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Reproductive and Contraceptive Knowledge, Contraceptive Self-Efficacy, and Contraceptive Behavior among Teenage Women

Article excerpt

The relationship between reproductive and contraceptive knowledge (RCK) and contraceptive behavior has been studied extensively in an effort to address coitally active teenagers' ineffective patterns of contraceptive use. Educators have explored the relationship between RCK and contraceptive behavior because it is direct and efficient in terms of instruction and assessment. Unfortunately, providing information to adolescents on sexual and contraceptive matters does not necessarily assure that they will become better contraceptors or alter their sexual behavior. Many studies in the early assessment of the impact of sex education showed that educational programs that focus on facts about reproduction and contraception could increase knowledge, but demonstrated inconsistent and inconclusive effects on sexual behavior and increased contraceptive usage (Hansson, Jones, & Chernovetz, 1979; Kirby, 1984; Marsiglio & Mott, 1986; Whitley & Schofield, 1986; Zelnik & Kim, 1982).

Despite these ambiguous past findings, some educational programs have had an impact on teenagers' contraceptive and sexual behavior (Eisen, Zellman, & McAlister, 1990; Howard & McCabe, 1990). These exceptions suggest that exploring the relationship between sex education, RCK, and contraceptive behavior should not be abandoned. Rather, we may need to illuminate the factors that distinguish successful sex education programs from those which did not affect behavior. On examining those educational programs which have had an impact on behavior, we find they have focused on motivational factors which may affect teenagers' initiation into sexual intercourse and contraceptive use. Components of effective programs have been the development of a saliency of the probability and consequences of pregnancy as well as the provision of incentives to avoid it. Other components that have affected behavior change have been skills training in: (1) communication about the use of contraceptives and utilization of contraceptives; (2) linkages and utilization of clinics for health care services; and (3) sexual decision making (Bilodeau, Forget, & Tetreault, 1991; Carrera, Baker, & McCombs, 1978; Eisen, Zellman, & McAlister, 1990; Polit & Kahn, 1985; Schinke, 1984; Schinke & Gilchrist, 1977; Zabin, Hirsch, Smith, Streett, & Hardy, 1986). A commonality among these programs is that they have all utilized a RCK base, but have also focused on making salient the consequences of unprotected sexual relations (emotional factors) and on practicing domain-specific skills training (behavioral factors). Information was delivered within a social-psychological and behavioral context.

The success of these programs seems to indicate that when information is delivered in a social-psychological context rather than in a cognitive context alone, it is more valued and more likely to be used to activate effective contraceptive or prophylactic behavior. By contrast, the traditional sex education models prevalent in public education have used a didactic approach to delivery. The assumption underlying this information-processing approach is that behavior will change if based on cognitive input. Since information-alone models have not resulted in behavior change, the social-psychological approaches which utilize contraceptive-specific information may prove more successful.

In a previous study, self-efficacy theory was applied to analyze teenage women's sexual and contraceptive behavior. A domain-specific theory of behavior change (Bandura, 1977), it was operationalized in an 18-item scale as Contraceptive Self-Efficacy (CSE). CSE scores distinguished patterns of contraceptive use among teenage women when the effects of influential demographic, sexual experience, and psychosocial variables were controlled (Levinson, 1986). In two subsequent studies with samples that were demographically diverse, the relationship between CSE and contraceptive behavior was confirmed (Bilodeau et al. …