|Year : 2000 | Volume
| Issue : 1 | Page : 8-13
Adolescent's sexual and reproductive health, behavioural change and the application of psychosocial theories
Department of Community Medicine, Pramukhswami Medical College, Karamsad, Pin-388325 (Gujarat), India
R K Bansal
Department of Community Medicine, Pramukhswami Medical College, Karamsad, Pin-388325 (Gujarat)
|How to cite this article:|
Bansal R K. Adolescent's sexual and reproductive health, behavioural change and the application of psychosocial theories. Indian J Med Sci 2000;54:8-13
|How to cite this URL:|
Bansal R K. Adolescent's sexual and reproductive health, behavioural change and the application of psychosocial theories. Indian J Med Sci [serial online] 2000 [cited 2013 May 22];54:8-13. Available from: http://www.indianjmedsci.org/text.asp?2000/54/1/8/12146
An estimated 190 million adolescents in India are poised on the brink of a new millennium awaiting their crucial, albeit vulnerable, transition to adulthood. Yet, most family planning and reproductive health services continue to target adult women neglecting tihs crucial group. Furthermore, adolescents are rarely considered a distinct group and therefore their reproductive health needs, sexuality, reproductive morbidity, abortion seeking and reproductive choice etc., are poorly understood and ill served. , Increased global concerns of HIV pandemic have. focused attention to sexual behaviour of adolescents  and the need for provision of specially tailored services. 
Some of the problems of adolescents and their consequences, are low female literacy;  early marriage and cohabitation; , sexually active adolescents;  low contraceptive use;  teen-age pregnancies and child birth; , pregnancies/ births outside wedlock;  unplanned births; large family size; STIs;  obstacles to contraceptive use; , illegal and delayed abortions;  high rate of medical and social complications during adolescence, abuse/exploitation, violence including rape and inability to negotiate use of contraception; , cultural norms and sex: unmet need for family planning;  inadequate improper knowledge of sexuality,  etc.
These facts point to an unsatisfactory state of sexual and reproductive health prevailing among adolescents and ;that too in the land of kamasutras and erotic temple scriptures, where sexual symbols are routinely worshipped. This indeed is baffling. It has been succinctly put that a vast majority of unqualified quacks in our country owe their daily bread to the oft-quoted "dhat syndrome", thanks to the myraiad myths perpetuated by ignorance.  This grim scenario points out to a need for IEC activities to promote safer behaviours.
By now it is well established that health educationn is a planned activity which requires familiarity of the predisposing, enabling and reinforcing factors. We need to understand as to why people behave in a particular manner? We need skills to assess current behaviour, plan for behaviour change, monitor behaviour change and maintain healthy practices. This is where social psychological theories come in, especially problem driven applied social. psychology, which refer to scientific activities focussing on changing or reducing a practical problem by using a transtheoretical (social) psychological approach. ,
Various general social-psychological theories can be applied for promoting safer sexual and reproductive health practices, such as using condoms, among adolescents. For instance, the Persuasion-communication Model of McGuire.  This model can help us find cut various reasons as to why adolescents do not perform recommended healthy behaviours :
1. Attention : They may have never heard of safe sex. This might be due to ineffectiveness of prevailing health education programmes.2. Comprehension : They do not understand the importance of safe sex, e.g., they probably have no knowledge about STIs, including AIDS, in particular, the fact that the disease is not curable and is fatal. This might also be due to ineffectiveness of the prevailing IEC programmes.3. Attitude: They are not convinced of the advantages of safe sex and the disadvantages of unsafe sex. This might be the case when they find protected sex less enjoyable. 4. Social support : There are some barriers hindering their following healthy behaviours, e.g., adolescents don't know how to carry/buy condoms in presence of their peers who don't believe in condom use or they may be afraid of being ridiculed/stigmatized/ isolated by them. 5. Self efficacy They are unable to have protected sex when they can hardly enjoy it. 6. Behavioural change : They do not think of safe sex at the moment. This might also be due to ineffectiveness of the prevailing health education programmes to offer them the required information. 7. Behavioural maintenance : They have tried having protected sex but .hey do not like it. This might be the case either when they are not satisfied with protected sex or when they don't receive enough positive feedbacks or social support after adopting recommended behaviours.
Another theory which to distinguish different stages of behavioural changes is the Prochaska & Di Clement's (1984) Stages of Change Model.  Adolescents with regard to their sexual behaviours can be distinguished in the following stages: 1. Pre-contemplation: They are not willing to con-template about the change of their unhealthy sexual, behaviours. This might be due to the inneffectiveness of the prevailing health education programmes. 2. Contemplation : They intend to change their unhealthy behaviours, but are still ambivalent about them. This might be due to low self-efficacy and inappropriate attitude towards performing recommended behaviours.3. Preparation : They have a plan of action and determine to change their unhealthy sexual behaviours. 4. Action : They have overtly changed their unhealthy sexual behaviours. Preparation and action of the adolescents reflects the effectiveness of the prevailing health education programmes. 5. Behavioural maintenance/relapse : They either keep up performing their healthy sexual behaviours or relapse. The latter happens when they are not satisfied with protected sex or when they don't receive enough positive feedbacks/social support after adopting recommended behaviours.
Another theory, Bandura's (1986) Social Congnitive Theory (SCT)  covers, both, the determinants of sexual behaviours and the process of the changes of such behaviours. The SCT cognitive variables are : 1. Outcome expectations: They do not anticipate any important consequence of their sexual behaviours. Yet, we may think that they still do not believe that adopting the recommended sexual behaviours is good for themselves and/or their families. 2. Self-efficacy expectations : They do not believe that they are capable of adhering to the recommended sexual behaviours. Thus, we assume That ao.ma of them have already been motivated to adopt healthy sexual behaviours (favourable attitude), but they perceive them extremely hard t o adopt.
Within these general frameworks, a number of other specific theories as, Risk Perception Models can explain why some of the adolescents wrongfully think that they don't run any risk by performing their unhealthy sexual hehaviours. They may believe that they run less risks than the others "Unrealistic Optimism," partly because they have a stereotyped perception of the people who actually run the risks, and partly because they understirnate the other's efforts to adopt the recommended sexual behaviours. Moreover, theories about "Fear Arousal" (R. W. Rogers, 1983;  Leventh l. 1984;  Janz & Becker, 1984  can give reasons as to why adolescents, despite having received IEC messages, do not ;change their attitudes. They can help us understand why health education messages have not had the desired effects as yet. Accordingly we may explore the insufficient interest of adolescents in actively processing of delivered messages.
Furthermore, theories as Social Comparison Theory (Sules & Wills,1991  and Social Inoculation (Evens et al., 1984  & 1991  ) illustrate the different types of social influences which make the adolescents perform unhealthy sexual behaviours such as : 1. Conformity : although they believe that not having safe sex can cause serious problems for themselves and/or their families they act at odds with their beliefs or perceptions and perform unhealthy sexual behaviours because their associates behave similarly. 2. Modelling : They are influenced by the unhealthy sexual behaviours of significant others. This might make them believe that nothing will happen to them if they also indulge in un-protected sex. 3. Social Pressure : Adolescents belong to a specific culture with particular types of sexual behaviours and have to comply with the norms and values of that culture. Any deviation might result in unfavourable outcomes as, stigmatization or isolation or even punishment.
Besides, Bandura's (1986) Social Learning Theory (SLT)  can help us to understand why adolescents believe that they are unable to perform the recommended sexual behaviours. According to have protected sex, which does not satisfy them. The situation gets worse when they do not find any chance to learn about other's success in adopting recommended behaviours. This happens because of lack of observational learning/enactive learning, owing to insufficient social support while following recommended healthy behaviours.
Since the change from self efficacy to behavioural change is not marked by a sharp line, therefore, some identical theories in these two steps may be applied it has been mentioned that the lack of "Enactive Learning" followed by "Positive Feedback" may obstruct the process of behavioural. changes in adolescents. In this context, we can make use of some specific theories such as Locke's (1991) Theory of Goal Setting '  and Zimbardo & Leippe's (1991) Theory. 
For example, Goal Setting Theory illustrates that adolescents would not make an attempt to change their unhealthy sexual behaviours, if they presume that that changing them is too difficult and implausible. Referring to Zimbardo & Leippe's theory (1991)  we may consider that prevailing health education programmes have not been successful because they have never helped adolescents to find the most appropriate place for the so-called prompts to adopt the recommended sexual behaviours.
Last but not least, the Theories of Attributions (Hewstone, 1989), Reattributions (Forsterlinng, 1988),and Relapse Prevention (Marlatt & Gordon, 1986) can be useful to explain why adolescents are not able to get along with the adopted healthy sexual. behaviours, and relapse i o their former sexual behaviours. These theories explain that adolescents showing new sexual behaviours, receive negative feedbacks or find themselves in so-called high risk situations [e.g., being ridiculed/stigmatized/isolated by the others], therefore they take the risk of relapse. Those who have already relapsed into their former behaviours and have attributed their failures to stable causes, will develop low self-efficacy and feel helpless.
Though we have discussed why adolescents do not use condoms, these theories can be applied to other issues as well. The article discusses some of the health behaviour theories and models that currently predominate in the field of health promotion and urges further research in this direction.
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