Sexual Health Practices Self-Efficacy Scale

Abstract

The Sexual Health Practices Self-Efficacy Scale (SHPSES) is a 20-item psychometric instrument developed to measure an individual’s confidence, or self-efficacy, in performing a diverse range of behaviors crucial for maintaining positive sexual health. Rooted in Bandura’s theory of self-efficacy, the scale assesses the respondent’s perceived knowledge, skills, and comfort necessary to execute these practices effectively.

Through factor analysis, the SHPSES was shown to comprise six distinct subscales: Sexual Relationships (5 items), Sexual Health Care (4 items), Sexual Assault (3 items), Safer Sex (4 items), Sexual Equality/Diversity (3 items), and Abstinence (1 item). Respondents indicate their confidence using a 5-point Likert-type scale, ranging from 1 (“Not at all Confident”) to 5 (“Extremely Confident”). The instrument is suitable for use across a broad demographic, including adolescents through older adults.

Keywords

Sexual Health Practices, Self-Efficacy, SHPSES, Sexual Health, Behavior Change, Safer Sex, Sexual Relationships, Confidence, Psychometric Scale.

Authors

Patricia Barthalow Koch, Clinton Colaco, Andrew W. Porter

Purpose

The primary objective of the Sexual Health Practices Self-Efficacy Scale (SHPSES) is to quantify the degree of confidence an individual possesses regarding their ability to execute key sexual health practices. This measurement aligns with the comprehensive definition of sexual health provided by the World Health Organization (WHO), which emphasizes physical, emotional, mental, and social well-being related to sexuality.

By measuring self-efficacy across various behavioral domains, the scale serves as a valuable tool for researchers, educators, and clinicians to assess preparedness for healthy sexual behavior and identify specific areas where educational interventions are necessary. High self-efficacy is understood to be a critical antecedent for initiating and maintaining positive behavior change.

Construct

The SHPSES is fundamentally grounded in the concept of **Self-Efficacy**, a cornerstone of psychological theory proposed by Albert Bandura (1977, 1982). Self-efficacy represents the conviction or belief that a person can successfully perform the behavior required to achieve a specific outcome.

In the context of sexual health, this construct assesses the respondent’s belief in their capacity to apply the requisite knowledge, skills, and comfort to navigate complex sexual situations—ranging from preventative health care (e.g., STI testing) to interpersonal skills (e.g., negotiating safer sex). The concept of self-efficacy is central to numerous influential health models, including the Social Cognitive Theory and the Health Belief Model, highlighting its importance as a predictor of behavior change in areas like contraceptive use and HIV prevention.

Validity

The validity of the SHPSES was established through thorough content and construct validation procedures.

Content Validity was determined by reviewing the sexual health content found in ten major sexuality textbooks and the syllabi of twenty sexuality classes across various U.S. colleges and universities. Furthermore, a panel of three experienced sexuality educators and researchers reviewed the initial pool of items to ensure relevance and eliminate redundancy.

Construct Validity was confirmed using a principal component analysis (PCA) with a varimax rotation and Kaiser normalization on survey data from 1,200 undergraduate students. This analysis successfully identified and confirmed the hypothesized six-factor structure. The scale also demonstrated **discriminant validity**, effectively differentiating between undergraduate students who had completed sexuality education courses versus those enrolled in non-sexuality or non-health-related classes (Koch, 2009). Additionally, SHPSES scores were found to be significantly correlated with both intentions to practice safer-sex behaviors and the actual practice of safer sex behaviors in the preceding month among a sample of community college students (Millstein, 2006).

Reliability

Internal reliability estimates were calculated based on data collected from 1,200 surveys completed by a convenience sample of undergraduate students between 2004 and 2008.

The overall scale demonstrated strong internal consistency, with the total scale yielding a high Cronbach’s alpha coefficient of **.89** (Koch, 2009). Reliability coefficients for the specific subscales were also found to be acceptable to good:

• Sexual Relationships: .82
• Sexual Health Care: .81
• Sexual Assault: .78
• Safer Sex: .71
• Sexual Equality/Diversity: .73

It is noted that the Abstinence subscale, consisting of only a single item, did not have an individual Cronbach’s alpha coefficient calculated.

Factor Analysis

Construct validation involved conducting a principal component analysis (PCA) utilizing a varimax rotation with Kaiser normalization. The analysis converged in six iterations, successfully identifying six distinct factors representing sexual health practices self-efficacy. These factors, along with the percentage of explained variance for each, are detailed below:

• Sexual Relationships: 15.4% explained variance
• Sexual Health Care: 13.4% explained variance
• Sexual Assault: 11.2% explained variance
• Safer Sex: 10.1% explained variance
• Sexual Equality/Diversity: 10.0% explained variance
• Abstinence: 5.8% explained variance

This factor analysis confirms the scale’s ability to measure distinct yet related dimensions of self-efficacy pertaining to sexual health management and interpersonal interactions.

Instrument

Test Type: Self-report psychological scale measuring behavioral self-efficacy.

Format: 20 items using a 5-point Likert scale (1 = Not at all Confident to 5 = Extremely Confident). Total scores range from 20 to 100.

Language Available: English (Original validation).

Population Group: Individuals concerned with positive sexual health behaviors.

Age Group: Adolescents to older adults.

Population Details: Initial validation sample consisted of 1,200 undergraduate students attending a major northeastern university.

Test Methodology: Brief questionnaire format; takes approximately 5 minutes to complete.

Keywords

Sexual Health Care, Sexual Assault Prevention, Safer Sex, Sexual Equality, Diversity, Abstinence, Sexual Relationships, Psychological Measurement, Confidence.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Patricia Barthalow Koch).

Correspondence Address: Patricia Barthalow Koch, Professor of Biobehavioral Health, The Pennsylvania State University, 304B Health and Human Development Building East, University Park, PA 16802.

Permissions & Fee and Test Year

The scale was developed by researchers at The Pennsylvania State University, with primary validation and presentation of data occurring around **2009** (Koch, 2009). Specific information regarding current usage fees or permissions is not detailed in the source material; interested parties should contact the corresponding author, Patricia Barthalow Koch, for licensing information.

Reference’s

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

Bandura, A. (1982). Self-efficacy mechanism is human agency. American Psychologist, 37, 121–147.

Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.

DiClemente, R. J., & Peterson, J. L. (1994). Preventing AIDS: Theories and methods of behavioral interventions. New York: Springer.

Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.

Koch, P. B. (2009, June). Promoting positive sexual health practices for university students: What works? Presentation at the World Congress for Sexual Health, Gothenburg, Sweden.

Millstein, S. (2006). The effects of a human sexuality course on students’ confidence to engage in healthy sexual practices. Unpublished doctoral dissertation, Widener University, Philadelphia.

Pan American Health Organization & World Health Organization. (2000). Promotion of sexual health: Recommendations for action. Retrieved June 22, 2009, from http://new.paho.org/hq/index.php?option=com_content&task=view&id=847&Itemid=1047

Sexuality Information and Education Council of the United States. (2009). Position statements. Retrieved June 22, 2009, from http://www.siecus.org/index.cfm?pageId=494

Strecher, V. J., DeVellis, B. M., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13(1), 73–92.

World Association of Sexual Health. (2008). Sexual health for the millennium. Retrieved June 22, 2009, from http://www.worldsexology.org

World Health Organization. (2009). Working definition of sexual health. Retrieved June 22, 2009, from http://www.who.int/reproductive-health/gender/sexual_health.html

Items of the Sexual Health Practices Self-Efficacy Scale

Please indicate how confident you are, at this point in time, in carrying out the following sexual health practices if you needed to. Think of confidence as having the knowledge, skills, and comfort necessary to effectively do these things. The term “partner” refers to whomever you might choose to share your sexuality with. Use the following scale for your answers:

1 = Not at all Confident

2 = Slightly Confident

3 = Moderately Confident

4 = Highly Confident

5 = Extremely Confident

How confident are you with:

1. Performing breast or testicular self-exams

   1 2 3 4 5

2. Getting tested for a sexually transmitted infection (STI)

   1 2 3 4 5

3. Getting an HIV test

   1 2 3 4 5

4. Talking with a health care worker about a sexual health issue like an STI

   1 2 3 4 5

5. Making thoughtful, good decisions about your sexual behaviors

   1 2 3 4 5

6. Practicing sexual abstinence

   1 2 3 4 5

7. Establishing a fulfilling sexual relationship

   1 2 3 4 5

8. Talking with a (prospective) sexual partner about your sexual histories

   1 2 3 4 5

9. Using a condom

   1 2 3 4 5

10. Using another form of birth control other than a condom

    1 2 3 4 5

11. Negotiating with a sexual partner to practice safer sex

    1 2 3 4 5

12. Talking with a sexual partner about a sexual health issue, like an STI

    1 2 3 4 5

13. Talking with a sexual partner about a relationship issue

    1 2 3 4 5

14. Dealing with a sexual functioning difficulty (like difficulty achieving orgasm or ejaculating too quickly)

    1 2 3 4 5

15. Preventing a sexual assault situation from occurring

    1 2 3 4 5

16. Dealing with a sexual assault if it occurs to you

    1 2 3 4 5

17. Helping a friend who has been sexually assaulted

    1 2 3 4 5

18. Eliminating sexual double standards (based on gender) in your life

    1 2 3 4 5

19. Eliminating gender stereotyping from your life

    1 2 3 4 5

20. Accepting diversity in sexual orientation (heterosexuality, homosexuality, bisexuality)

    1 2 3 4 5