Contraceptive Self-Efficacy Scale

Abstract

The Contraceptive Self-Efficacy Scale (CSE) is an 18-item self-report instrument designed to evaluate motivational barriers and perceived competency regarding contraceptive use, primarily among sexually active young women. The scale measures the strength of a woman’s conviction that she should and can control sexual and contraceptive situations to prioritize protection. Items are rated on a 5-point Likert-type scale. Spanning over 25 years of research, the CSE has demonstrated significant correlation with actual contraceptive behavior across diverse global samples, ranging in age from 13 to 45 years. It is utilized by clinicians and educators as a diagnostic tool for designing tailored interventions and serves as a reliable research instrument in sexual health studies.

The scale incorporates various situational stressors within its items to identify specific issues that may inhibit an individual’s feelings of Self-Efficacy. Research indicates that different demographic groups face unique challenges related to effective contraceptive use, underscoring the importance of using the CSE prior to interventions to align strategies with specific participant needs.

Keywords

Contraceptive Self-Efficacy, Sexual Health, Self-Efficacy, Reproductive Health, Adolescence, Contraceptive Behavior, Psychological Assessment, Motivational Barriers

Authors

Ruth Andrea Levinson

Purpose

The primary purpose of the Contraceptive Self-Efficacy (CSE) scale is to assess motivational barriers that prevent sexually active teenage women from consistently using contraceptives. It focuses on behaviors that result in the nonuse of contraception even when a pregnancy is undesired, treating this avoidance behavior as a specific domain for the application of Self-Efficacy theory.

The scale is intended for dual use: first, as a diagnostic tool for educators and clinicians to design and assess the effectiveness of interventions tailored to individual or group needs; and second, as a research instrument to predict and understand variance in contraceptive use across different populations.

Construct

The scale measures the construct of Contraceptive Self-Efficacy (CSE), rooted in the broader social cognitive theory developed by Bandura. According to this construct, an individual’s expectations regarding their ability to execute a specific behavior (efficacy expectations) will determine the initiation and persistence required to achieve a desired goal, such as preventing pregnancy.

The CSE specifically quantifies the strength of a young woman’s conviction in her ability to control sexual and contraceptive situations. This includes measuring confidence in communication, assertiveness, and responsibility related to sexual encounters and birth control methods. The conceptualization treats the nonuse of contraceptives by sexually active teens who wish to avoid pregnancy as analogous to other types of phobic or avoidance behaviors, necessitating intervention based on efficacy enhancement.

Validity

Initial instrument construction involved rigorous scrutiny for face validity and content validity. The criteria for validation focused on two major points: ensuring the items accurately simulated common and critical events required for a teenage woman’s successful use of contraceptives, and confirming that the content and response format corresponded appropriately to standard self-efficacy assessments of the target behavior.

The original CSE instrument underwent multiple revisions based on pretesting within various populations and through direct consultation with Bandura and his associates. Subsequent research has confirmed its predictive validity across diverse ethnic and geographical samples (e.g., African American, French Canadian, Brazilian, Hong Kong Chinese). Furthermore, validity testing methods, including rigorous translation procedures, have been employed when adapting the scale for use in languages other than English.

Reliability

The internal consistency reliability of the Contraceptive Self-Efficacy scale has been consistently high across multiple research investigations and diverse samples. Reliability estimates, measured using Cronbach’s alpha, have yielded values of .73 or higher, indicating acceptable to good internal consistency for the composite 18-item scale.

Factor Analysis

To determine the optimal measurement structure, correlational analyses were conducted across four diverse samples. These analyses revealed a pattern of low correlations among individual CSE items (averaging near .15), suggesting that the items address distinct situational barriers. This outcome justified using the total item set or focusing on specific sub-factors rather than relying solely on a single factor structure.

While the total 18-item sum or average is predictive, studies have successfully utilized a four-factor solution or a Structural Equation Modeling approach (such as LISREL) to predict contraceptive behavior. Notably, Item 8 was consistently predictive across three out of four samples, emphasizing the importance of the “discourse of desire” in sexuality education. Other items uniquely related to behavior assessed confidence in confronting significant others (partner, parents, pharmacist) about sexual needs, highlighting the need for targeted interventions based on specific factor weaknesses.

Instrument

Test Type: Self-report psychological inventory (Contraceptive Self-Efficacy)

Format: 18 items, rated on a 5-point Likert-type scale (1 = Not at all True of Me to 5 = Completely True of Me). Completion time is approximately 10 minutes.

Language Available: English, French (validated), Chinese (validated).

Population Group: Sexually active young women (original focus). Gender-neutral and male versions have since been developed for use with young men.

Age Group: Ranging from 13 to 45 years old.

Population Details: Validation and research have been conducted across highly diverse samples, including inner-city African American youth, predominantly White French Canadian youth, Brazilian youth, Hong Kong Chinese women, and suburban European American and Latina American youth. Settings included family planning clinics, high schools, colleges, hospitals, and institutionalized youth.

Test Methodology: Respondents circle the number corresponding to how true or untrue the statement is for them. Scoring involves summing or averaging the scores, with 9 specific items (2, 5, 6, 8, 9, 11, 12, 14, and 15) requiring reverse scoring to ensure that higher overall scores represent higher Contraceptive Self-Efficacy.

Keywords

Birth Control, Sexual Behavior, Adolescent Psychology, Health Education, Bandura Theory, Assertiveness, Contraceptive Barriers, Cronbach’s alpha

Authors

Author ORCID Identifier: N/A (Not provided in source material)

Affiliation Email addresses: [email protected]

Correspondence Address: Ruth Andrea Levinson, 1511 Peaceable Street, Ballston Spa, NY 12020

Permissions & Fee and Test Year

The Contraceptive Self-Efficacy Scale is copyrighted by the author, Ruth Andrea Levinson. It may be used for research, clinical, or educational purposes only after obtaining explicit permission from the author.

Test Year (Initial Publication): 1986 (Conceptualized and initially published in Levinson, 1986).

Fee: Not specified; permission required.

Reference’s

• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.

• Bandura, A. (1990). Perceived self-efficacy in the exercise of control over AIDS infection. Evaluation and Program Planning, 13, 9–17.

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• Bilodeau, A., Forget, G., & Tétreault, J. (1994). L’auto-efficacité relative à la contraception chez les adolescentes et les adolescents: La validation de la version française de l’échelle de mesure de Levinson. Canadian Journal of Public Health, 85, 115–120.

• Fine, M. (1988). Sexuality, schooling, and adolescent females: The missing discourse of desire. Harvard Educational Review, 58(1), 29–53.

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Items of the Contraceptive Self-Efficacy Scale

The items on the following page are a list of statements. Please rate each item on a 1 to 5 scale according to how true the statement is of you. Using the scale, circle one number for each question:

1 = Not at all True of Me 2 = Slightly True of Me

3 = Somewhat True of Me 4 = Mostly True of Me

5 = Completely True of Me

1. When I am with a boyfriend, I feel that I can always be responsible for what happens sexually with him.

2. Even if a boyfriend can talk about sex, I can’t tell a man how I really feel about sexual things.

3. When I have sex, I can enjoy it as something that I really wanted to do.

4. If my boyfriend and I are getting “turned on” sexually and I don’t really want to have sexual intercourse (go all the way, get down), I can easily tell him “no” and mean it.

5. If my boyfriend didn’t talk about the sex that was happening between us, I couldn’t either.

6. When I think about what having sex means, I can’t have sex so easily.

7. If my boyfriend and I are getting “turned on” sexually and I don’t really want to have sexual intercourse (go all the way, get down), I can easily stop things so that we don’t have intercourse.

8. There are times when I’d be so involved sexually or emotionally that I could have sexual intercourse even if I weren’t protected (using a form of birth control).

9. Sometimes I just go along with what my date wants to do sexually because I don’t think I can take the hassle of trying to say what I want.

10. If there were a man (boyfriend) to whom I was very attracted physically and emotionally, I could feel comfortable telling him that I wanted to have sex with him.

11. I couldn’t continue to use a birth control method if I thought my parents might find out.

12. It would be hard for me to go to the drugstore and ask for foam (Encare Ovals, a diaphragm, a pill prescription, etc.) without feeling embarrassed.

13. If my boyfriend and I were getting really heavily into sex and moving towards intercourse and I wasn’t protected . . .

    1. I could easily ask him if he had protection (or tell him that I didn’t).

    2. I could excuse myself to put in a diaphragm or foam (if I used them for birth control).

    3. I could tell him that I was on the pill or had an IUD (if I used them for birth control).

    4. I could stop things before intercourse, if I couldn’t bring up the subject of protection.

14. There are times when I should talk to my boyfriend about using contraceptives, but I can’t seem to do it in the situation.

15. Sometimes I end up having sex with a boyfriend because I can’t find a way to stop it.

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