one has sex. This study has shown that when it comes to the intention to delay sexual intercourse, compared to the intention to secondary abstinence, the predictors are relatively similar. For both groups (virgins and non-virgins), attitudes towards, perceived social norms regarding and self-efficacy to delay sexual intercourse were significant predictors of the intention to delay sexual intercourse. Additionally, among those without previous sexual experience, age was negatively related to the intention to delay intercourse thus implying that the likelihood that adolescents delay sexual intercourse decreases with age. Furthermore, among adolescents without previous sexual experience, beliefs about pregnancy were positively related to the intention to delay sexual intercourse. In sub-Saharan Africa, including Uganda, “secondary abstinence” is common among young people [6, 38–40]. This might explain the similarity in predictors of delayed sexual intercourse between participants with and participants without previous sexual experience.
With respect to the predictors of the intention to use condoms, our findings demonstrate a clear difference between adolescents with and adolescents without previous sexual experience. Among those without previous experience, attitudes towards condom use, the perceived social norm regarding condom use and self-efficacy to use a condom were important predictors of the intention to use a condom. Among those with previous sexual experience, only the perceived social norm appeared to predict intention to use a condom. With this group, self-efficacy and attitude were non-significant.
Overall, our findings support, at least in part, the RAA as a means of understanding what underlies the intention to delay sexual intercourse, secondary abstinence and the intention to use condoms among sub-Saharan African adolescents. However, the variance explained by the predictors (.23 for the intention to delay sexual intercourse and .17 for the intention to use a condom) was lower than what is normally found in studies conducted in Europe and the USA. On average, RAA factors explain about 39% of variance in intention to perform a certain behaviour in European and American contexts [19, 20, 22]. African studies tend to show less explained variance. In fact, of the few studies conducted in an African context, only one demonstrated an explained variance comparable to studies conducted in Europe and the USA . In that study, not only socio-cognitive factors but also geographic variables, socio-economic factors and access to condoms were included as predictors of condom use. In line with Fishbein , Ajzen , and supported by the fact that the explained variance in our study is different from that in other studies conducted in Europe and the USA, we contend that the relative importance of each of the RAA variables may vary according to the behaviour, the population targeted and the socio-cultural context in which that behaviour takes place.
Further, in our study, we found that, among adolescents with previous sexual experience, only the perceived social norm predicted condom use. This is supported by other studies conducted in an African context, where subjective norms were found to be (one of) the strongest predictors of condom use [30, 41, 42]. This dominant role of perceived norm may be, at least in part, attributable to the more collectivist nature of African societies in contrast to the more individualistic decision-making that occurs in Europe and North America [43, 44].
Although this study has demonstrated that there are important socio-cognitive predictors of delayed sexual intercourse and condom use, we must recognize that actual delay in sexual intercourse and actual condom use is also impacted by environmental factors (e.g., access to condoms) [45, 46], structural factors (e.g., poverty and legal context) [47, 48], and one’s ability (e.g., skills necessary to discuss delayed sexual intercourse or use condoms) [49, 50]. Additionally, socio-cultural factors, like gender roles that impact the degree to which girls can discuss condom use or buy and carry condoms, the presence of HIV-related stigma, and taboos on discussing sexuality in general, are all negatively related to condom use [51, 52].
Strengths and limitations
This study is one of the few to assess the socio-cognitive predictors of delayed sexual intercourse and condom use among a large sample of young people in a sub-Saharan African context. Furthermore, it is, to our knowledge, the first study to explore the influence of previous sexual experience on the intention to use condoms and (secondary) delayed sexual intercourse. As such, it contributes to filling the gap in the current literature on the determinants of safe sex behaviour among adolescents in low-income countries where HIV and AIDS are major health risks for young people, and where secondary abstinence is more common than in other parts of the world . Furthermore, knowing that the determinants of safe sex behaviour differ for those with and those without previous sexual experience provides valuable input for the development of safe sex interventions among Ugandan adolescents.
This study also has some limitations. First, the questionnaire was in English, which for some participants may have been difficult to comprehend. Problems with comprehension were dealt with by training research assistants to provide vernacular translations for texts that students found difficult to understand. Second, the questionnaires were administered in classrooms where privacy was not always possible. Despite having given research assistants careful instructions to secure privacy and confidentiality, this could not always be guaranteed (e.g. teacher walking around the classroom). Third, the Principles of the schools were asked to select the participants based on an equal distribution of gender (if possible) and age. This non-random selection may lead to biased results, as the Principals may have selected those students who are “positive” role-models. Fourth, this study investigated only socio-cognitive factors. It is possible that other factors such as environmental factors (e.g. availability of affordable condoms), structural factors (poverty and legal context), factors related to ability (e.g. being able to discuss delayed sexual intercourse or condom use) and socio-cultural factors (e.g. gender norms, HIV-related stigma and taboos on talking about sexuality) could explain some variance in the intention to delay sexual intercourse, intention to secondary abstinence and the intention to use condoms. Fifth, because we used cross-sectional data, we were only able to assess associations between variables. We could not draw conclusions regarding causality. Sixth, in our study, we did not measure actual sexual intercourse delay and actual condom use. We relied solely on the fact that other studies have demonstrated a robust relationship between intention and actual behaviour [16, 22, 31]. Seventh, the respondents were all secondary school students, which limit the conclusions made to this group only. This fact should be taken into account when interpreting the results of this study, as adolescents who are not attending school may be more vulnerable to early sexual debut, HIV and other sexually transmitted infections and unintended pregnancy . Finally, we assessed the socio-cognitive factors using single items or two-items constructs. This could be seen as a possible shortcoming. However, it has previously been argued that the use of single items or two-item constructs is viable if the item correctly measures the core element of the construct . We did indeed seek to construct our single-item and two-item measures in such a way that they represented the central aspect of the construct being measured.
Future research should employ a longitudinal research design thereby enabling causal inferences regarding the impact of the determinants of delayed sexual intercourse and condom use on the actual behaviour using scales that are reliable in a sub-Saharan African context.