Sexual Risk Behavior Beliefs and Self-Efficacy Scales

Abstract

The Sexual Risk Behavior Beliefs and Self-Efficacy Scales (SRBBS) were developed as a crucial measurement tool for assessing key psychosocial variables that influence both sexual risk-taking and protective behaviors among adolescents. Initially, the SRBBS constituted a core component of a larger questionnaire used in the evaluation of a comprehensive, school-based intervention program designed to prevent Human Immunodeficiency Virus (HIV), sexually transmitted diseases (STD), and pregnancy in high school students (Coyle et al., 1996).

The development process involved four rigorous stages: identifying relevant psychosocial constructs derived from established theoretical frameworks, generating and refining 22 questionnaire items, conducting pretesting via focus groups with high school students, and final instrument revision. The scales are theoretically grounded in the Theory of Reasoned Action, Bandura’s Social Learning Theory, and the Health Belief Model. The instrument comprises eight distinct scales covering attitudes, norms, self-efficacy, and perceived barriers related specifically to sexual intercourse and condom use.

Keywords

Sexual Risk Behavior Beliefs and Self-Efficacy Scales, SRBBS, Attitudes, Norms, Self-Efficacy, Condom Use, HIV prevention, STD prevention, Adolescent health, Psychosocial assessment, Sexual risk-taking behavior.

Authors

KAREN BASEN-ENGQUIST, LOUISE C. MÂSSE, KARIN COYLE, DOUGLAS KIRBY, GUY PARCEL, STEPHEN BANSPACH, JESSE NODORA

Purpose

The primary purpose of the SRBBS scales is to quantitatively measure the psychosocial determinants of sexual health behaviors in adolescents. By assessing variables like attitudes, subjective norms, self-efficacy, and perceived barriers related to condom use and sexual intercourse, the instrument provides researchers and program evaluators with data essential for understanding the mechanisms driving high-risk and protective behaviors.

Specifically, the scales were designed to evaluate the effectiveness of school-based prevention programs aimed at reducing the incidence of HIV, STD, and adolescent pregnancy. The structured nature of the scales allows for the direct measurement of change in these key variables following intervention implementation, providing empirical evidence for the program’s impact on theoretical constructs of behavior change.

Construct

The SRBBS scales measure eight core constructs, derived from prominent social and health psychology theories, focusing on two domains: sexual risk-taking and protective behavior.

The scales addressing sexual risk-taking behavior include:

• Attitudes about Sexual Intercourse (ASI): Personal beliefs regarding the appropriateness of sexual activity for their age group.
• Norms about Sexual Intercourse (NSI): Perceptions of friends’ beliefs regarding sexual activity.
• Self-Efficacy in Refusing Sex (SER): Confidence in one’s ability to abstain from or refuse sexual activity.

The scales addressing protective behavior (condom use) include:

• Attitudes about Condom Use (ACU): Personal beliefs regarding the necessity and importance of using condoms.
• Norms about Condom Use (NCU): Perceived beliefs of friends regarding the importance of condom use.
• Self-Efficacy in Communication about Condoms (SECM): Confidence in discussing condom use with a partner.
• Self-Efficacy in Using and Buying Condoms (SECU): Confidence in the practical skills required for acquiring and correctly using condoms.
• Barriers to Condom Use (BCU): Perceived difficulties or negative consequences associated with carrying or purchasing condoms.

Validity

Validity for the SRBBS was established using data from a large multiethnic sample of 6,213 high school students in Texas and California (Basen-Engquist et al., 1996), focusing on construct and concurrent validity.

Construct Validity: Confirmatory factor analysis (CFA) was employed, evaluating two distinct theoretical models: one for sexual risk behavior (ASI, NSI, SER) and one for protective behavior (ACU, NCU, SECM, SECU, BCU). Both final models demonstrated good fit indices, confirming the underlying factor structure. A notable finding was the necessity of adding correlated error terms between grammatically similar attitude and norm items to achieve model fit, suggesting shared method variance or close conceptual overlap between these constructs.

Concurrent Validity: This was demonstrated through the scales’ ability to distinguish between groups based on actual behavior. The sexual risk behavior scales successfully differentiated between sexually experienced students and those who had never had sexual intercourse. Furthermore, the protective behavior scales effectively differentiated between sexually active students who were consistent condom users and those who were inconsistent users. Consistent users reported significantly more positive attitudes, more favorable norms, and higher levels of self-efficacy for condom communication and use, while perceiving fewer barriers.

Reliability

Internal consistency reliability was assessed using Cronbach alpha coefficients based on the multiethnic high school sample (N = 6,213). The reliability estimates for the eight subscales were generally acceptable to strong for a behavioral measure, demonstrating consistent internal structure:

• Attitudes about sexual intercourse: .78
• Norms about sexual intercourse: .78
• Self-efficacy for refusing sex: .70
• Attitudes about condom use: .87
• Norms about condom use: .84
• Self-efficacy in communicating about condoms: .66
• Self-efficacy in buying and using condoms: .61
• Barriers to condom use: .73

The reliability scores for attitudes and norms regarding condom use were particularly strong (.87 and .84, respectively). The self-efficacy scales, while adequate, showed slightly lower coefficients, reflecting the complexity of measuring behavioral self-efficacy constructs.

Factor Analysis

The factor structure of the SRBBS was confirmed using Confirmatory Factor Analysis (CFA) to ensure the items loaded onto their intended theoretical constructs. The analysis was split into two distinct models reflecting the behavioral domains being measured.

The first model focused on the three scales related to sexual risk-taking behavior (ASI, NSI, SER). The fit indices demonstrated that the data aligned well with this proposed structure (e.g., the chi-square was not significant, residuals were normally distributed, and the root mean square error of approximation was less than .05). The second model focused on the five scales related to protective behavior (ACU, NCU, SECM, SECU, and BCU). This model also yielded good fit indices, confirming the distinct nature of these protective constructs. In both models, correlated error paths were necessary between items that were structurally or grammatically similar, particularly between corresponding attitude and norm items, to achieve optimal model fit.

Instrument

Test Type: Psychometric Scale assessing psychosocial determinants of sexual risk-taking behavior and protective behavior.

Format: 22 items administered as part of a larger self-administered questionnaire (110 items total).

Language Available: English, Spanish.

Population Group: Adolescents/Students.

Age Group: Primarily high school students (aged 14 to 18). Also used experimentally with middle school students (grades 7 and 8).

Population Details: The reliability and validity data are based on a large multiethnic sample (N=6,213) of high school students from Texas and California.

Test Methodology: Self-administered paper questionnaire. Response formats are Likert-type, either 3-point or 4-point scales, used across the eight subscales. The questionnaire was originally designed to be optically scanned, requiring respondents to mark circles corresponding to their answers, though it can be adapted for manual scoring.

Scoring: Scores are calculated by totaling individual item scores within a scale and dividing by the number of items, yielding a scale score that corresponds directly to the original response value range. The range for ASI, ACU, NSI, NCU, and BCU is 1 to 4. The range for SER, SECM, and SECU is 1 to 3. Items ASI2 and NSI2 require reverse scoring.

Keywords

Adolescent sexual health, Condom use self-efficacy, Psychosocial determinants, Behavioral prevention, STD prevention, HIV/AIDS, Likert scale, Confirmatory factor analysis, Theory of Reasoned Action.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: [email protected] (Karen Basen-Engquist)

Correspondence Address: Karen Basen-Engquist, University of Texas M.D. Anderson Cancer Center, Department of Behavioral Science—Box 243, 1515 Holcombe, Houston, TX 77030.

Permissions & Fee and Test Year

The development of this work was conducted under Contract #200–91–0938 with the Centers for Disease Control and Prevention (CDC). The primary psychometric data was published in 1996 (Basen-Engquist et al., 1996), indicating the scales were in use and validated around that time. No specific information regarding current licensing fees or explicit permission requirements is provided in the source material; users should contact the corresponding author for current usage rights.

Reference’s

• Bandura A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.
• Basen-Engquist, K., Masse, L., Coyle, K., Parcel, G. S., Banspach, S., Kirby, D., et al. (1996). Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents. Unpublished manuscript.
• Coyle, K., Kirby, D., Parcel, G., Basen-Engquist, K., Banspach, S., Rugg, D., et al. (1996). Safer Choices: A multi-component school-based HIV/ STD and pregnancy prevention program for adolescents. Journal of School Health, 66, 89–94.
• Fishbein, M., & Ajzen, I.(1975). Beliefs, attitudes, intentions, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
• Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. In: M. H. Becker (Ed.), The Health Belief Model and personal health behavior (Vol. 2, pp. 328–335). Thorofare, NJ: Charles B. Slack.

Items of the Sexual Risk Behavior Beliefs and Self-Efficacy Scales

The following items constitute the SRBBS scales, originally presented as part of the Student Health Questionnaire:

Your beliefs

Please fill in the answer for each question that best describes how you feel.

ASI1. I believe people my age should wait until they are older before they have sex.

*ASI2. I believe it’s OK for people my age to have sex with a steady boyfriend or girlfriend. ACU1. I believe condoms (rubbers) should always be used if a person my age has sex.

ACU2. I believe condoms (rubbers) should always be used if a person my age has sex, even if the girl uses birth control pills.

ACU3. I believe condoms (rubbers) should always be used if a person my age has sex, even if the two people know each other very well.

• What do your friends believe?

The following questions ask you about your FRIENDS and what they think. Even if you’re not sure, mark the answer that you think best describes what they think.

NSI1. Most of my friends believe people my age should wait until they are older before they have sex.

*NSI2. Most of my friends believe it’s OK for people my age to have sex with a steady boyfriend or girlfriend. NCU1. Most of my friends believe condoms (rubbers) should always be used if a person my age has sex.

NCU2. Most of my friends believe condoms (rubbers) should always be used if a person my age has sex, even if the girl uses birth control pills.

NCU3. Most of my friends believe condoms (rubbers) should always be used if a person my age has sex, even if the two people know each other very well.

• How sure are you?

What if the following things happened to you? Imagine that these situations were to happen to you. Then tell us how sure you are that you could do what is described.

SER1. Imagine that you met someone at a party. He or she wants to have sex with you. Even though you are very attracted to each other, you’re not ready to have sex. How sure are you that you could keep from having sex?

SER2. Imagine that you and your boyfriend or girlfriend have been going together, but you have not had sex. He or she really wants to have sex. Still, you don’t feel ready. How sure are you that you could keep from having sex until you feel ready?

SER3. Imagine that you and your boyfriend or girlfriend decide to have sex, but he or she will not use a condom (rubber). You do not want to have sex without a condom (rubber). How sure are you that you could keep from having sex, until your partner agrees it is OK to use a condom (rubber)?

SECM1. Imagine that you and your boyfriend or girlfriend have been having sex but have not used condoms (rubbers). You really want to start using condoms (rubbers). How sure are you that you could tell your partner you want to start using condoms (rubbers)?

SECM2. Imagine that you are having sex with someone you just met. You feel it is important to use condoms (rubbers). How sure are you that you could tell that person that you want to use condoms (rubbers)?

SECM3. Imagine that you or your partner use birth control pills to prevent pregnancy. You want to use condoms (rubbers) to keep from getting STD or HIV. How sure are you that you could convince your partner that you also need to use condoms (rubbers)?

SECU1. How sure are you that you could use a condom (rubber) correctly or explain to your partner how to use a condom (rubber) correctly?

SECU2. If you wanted to get a condom (rubber), how sure are you that you could go to the store and buy one?

SECU3. If you decided to have sex, how sure are you that you could have a condom (rubber) with you when you needed it?

• What do you think about condoms?

Please tell us how much you agree or disagree with the following statements. BCU1. It would be embarrassing to buy condoms (rubbers) in a store.

BCU2. I would feel uncomfortable carrying condoms (rubbers) with me.

BCU3. It would be wrong to carry a condom (rubber) with me because it would mean that I’m planning to have sex.

Key to identification of scale items and description of response formats:

ASI = Attitudes about sexual intercourse

ACU = Attitudes about condom use

NSI = Norms about sexual intercourse

NCU = Norms about condom use

Response format for attitude and norm items:

4 = Definitely Yes

3 = Probably Yes

2 = Probably No

1 = Definitely No

SER = Self-efficacy for refusing sexual intercourse

SECM = Self-efficacy for communicating about condom use

SECU = Self-efficacy for buying and using condoms

Response format for self-efficacy items:

1 = Not Sure at All

2 = Kind of Sure

3 = Totally Sure

BCU = Barriers to condom use

Response format for barrier items:

4 = I Strongly Agree

3 = I Kind of Agree

2 = I Kind of Disagree

1 = I Strongly Disagree

*Item should be scored in reverse.