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Article

How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda

by
Peter Kisaakye
1,*,
Paul Bukuluki
2,
Symon Peter Wandiembe
3,
Victor Kiwujja
4,
Christine Kajungu
4,
Wilberforce Mugwanya
4,
Shakira Nabakooza
4,
Cyprian Anyii
4,
Cinderella Anena
4 and
Fiona Kaikai
4
1
Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala P.O. Box 7062, Uganda
2
Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
3
Department of Statistical Method and Actuarial Sciences, School of Statistics and Planning, Makerere University, Kampala P.O. Box 7062, Uganda
4
United Nations Population Fund, Kampala P.O. Box 7184, Uganda
*
Author to whom correspondence should be addressed.
Adolescents 2023, 3(3), 404-415; https://doi.org/10.3390/adolescents3030028
Submission received: 4 March 2023 / Revised: 6 June 2023 / Accepted: 30 June 2023 / Published: 4 July 2023
(This article belongs to the Section Adolescent Health and Mental Health)
Versions Notes

Abstract

:
Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior.

1. Introduction

The recent 2016 Uganda demographic and health survey estimated that about 44% of births among women below the age of 20 and 36% of birth among women in the age group of 20–24 years were unwanted [1]. Yet, unwanted births among young people have been associated with pregnancy complications [2], pregnancy-related deaths [1,3], and unsafe abortion complications [4]. Moreover, unwanted births compromise education attainment among young people which consequently leads to poverty and increases vulnerabilities [5]. Yet, this negative burden is most felt in developing countries, particularly in sub-Saharan Africa [6].
Previous research has pointed to an association between young people and risky sexual behavior [7]. Risky sexual behavior such as non-condom use and having sex with multiple partners [8,9] has been observed to lead to unwanted pregnancies [7,10] or even HIV [7,11]. Risky sexual behavior is any behavior that leads to negative effects as a result of engaging in sex such as unwanted pregnancies, sexually transmitted infections (STIs), and HIV [12]. An early sexual debut may facilitate risky sexual behavior [13,14].
Self-efficacy and agency have been suggested to improve sexual and reproductive health (SRH) choices [15,16,17] or lead to sexual behavioral change [18]. Self-efficacy refers to the control or confidence one has in making decisions [18,19] or the ability to do things needed in a demanding situation [20]. On the other hand, agency refers to the ability to act on the goals set to achieve a set goal [2]. Agency is dynamic rather than static where it can decline or increase to influence reproductive health decisions. That is, if agency declines, then people are less likely to be empowered to make informed decisions regarding SRH decisions [2]. Some of the literature has suggested that early sexual debut is largely a result of poor self-efficacy to negotiate refusal sex [21], which can be in the form of delayed sex [22] or sexual abstinence [23,24]. Low self-efficacy may lead to low or non-condom use [25,26,27,28] or non-use of contraception [29,30]. In Ethiopia, a study conducted among preparatory school students in Sodo Town, Southern Ethiopia, indicates that good self-efficacy was associated with condom use [19]. Low self-efficacy has also been associated with an increased risk of HIV due to poor SRH choices [31].
According to Bandura (1982), self-efficacy can be influenced by accomplishments, experiences, persuasion, or physiological or emotional arousal [20]. According to the framework, self-efficacy can be influenced by accomplishments where success increases self-efficacy. Experience relates to the positive gains achieved through engaging others or observing them. Persuasion is when people take on behavior after they are meant to believe that such behavior is successful. Self-efficacy can be influenced negatively through negative physiological or emotional states, such as, for example, when people become anxious or sad due to physiological or emotional state [20]. In such cases, self-efficacy will be low. Based on Badura’s theory of self-efficacy, we also hypothesize that demographic characteristics, knowledge of sexual and reproductive health (SRH) issues such as pregnancy, pregnancy prevention, contraceptives including condoms, and prevention of HIV and sexually transmitted infections (STIs), community perceptions or social norms influence young peoples’ self-efficacy to avoid risky sexual behavior. Previous research has suggested that studies related to agency in influencing reproductive health decisions have not exclusively focused on young people or adolescents [2].
Previous research had reported that higher self-esteem is associated with higher self-efficacy. That is, risky sexual behavior is likely to be low if self-esteem and self-efficacy are positive [16]. Having personal control or the ability to negotiate safer sex is also associated with self-efficacy [32]. For example, in South Africa, self-efficacy among youth was associated with safer sex relations and having knowledge of how to prevent the spread of HIV [33]. The literature reveals that alcohol consumption is associated with low self-efficacy [34,35,36]. A study on college students found that students with low self-efficacy were associated with alcohol consumption [36]—implying that alcohol consumption impairs one’s ability to translate self-efficacy into agency. Previous studies have demonstrated that traditional social and gender norms can affect self-efficacy [37,38]. That is, women are likely to have lower self-efficacy than men, especially if they are deprived of access to services such as education due to traditional social and gender norms. While social and gender norms could be developed during childhood years, there is a potential impact experienced at a later stage in life. Gender disparities can compel children to develop attitudes, beliefs, expectations, and roles that they think can suite their gender—which negatively affects their future ability to translate self-efficacy into agency [39].
In this paper, we explore factors associated with adolescents’ self-efficacy and agency to avoid risky sexual behavior. We focus on young people because it is a special needs group regarding sexual behavior [40]. We hypothesize that behavioral factors such as sexual experience, alcohol use, and social and gender norms could influence their self-efficacy directly. Young people often find themselves in positions that make them experiment or engage in risk-taking sexual behavior such as early sex and non-condom use [24].

2. Methods

Study Sample: The current study consists of a sub-sample of adolescents, 15–19 years of age, who were interviewed as part of the baseline knowledge, attitudes, and practices (KAP) survey of the UNFPA’s supported program on Advancing Sexual Reproductive Health and Rights (ANSWER) in Northern Uganda. The KAP survey covered 6056 young people (15–24 years) in August–September 2021, of which 465 were aged between 15 and 19 years. The household KAP survey was based on a stratified two-stage cluster design with stratification on districts and cross-stratified on the rural–urban residence. In the first stage, a probability proportional to the size sample of villages was taken from each stratum. In the second stage, a systematic sample of households with young people (15–24 years) was taken.
To investigate factors associated with adolescents failing to actualize their stated avoidance self-efficacy, we assume 50% of the adolescents fail. This gives the largest sample size possible using Cochran’s (1977) formula. Overall, 268 respondents are required to ensure an estimate of a proportion of adolescents with self-efficacy but who otherwise fail to actualize it within a 10% relative standard error with 95% certainty. Thus, the sample size of 396 used in the current analysis is large enough for the detailed analysis presented herein.
Measures: The main dependent variable is acting on self-efficacy to avoid risky sex, including using a condom. Self-efficacy was measured by asking the respondents to affirm the following statements: (a) Even if my friends pressure me to do something, I should do what I believe is right; (b) I am confident if I did not want to have sex, I would be able to refuse sex with a person who has power over me, like a teacher, employer, relative, etc.; (c) I am confident I can get the person with whom I have sex to use a condom, even if they do not want me to use a condom; (d) I am confident if my partner and I do not have a condom, I can say no to sex; (e) I make smart decisions; and (f) When I make a decision, I think about the good and bad things that can happen before making a decision. Acting on self-efficacy was based on self-reported sexual behavior in the past 12 months preceding the survey.
Independent variables included sex (male or female), age (15–17 or 18–19), the highest level of education (primary or less, secondary or tertiary, vocational education and training), religion (Roman Catholic, Anglican or Protestant, Moslem), disability status (no disability or has a disability), nationality status (Ugandan or refugee), listening to SRH programs through mass media (yes or no), gender norms (positive or negative), household assent index (low or moderate), and schooling status (in school or out of school). Alcohol consumption was measured using the question: have you ever consumed alcohol in the last 3 months (yes or no)?
Community negative perception about young people accessing contraceptives and contraceptive information was constructed from affirmative responses (on a Likert scale—very common and common options) of at least two of the following: (a) belief that exposing adolescents to information about sexual health encourages them to start having sex; (b) stigmatization of unmarried girls 15–19 years using contraceptives; (c) belief that adolescent girls and young women who carry condoms are promiscuous and cannot be trusted; (d) girls shy away from using SRHR services due to the fear that someone might see them or the health-workers might tell their parents; and (e) belief that girls who use contraceptives are promiscuous.
Knowledge of SRH issues was rated on 23 response items about pregnancy, pregnancy prevention, contraceptives, and HIV and STI prevention methods. Individuals who achieved 80% correct item responses were classified as having comprehensive knowledge; otherwise, they were classified as having limited knowledge. Knowledge of SRH rights for adolescents was scored from 8-item responses: (a) right to access information on sexual and reproductive health issues such as pregnancy; (b) right to access sexual and reproductive health issues services such as contraceptives; (c) right to marry at the time of their choice; (d) right to have sex; (e) right not to be forced into sexual activity (including by boyfriend/girlfriend, relatives); (f) right to be free from all acts of violence (including forced sex and sexual harassment); (g) right to have full control over their bodies; and (h) right to keep a pregnancy.
Data Analysis: We conducted data analysis in three stages. In the first stage, we computed descriptive statistics for all the variables included in the study. Two outcome variables are analyzed: possession of self-efficacy, and acting on self-efficacy in the past 12 months preceding the survey. The analysis is based on 396 sexually active unmarried young people aged 15–19 years. At the bivariate analysis level, a Poisson regression model was used to test for associations (with unadjusted and adjusted estimates generated). Variables with p < 0.20 at the bivariate level and those contextually important (sex, age, schooling status) were included in the multilevel Poisson regression model. Forward estimation stepwise approach set at the probability of 0.25 was used in running the multilevel Poisson regression model for the factors associated with failure to act on the expressed self-efficacy (with unadjusted and adjusted estimates generated). Inverse probabilities of sample selection were included in the models as weights to account for the complex sample survey design features. Most of the analyses were executed in Stata V15.

3. Results

3.1. Sample Characteristics

Table 1 shows that of the 396 young people, 62.4% were male, 70.2% were aged between 18 and 19 years, and 36.6% were currently in school. Thirteen percent had a disability, 10.6% were refugees, and 74.0% were living in households with a low household asset index.

3.2. Factors Associated with Having Self-Efficacy

In bivariate analysis, factors associated with sexually active adolescents lacking self-efficacy relative to those acting on their self-efficacy included being female, having a primary or lower education level, having limited exposure to SRH information, limited knowledge of SRH issues (pregnancy, pregnancy prevention, contraceptives, and HIV and STIs prevention) or limited knowledge of SRH rights (Table 2). Less female than male sexually active adolescents were likely to have self-efficacy (63.8% vs. 93.5%; PR = 0.69, p-value = 0.000). Individuals who listened to media about a program on SRH were least likely to lack self-efficacy (96.8% vs. 79.6%; PR = 1.13, p-value < 0.002). Further, individuals who are aware of most of their SRH rights (85.3%) as compared to 66.1% of those with limited knowledge were more likely to have self-efficacy (PR = 1.33, p-value = 0.007). Most of the individuals with comprehensive knowledge of SRH had self-efficacy as compared to those with limited knowledge (86.9% vs. 69.5%; PR = 1.20, p-value < 0.013).

3.3. Factors Associated with Failure to Maintain Expressed Self-Efficacy among Unmarried Young People

In multivariable analysis (Table 3), lacking self-efficacy was common among females in comparison to males, although this relationship is borderline (PR = 0.70, 95%CI: 0.48, 1.02). Respondents who reported consuming alcohol were less likely to act on expressed self-efficacy than their counterparts who reported not consuming alcohol (PR = 0.74, 95%CI: 0.56, 0.99).
Of those that failed to use a condom in the last risky sex act, 57.2% reported emotional impulsivity or being in the “heat of a moment” and forgot about the condom, 22.4% reported their partner refusing to use a condom, 4.4% feared asking their partner to use a condom, 4.0% reported coerced sex, 7.8% had no condoms at the moment and 4.2% reported other reasons. The reporting of the partner’s refusal or female adolescents’ fear to ask the sexual partner to use a condom underscore the weakness in the young people’s partner communication skills and assertiveness, even when they feel they have the self-efficacy to avoid RSB.
In multivariable analysis, girls and young women were least likely to uphold their self-efficacy (PR = 0.69, 95%CI: 0.48, 1.02). Further, alcohol consumption was associated with failure to act on one’s self-efficacy (PR = 0.74; 95%CI: (0.56, 0.99). As noted above, many young people who failed to use condoms cited emotional impulsivity or being in the “heat of a moment” as the main reason, followed by partner refusal or failure to communicate with the partner.

4. Discussion

This paper explored the factors associated with young people’s self-efficacy to avoid risky sexual behavior and barriers that might limit young people who express self-efficacy to actualize it at the time of engaging in sexual intercourse.
Our results have demonstrated that self-efficacy is important in changing risky sexual behaviors among young people [41,42]. For example, results show that individuals who expressed self-efficacy were least likely to be involved in risky sexual behaviors. Results demonstrate that alcohol consumption is associated with low self-efficacy in relation to engagement in risky sexual behavior. Alcohol consumption does affect the ability of unmarried people to translate self-efficacy or behavioral intentions aimed at avoiding risky sexual behavior into action (or exercising agency). This implies that alcohol consumption compromises unmarried young people’s ability to translate the self-efficacy expressed into the agency to translate their behavioral intentions into safe sexual behavior. This confirms findings from other studies that emphasize the associations between alcohol consumption and risky sexual behavior of young people [43,44,45].
Results show gender differentials in exercising self-efficacy—lacking self-efficacy at the time of engaging in risky sexual encounters was more common among young females than males, although previous research has reported young male adults being more prone to risky sexual behaviors and STIs than females [46]. Indeed, the results clearly highlight the association between inequitable gender norms and their negative influence on the ability of young people who are sexually active to translate self-efficacy or behavioral intentions into actions geared to avoid high-risk sexual behavior. This suggests that sex and more so, gender dynamics, including gender norms [47,48], do have a role in determining self-efficacy to engage in risky sexual behavior. This is in line with several studies that have demonstrated the role of social and gender norms affecting the self-efficacy and agency of young people to avoid engaging in risky sexual behavior [25,48]. These results also emphasize the importance of paying attention not only to individual factors but also to group and social or gender norms in designing and implementing interventions aimed at promoting young people’s self-efficacy and agency to avoid engaging in risky sexual behavior.
The findings have shown that education is a protective factor and an asset in enhancing the self-efficacy of unmarried young people. This underscores the need to invest in structural-level interventions such as education, particularly ensuring that young people attain at least a secondary level of education [49].
Our results further demonstrate that self-efficacy is associated with knowledge of SRH rights and comprehensive knowledge of SRH issues. This further underscores the need to integrate comprehensive information and knowledge on SRH issues with rights in programs targeting to promote the self-efficacy of young people to avoid engaging in risky sexual behaviors [50,51].
However, the results from this study also confirm findings from other studies, which state that having comprehensive knowledge, for example, on male condom use, does not facilitate translating expressed self-efficacy into action in relation to risky sexual behavior [27,28]. For example, many young people who had expressed self-efficacy and failed to use condoms cited emotional impulsivity or being in the “heat of a moment” and partner refusal or failure to communicate to the partner as reasons why they failed to use condoms. This points to the importance of going beyond promoting knowledge to exploring other factors that combine with the knowledge to enable young people to translate the expressed self-efficacy into the agency to act on their behavioral intentions [47,52] to engage in safe sexual practices such as the use of condoms correctly and consistently. The inability of young people to translate their behavioral intentions (self-efficacy) into action through using condoms during high-ris sexual encounters was mediated by several factors such as inequitable gender norms that may affect the ability of young unmarried people to negotiate for safer sex and to effectively communicate to their partners and demand or insist on “safe sex or no sex”. Therefore, beyond self-efficacy, this study recommends exploring and designing interventions that increase or promote the agency of young unmarried people to act on their behavioral intentions or self-efficacy to translate it into actions that promote safe sexual behaviors [53,54].

5. Conclusions, Program Implications, and Study Limitations

All taken together, though self-efficacy is important in avoiding risky sexual behavior among young people, translating it into actual safe sexual behavior among young people requires consideration of other factors that may inhibit adolescents and young people from translating that self-efficacy into action or agency to avoid engaging in high-risk sex. Therefore, beyond the self-efficacy of an individual, there is a need for consideration of other factors such as inequitable gender norms, alcohol consumption, access to education, internalization of their rights, and life skills, including, notably, partner communication skills, that can facilitate the process of translating their self-efficacy into the agency to engage in safe sexual practices that lead to positive sexual and reproductive health outcomes, especially in low-income settings like Uganda. Therefore, programs targeting young people to prevent unwanted pregnancies and STIs and their consequences should aim at exploring context-specific enablers of self-efficacy, the agency to translate the self-efficacy into action addressing constraints to that agency, and harnessing agency enablers to promote the ability of young people to avoid engagement in high-risk sex and its negative reproductive health outcomes. They should particularly emphasize social and gender norm change and investment in retaining adolescents and young people in school, given that education has been observed as a protective factor for most categories of adolescents and unmarried young people. Given the effect of alcohol consumption in affecting the ability of unmarried young people to translate their expressed self-efficacy to avoid risky sex into action, there is a need to integrate interventions that address alcohol consumption as a risk factor, including psychosocial support interventions into sexual and reproductive health interventions targeting young people.
Our study had some limitations. Self-efficacy was measured in a general way as a global belief rather than as a confidence rating across a series of sequentially arranged behavioral attainments as described in Brafford and Beck (1991). For example, some individuals may be unable to plan ahead and have condoms with them, even if they have good partner communication skills, yet others can plan ahead and have condoms with them but fail to negotiate with their partner. Another potential limitation of our study has to do with the self-reporting of sociodemographic characteristics and measures of self-efficacy, which could potentially be affected by social desirability bias. Finally, this study could not ascertain in detail the effect of the different facets of gender norms on risky sexual behavior among adolescents.

Author Contributions

Conceptualization: P.B., S.P.W., P.K., V.K., C.K., C.A. (Cyprian Anyii), C.A. (Cinderella Anena), F.K.; Data curation: S.P.W., P.K.; Formal analysis: S.P.W.; Investigation: P.B., S.P.W., P.K., V.K., C.K., W.M., S.N., C.A. (Cyprian Anyii), C.A. (Cinderella Anena), F.K.; Methodology: S.P.W.; Resources: V.K., C.K., W.M., S.N., C.A. (Cyprian Anyii), C.A. (Cinderella Anena), F.K.; Writing—original draft: P.K., S.P.W., P.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The studies involving human participants were reviewed and approved by Makerere University School of Public Health Research and Ethics Committee (HS1079ES).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

All data used in this study are available from the corresponding author on request.

Conflicts of Interest

The authors declare no conflict of interest.

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Table
Table 1. Sample characteristics.
Table 1. Sample characteristics.
n%
Sex
Male24762.4
Female14937.6
Age group
15–1711829.8
18–1927870.2
Highest level of education
Primary/less29374.0
Secondary9423.7
TVET92.3
Religion
Roman Catholic25263.6
Anglican/Protestant10927.5
Moslem358.8
Disability status
No disability34386.6
Has disability5313.4
Nationality
Ugandan35489.4
Refugee4210.6
Listened to SRH program on mass media in last 3 months6315.9
Perceives community to hold negative attitudes toward unmarried young people accessing SRH25263.6
Knows SRH Rights (at least 80% of measured items)33477.3
Has comprehensive knowledge of SRH issues29173.5
Gender norms scores
Positive21554.3
Negative18145.7
Household asset index
Low29374.0
Moderate10326.0
Schooling status
In school14536.6
Out of school25163.4
Accessed SRH information through media or phone25764.9
Consumed alcohol in the last 3 months6317.2
Table
Table 2. Multilevel Poisson regression model for factors associated with lack of self-efficacy (prevalence ratios (PR) and 95% CI).
Table 2. Multilevel Poisson regression model for factors associated with lack of self-efficacy (prevalence ratios (PR) and 95% CI).
% with Self-EfficacyUnadjusted PRAdjusted PR
nPR (95%CI)p-ValuePR (95%CI)p-Value
Sex
Male24793.5 1.00 1.00
Female14963.80.67 (0.55, 0.81)0.0000.69 (0.57, 0.82)0.000
Age group
15–1711881.4 1.00
18–1927882.71.00 (0.89, 1.13)0.936
Highest level of education
Primary/less29380.9 1.0
Secondary9491.51.10 (0.98, 1.24)0.1071.06 (0.95, 1.19)0.309
TVET966.70.94 (0.65, 1.36)0.7350.89 (0.67, 1.18)0.403
Religion
Roman Catholic25281.7 1.00
Anglican/Protestant10983.51.03 (0.91, 1.15)0.663
Moslem3582.91.02 (0.85, 1.22)0.868
Disability status
No disability34382.5 1.00
Has disability5381.10.95 (0.80, 1.12)0.538
Nationality
Ugandan35481.6
Refugee4288.11.03 (0.90, 1.19)0.655
Listened to SRH program on mass media in last 3 months
No33379.6 1.00 1.00
Yes6396.81.2 (1.12, 1.30)0.0001.13 (1.05, 1.22)0.002
Knows all SRH rights
No6266.1 1.00 1.00
Yes33485.31.31 (1.03, 1.68)0.0301.33 (1.08, 1.63)0.007
Has comprehensive knowledge of SRH issues
No10569.5 1.00 1.00
Yes29186.91.24 (1.05, 1.47)0.0131.2 (1.04, 1.39)0.013
Gender norms scores
Positive21583.7 1.00
Negative18180.70.97 (0.86, 1.08)0.538
Household asset index
Low29381.6 1.00
Moderate10384.51.07 (0.97, 1.19)0.1910.96 (0.87, 1.06)0.411
Schooling status
In school14586.9 1.00 1.00
Out of school25179.70.92 (0.84, 1.00)0.0631.03 (0.93, 1.15)0.572
Access to media/phone for SRH information
No13972.7 1.00
Yes25787.51.27 (1.07, 1.51)0.008
Consumes alcohol
No33382.6 1.00
Yes6381.01.02 (0.51, 1.99)0.913
Table
Table 3. Multilevel Poisson regression model for factors associated with failure to act on the expressed self-efficacy (prevalence ratios (PR) and 95% CI).
Table 3. Multilevel Poisson regression model for factors associated with failure to act on the expressed self-efficacy (prevalence ratios (PR) and 95% CI).
% Avoid Risky Behavior in Past 12 MonthsUnadjusted PRAdjusted PR
nPR (95%CI)p-ValuePR (95%CI)p-Value
Sex
Male23152.41.00 1.00
Female9541.10.72 (0.49, 1.05)0.0910.74 (0.48, 1.02)0.064
Age group
15–179652.11.00
18–1923047.80.95 (0.68, 1.33)0.784
Highest level of education
Primary/less23452.81.00
Secondary8641.90.94 (0.70, 1.27)0.704
TVET633.30.38 (0.08, 1.76)0.214
Religion 1.00
Roman Catholic20646.6
Anglican/Protestant9147.31.16 (0.82, 1.66)0.400
Moslem2972.41.60 (1.12, 2.30)0.010
Disability status
No disability28348.81.00
Has disability4351.21.13 (0.80, 1.58)0.488
Nationality
Ugandan28948.41.00
Refugee3754.11.17 (0.71, 1.93)0.524
Listened to SRH program on mass media in last 3 months
No26549.41.00
Yes6147.50.95 (0.65, 1.37)0.770
Knows all SRH rights
No4136.61.00 1.00
Yes28550.91.33 (0.82, 2.14)0.2051.32 (0.83, 2.1)0.241
Has comprehensive knowledge of SRH issues
No7360.31.00
Yes25345.80.83 (0.61, 1.15)0.261
Gender norms scores
Positive18050.01.00
Negative14647.90.95 (0.69, 1.30)0.754
Household asset index
Low23948.11.00
Moderate8751.70.94 (0.68, 1.30)0.690
Schooling status
In school12647.61.00
Out of school20050.01.02 (0.80, 1.29)0.878
Access to media/phone for SRH information
No10154.51.00
Yes22546.70.85 (0.62, 1.16)0.314
Consumes alcohol
No27548.41.00 1.00
Yes5152.90.49 (0.27, 0.89)0.0210.74 (0.56, 0.99)0.048
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Kisaakye, P.; Bukuluki, P.; Wandiembe, S.P.; Kiwujja, V.; Kajungu, C.; Mugwanya, W.; Nabakooza, S.; Anyii, C.; Anena, C.; Kaikai, F. How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda. Adolescents 2023, 3, 404-415. https://doi.org/10.3390/adolescents3030028

AMA Style

Kisaakye P, Bukuluki P, Wandiembe SP, Kiwujja V, Kajungu C, Mugwanya W, Nabakooza S, Anyii C, Anena C, Kaikai F. How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda. Adolescents. 2023; 3(3):404-415. https://doi.org/10.3390/adolescents3030028

Chicago/Turabian Style

Kisaakye, Peter, Paul Bukuluki, Symon Peter Wandiembe, Victor Kiwujja, Christine Kajungu, Wilberforce Mugwanya, Shakira Nabakooza, Cyprian Anyii, Cinderella Anena, and Fiona Kaikai. 2023. "How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda" Adolescents 3, no. 3: 404-415. https://doi.org/10.3390/adolescents3030028

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