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Keywords:

  • abstinence;
  • adolescents;
  • correlates;
  • Indonesia;
  • sexual intercourse

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

Objectives

Adolescents in Indonesia have limited access to sexuality education, resulting in increased risk of sexually transmitted infections and unplanned pregnancies. This study aimed to understand psychosocial correlates of sexual abstinence intentions to inform future sexuality education.

Methods

Data were collected in 79 secondary schools among 2315 students, aged 14–20 years, in Jambi, Lampung, Jakarta and Bali. A self-completed questionnaire measured attitudes, risk perception, subjective norms, perceived behavioural control and intentions towards sexual abstinence.

Results

Significant associations with intention to abstain from sexual intercourse were found for experience with sexual intercourse, perceived behavioural control, attitude and subjective norms of peers and parents, explaining 31% of the variance in abstinence intention.

Conclusions

To promote adolescents' informed sexual decision-making, sexuality education programmes in Indonesia may benefit from addressing past sexual behaviour and perceived behavioural control, subjective norms of peers and attitudes.

Objectifs

Les adolescents en Indonésie ont un accès limité à l’éducation sexuelle, ce qui entraîne un risque accru d'infections sexuellement transmissibles et de grossesses non désirées. Cette étude visait à comprendre les corrélats psychosociaux des intentions pour l'abstinence sexuelle afin d'informer une future éducation sexuelle.

Méthodes

Les données ont été recueillies dans 79 écoles secondaires chez 2315 élèves, âgés de 14 à 20 ans, à Jambi, Lampung, Jakarta et Bali. Un questionnaire à remplir soi-même a permis de mesurer les attitudes, la perception du risque, les normes subjectives, le contrôle comportemental perçu et les intentions pour l'abstinence sexuelle.

Résultats

Des associations significatives avec l'intention de s'abstenir de rapports sexuels ont été trouvées avec l'expérience des rapports sexuels, le contrôle comportemental perçu, l'attitude et les normes subjectives des pairs et des parents, ce qui explique 31% de la variance dans l'intention de l'abstinence.

Conclusions

Pour promouvoir la prise de décisions sexuelles informées chez les adolescents, les programmes d’éducation sexuelle en Indonésie pourraient bénéficier en abordant le comportement sexuel passé et le contrôle comportemental perçu, les normes subjectives des pairs et les attitudes.

Objetivos

Los adolescentes en Indonesia tienen un acceso limitado a la educación sexual, resultando en un riesgo aumentado de infecciones de transmisión sexual y embarazos no planeados. Este estudio buscaba entender los correlatos psicosociales de la intención de abstinencia sexual, con el fin de informar a los futuros programas de educación sexual.

Métodos

Se han recolectado datos en 79 instituciones de educación secundaria de 2315 estudiantes, con edades entre los 14–20 años, en Jambi, Lampung, Jakarta y Bali. Mediante cuestionarios completados por los encuestados, se midieron las actitudes, la percepción del riesgo, las normas subjetivas, el control del comportamiento percibido y sus intenciones con respecto a la abstinencia sexual.

Resultados

Se encontraron asociaciones significativas entre la intención de abstenerse de tener relaciones sexuales y la experiencia previa de relaciones sexuales, la actitud y las normas subjetivas de sus compañeros y padres, explicando un 31% de la varianza en la intención de abstinencia.

Conclusiones

Para promover la toma de decisiones informada de los adolescentes, los programas de educación sexual de Indonesia podrían beneficiarse de abordar los comportamientos sexuales del pasado y el control del comportamiento percibido, la actitud y las normas subjetivas de iguales.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

In Indonesia, the rising number of adolescent pregnancies outside marriage indicates an increase in premarital sex. People get married and have children at an older age while becoming sexually active at a younger age (Riono & Jazant 2004; Simon & Paxton 2004; Diarsvitriab et al. 2011), even though sex before marriage is socially unacceptable (Utomo 2003). These developments imply an increasing need for information about sexuality, especially among adolescents. However, sexuality education is not formally taught at school, communication about sexuality with parents is rare because of cultural norms and talking about sex in public is a taboo. The lack of sexuality education, coupled with increased early and unprotected sex among adolescents, relates to a range of negative health outcomes such as rising numbers of HIV/AIDS and other sexually transmitted infections (STIs), unplanned pregnancies and unsafe abortions (Simon & Paxton 2004; Statistics Indonesia & Macro International 2008).

Prevention of negative health outcomes and promotion of adolescents' sexual and reproductive rights are elements of comprehensive sexuality education. According to the United Nations Convention of the Rights of the Child (United Nations 1989), adolescents have the right to take their own well-informed decisions to be sexually active or to abstain from sex, and to protect themselves against health risks if they are sexually active. In this study, we define abstinence from sexual intercourse as refraining from vaginal or anal intercourse until adolescents are mentally, physically and emotionally ready for it. ‘Being ready’ varies for each individual adolescent and entails informed decision-making and having sexual intercourse when this is a consensual decision between both partners.

To address abstinence as one of the behavioural messages in evidence- and theory-based comprehensive sexuality education, insight into potentially modifiable cognitive antecedents of sexual behaviour and protective behaviours is essential (Bartholomew et al. 2011). Several theoretical frameworks have been empirically developed to assess social cognitive factors that explain people's motivation to perform a given behaviour, including the theory of planned behaviour (TPB) (Ajzen 1991). TPB suggests that the most important predictor of behaviour is an individual's intention to perform or not to perform the behaviour (Webb & Sheeran 2006). Intention, in turn, is determined by (i) attitude, referring to a person's overall evaluation of the proposed behaviour; (ii) subjective norms, which refer to beliefs about whether significant others such as friends, family and society approve of behaviour and whether that approval is valued; and (iii) perceived behavioural control, that is, the person's anticipated mastery of the behaviour. Meta-analyses have provided evidence of the (causal) link between attitude, subjective norm and perceived behavioural control and the intention and behaviour (Sheeran et al. 1999; Armitage & Conner 2001; McEachan et al. 2011).

Compared with the number of studies that have explored correlates of intention to use condoms (Sheeran et al. 1999), relatively few research studies have explored the correlates of adolescents' intention to abstain from sexual intercourse or intention to abstain from sex (Buhi & Goodson 2007). Studies that measured correlates of adolescents' intention to abstain from sexual intercourse found attitudes, subjective norms and perceived behavioural control being the strongest predictors (Basen-Engquist & Parcel 1992; Basen-Engquist et al. 1997; Villarruel et al. 2004; Collazo 2005). Other research reported gender (being female) and lack of previous sexual experience as predictors of intention to abstain from sexual intercourse (Nahom et al. 2001). Studies that included past behaviour as dependent variable, instead of intention, found that low frequency of being in sexual situations, positive attitudes towards abstinence from sex, perceived abstinence from sex among peers, higher education level of particularly father, high self-esteem, good parental relationships and higher level of education are positively associated with abstinence from sexual intercourse (Carvajal et al. 1999; Price & Hyde 2009; Mehrotra et al. 2013).

The study described in this paper is conducted in a predominantly Muslim society. We found one study that assessed theory-based correlates of sexual abstinence of any sexual practice (including sexual intercourse) among male adolescents in the Islamic Republic of Iran (Mohtasham et al. 2009). The study identified subjective norms, perceived behavioural control and perceived susceptibility to contract HIV as positive correlates of intention to abstain from sex until marriage, and employment of mother and higher daily allowance to be negative correlates. HIV/AIDS knowledge did not correlate significantly with intention to remain abstinent. No peer-reviewed publications were found that have explored TPB correlates of Indonesian adolescents' intention to abstain from sexual intercourse.

The aim of our study was to assess social cognitive correlates in a cross-sectional survey study among school going adolescents in four provinces in Indonesia. To explore whether the perceived severity and susceptibility of HIV/AIDS, STI's and pregnancy would be potentially modifiable cognitive antecedents of sexual behaviour of Indonesian adolescents, these two elements of the health belief model (Janz & Becker 1984) were incorporated in the explanatory model. Perceived severity refers to a person's perception of the seriousness of the consequences of contracting a disease. Perceived susceptibility refers to a person's perception of the likelihood of contracting a disease.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

Participants

To measure behavioural correlates of adolescents' intention to abstain from sexual intercourse, participants were recruited from 79 secondary and vocational schools in Indonesia. The study was the baseline measurement of an effect evaluation of the digital sexuality education programme ‘The World Starts With Me’ (WSWM/DAKU) (Leerlooijer et al. 2011) and was conducted in 39 schools that intended to implement WSWM and 40 schools that were selected as matching comparison group. The study was carried out before implementation of the programme. For this study, a representative sample of 80 schools was selected with regard to private vs. public schools, and secondary vs. vocational schools in the four provinces Jambi (Sumatra), Lampung (Sumatra), Jakarta (Java) and Bali. Twenty schools were selected in each province. One school (in Jakarta) was discarded from the original sample because the questionnaire was pretested in this school. This resulted in a total sample of 79 schools. All schools were located in urban areas, because WSWM implementation required electricity and computer availability. Students in the 39 WSWM schools voluntarily signed up to participate in the programme and were also selected for the baseline sample. In the remaining 40 secondary or vocational schools, one class from the first two grades was randomly selected by the headmaster, and all students present in each class (22–46 students) were surveyed. The total sample size in the four provinces was 2315 students, aged 14–20 years (= 15.89, SD = 0.89), of whom 61.7% was female and 38.3% was male. Females were more willing to voluntarily participate in WSWM than males. This explains the larger proportion of female respondents in the study sample.

Instrument

A measurement instrument was developed based on a review of the literature and on psychosocial theories (TPB, HBM) that explain human behaviour (Janz & Becker 1984; Ajzen 1991). Most items were measured using 5-point Likert scales. Higher scores reflect a higher occurrence of the variable concerned. The ‘I do not know’ option was added to the Likert scale, as well as the non-disclosure option ‘I don't want to talk about it’ for questions addressing sensitive topics. Skip patterns were applied where relevant (e.g. respondents who never had sexual intercourse skipped questions about past condom-use behaviour). Female and male versions of the questionnaire were developed. When relevant, the questions were phrased towards each of the two sexes to make the questionnaire understandable, for example for males: ‘Have you ever made one of the lovers you had sexual intercourse with, pregnant?’ and for females: ‘Have you ever been pregnant?’.

Factor analysis was conducted to assess the structure of the scales, and reliability analysis was used to measure the resulting internal consistency of scores on items within scales. See Table 1 for an overview of variables including example items and scale reliability measured with Cronbach's α (three or more items) or Pearson's correlations (two items). The internal consistencies of most scales were satisfactory (α's > 0.70). Even though the consistency of the attitude scale (= 0.24, < 0.001) and perceived peer norms scale (= 0.22, < 0.001) were relatively weak, we decided to include the variables as such in the analyses.

Table 1. Overview of scale measures
Measures (and example item)Range M SDNumber of itemsα or r
  1. n/a = not applicable, ***P < 0.001.

Intention to abstain from sexual intercourse

‘Do you think that you will have sexual intercourse within the next 6 months?’ (reversed)

1 (very unlikely) – 5 (very likely)4.11.01n/a

Perceived susceptibility

‘If I have vaginal sexual intercourse without a condom or another contraceptive, this may lead to pregnancy’

1 (strongly disagree) – 5 (strongly agree)3.80.73α = 0.75

Perceived severity

If my lover becomes (/I become) pregnant, I will not be able to fulfil my dreams'

1 (strongly disagree) – 5 (strongly agree)4.00.93α = 0.81

Attitude

‘Young people should not engage in sex until they are married’

1 (strongly disagree) – 5 (strongly agree)4.30.82= 0.24***

Subjective peer norms

‘My friends believe that people my age should postpone sexual intercourse until they are older

1 (definitely no) – 5 (definitely yes)3.70.82= 0.22***

Perceived behavioural control

‘For me, waiting to have sexual intercourse until I am older is difficult (reversed)

1 (strongly disagree) – 5 (strongly agree)3.50.76α = 0.70

Experience with sexual intercourse

‘How old were you when you had sexual intercourse for the first time?’

0 (no intercourse) – 1 (yes intercourse)0.10.23α = 0.88

Procedure

This study was approved by the Ethical Committee Psychology (ECP) of the Faculty of Psychology and Neuroscience at Maastricht University in the Netherlands, and by District Education Officers and school administrators of schools in Indonesia. All respondents gave written informed consent. Confidentiality was assured by anonymous completion of the questionnaire and explanation that the questionnaires would be accessible for the research team only. Students did not write their names on the questionnaire, and the questionnaires were collected from the students by external research teams.

Data were obtained between November 2008 and February 2009. The questionnaires used a self-report closed response format. Research teams in each province were trained during a 4-day training which included topics such as sampling procedures, the research instrument, data recording, cross-checking and validating techniques, and pilot testing of the questionnaire among 90 students in Jakarta. The testing resulted in minor changes in the instrument (e.g. rephrasing of questions towards male and female participants).

The research teams visited the schools on the day of the survey and explained in the selected classes the aims of the study, gave instruction on how to complete the questionnaire and provided clarity in case of any questions. Participation was voluntary, and students who did not want to participate could leave the classroom. All students accepted to participate in the study and gave their consent on paper. Distraction, teacher interference, fellow student interference and interaction in the class room were eliminated as much as possible by giving clear instructions at the start of questionnaire completion, and by not allowing teachers and other students to come in or near the classroom.

Data analysis

Software package SPSS for Windows, version 19.0 was used to analyse the data. Bivariate correlations were calculated for intention,1 psychosocial, demographic and school-related variables. Those variables that showed significant associations with intention (P < 0.01) were entered in a hierarchical multiple linear regression analysis to assess the unique contributions of these correlates and the total amount of variance explained in intention. In the first step, we entered the psychosocial variables, in the second step the demographic variables and in the third step the school-related variables. For each step, the Enter method was used to enter the variables simultaneously. The same multiple linear regression analysis was conducted for males and females separately. A significance level of < 0.05 was used throughout the study.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

Sample characteristics

The demographic details are presented in Table 2. The majority of respondents were female (61.7%) and Muslim (68.2%). Ages ranged from 14 to 20 years (= 15.89, SD = 0.89). Almost half of the respondents attended a public school, and the other half attended a private school. Most of them were in grade 1 and grade 2, and a minority was in grade 3. Education level of parents and guardians was relatively high with 74.9% of father/male guardian, and 66.0% of mother/female guardian have finished at least senior high school.

Table 2. Demographic variables
Variables= 2315%
Gender
Male88738.3
Female142861.7
Age (= 2283)
14693.0
1573732.3
1694541.4
1746120.2
18602.6
1980.4
2030.1
Province
Jambi52722.8
Lampung65328.2
DKI Jakarta56124.2
Bali57424.8
School type
Public secondary school78834.0
Public vocational school1948.4
Private secondary school84636.6
Private vocational school48721.0
School grade
Grade 1107346.3
Grade 2100243.3
Grade 324010.4
Religion
Catholic502.2
Protestant1737.5
Muslim157968.2
Buddhism592.5
Hindu45419.6
Education level mother/female guardian (= 2209)
No formal schooling381.7
Primary school37617.0
Junior high school33715.3
Senior high school96643.7
College/university49222.3
Education level father/male guardian (= 2213)
No formal schooling210.9
Primary school27312.3
Junior high school26011.7
Senior high school99444.9
College/university66530.0
Economic background at household level (= 2307)
We don't have enough food462
We have enough food, but not other basic items such as clothes853.7
We have enough money for food and clothes but are very short1396
We have the most important things, but few luxury goods173175.0
We have money for luxury goods and extra things30613.3

A majority of 89.5% (male: 82.6%; female: 93.8%) respondents reported that they never had sexual intercourse; 3.8% (male: 6.7%; female: 2.0%) reported that they had sexual intercourse in life at least once; 2.4% (male: 4.6%; female: 1.0%) did not want to answer the three questions measuring experience with sexual intercourse; and 4.3% (male: 6.1%; female: 3.2%) did not provide consistent answers to the three items. On average, respondents had a relatively high intention to abstain from sexual intercourse (= 4.05, SD = 1.03). A majority reported the likelihood of abstaining from sexual intercourse as likely or very likely (66.4%), 12.9% reported neutral, 9.2% was unlikely or very unlikely to abstain and 11.3% indicated they did not want to disclose their answer. The respondents who did not want to disclose their answer were excluded from correlation and multiple linear regression analyses.

Correlates of intention to abstain from sexual intercourse

Means and standard deviations of the psychosocial measures are presented in Table 1. Table 3 provides an overview of intercorrelations. Perceived behavioural control to abstain correlated most strongly and positively with abstinence intention. A strong negative correlation was found for respondents' experience with sexual intercourse. Moderate positive correlations were found for perceived supportive norms of peers towards abstinence, gender (being a girl) and attitude towards abstinence. Weak negative associations with intention (> −0.13) were found for age and school intention to use the sexuality education programme WSWM (intervention school). School type and religion also correlated weakly with intention (< 0.10). No significant associations with intention were found for perceived susceptibility and perceived severity of pregnancy, HIV infection and STI infection, and for province, school grade, economic family background and the education levels of mother/female guardian and father/male guardian.

Table 3. Intercorrelations of determinants of intention to abstain from sexual intercourse
 1234567891011121314151617
  1. *P < 0.05, **P < 0.01, ***P < 0.001.

1 Intention to abstain from sexual intercourse                
2 Gender0.31***               
3 Age−0.13***−0.07***              
4 Province−0.04−0.04−0.08***             
5 School type−0.10***−0.05*0.05*−0.28***            
6 School intention to use programme−0.08**−0.06**0.25***−0.10***0.21***           
7 Religion−0.09***−0.02−0.000.03−0.080.01          
8 Education level father/male guardian−0.04−0.04−0.08***1.0***−0.28***−0.10***0.03         
9 Education level mother/female guardian−0.01−0.04−0.09***0.66***−0.30***−0.10***−0.010.66***        
10 Economic family background0.040.07***−0.040.20***−0.16***−0.09***0.000.20***0.19***       
11 School grade−0.030.06**0.63***0.04−0.08***0.24***−0.15***0.040.020.06**      
12 Perceived susceptibility0.01−0.10***−0.010.13***−0.11***−0.06**0.020.13***0.14***0.08***0.05*     
13 Perceived severity0.040.08***−0.020.05*−0.05*−0.04−0.010.05*0.04*0.020.030.42    
14 Attitude0.27***0.13***−0.09***0.12***−0.10***−0.08***−0.080.12***0.11***0.10***0.020.22***0.19***   
15 Subjective peer norms0.35***0.22***−0.09***0.04−0.11***−0.10***−0.05*0.040.05*0.07***0.010.09***0.07**0.37***  
16 Perceived behavioural control0.43***0.34***−0.06**0.01−0.15***−0.14***−0.10***0.010.030.09***0.06**0.06**0.09***0.26***0.36*** 
17 Experience with sexual intercourse−0.42***−0.15***0.12***0.010.10***0.07**0.06**0.010.01−0.05*0.03−0.03−0.01−0.21***−0.32***−0.29***

Past experience with sexual intercourse correlated strongly and positively with abstinence-supporting subjective norms, perceived behavioural control and a positive attitude towards abstinence. Perceived susceptibility and perceived severity correlated strongly and positively with attitude towards abstinence. In the regression analyses, we excluded variables that showed no significant association with abstinence intention.

Multiple linear regression

Three-step multiple linear regression was employed to explore the correlates of intention. Table 4 displays the regression statistics, including the standardised regression coefficients (βs). In the first step, the regression model included the TPB variables and past experience and was significant, F(4, 1982) = 201.29, < 0.001. The correlates together explained 28.7% of the variance in abstinence intentions (R2 = 0.29). In the second step, gender, age and religion were added, and this model change was significant, F change(3, 1979) = 23.79, < 0.001, adding 2% to explained variance (R2 = 0.31). In this model, all correlates provided a significant unique contribution to the variance in intentions, with past experience with sexual intercourse and perceived behavioural control explaining most unique variance. Gender, attitude and subjective norms of peers contributed moderately, and age and religion contributed weakly to the variance in abstinence intentions. Adding school type and school intention to use a sexuality education programme did not result in additional explained variance, F change(2, 1977) = 0.927, = 0.396 (R2 = 0.31).

Table 4. Results of multiple linear regression analysis for the total sample (= 1987)
  B SEβ B SEβ B SEβ
  1. *P < 0.05, **P < 0.01, ***P < 0.001.

Step 1Attitude0.130.030.09***0.120.030.09***0.120.030.08***
Subjective peer norms0.140.030.12***0.130.030.10***0.130.030.10***
Perceived behavioural control0.380.030.27***0.310.030.22***0.310.030.22***
Experience with sexual intercourse−1.300.09−0.28***−1.250.09−0.27***−1.240.09−0.27***
Step 2Gender   0.310.040.15***0.310.040.15***
Age   −0.060.02−0.06**−0.070.02−0.06**
Religion   −0.050.02−0.04*−0.050.02−0.05*
Step 3School intention to use programme      0.020.040.01
School type      −0.020.02−0.03
R 2   0.29  0.31  0.31

Multiple linear regressions for males and females

Separate three-step multiple linear regression analyses were employed for male (= 720) and female (= 1267) respondents. In the final model for males, F(8,711) = 39.24, < 0.001 (R2 = 0.31), past experience with sexual intercourse, perceived behavioural control, subjective peer norms and attitude contributed significantly to the variance in abstinence intentions. Age, religion, school type and school intention to use a sexuality education programme did not contribute significantly. The final model for females, F(8,1258) = 40.94, < 0.001 (R2 = 0.21), showed that experience with sexual intercourse and perceived behavioural control contributed strongly, whereas age and subjective peer norms contributed weakly. Attitude, religion, school intention to use a sexuality education programme and school type did not contribute significantly.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

The study described in this paper explored psychosocial correlates of Indonesian adolescents' motivation to abstain from sexual intercourse. The findings provide guidance for evidence-based planning of sexuality education programmes in Indonesia and beyond. The study found that TPB provides a relatively good basis for understanding abstinence intentions of Indonesian adolescents, with similar success as other studies worldwide (Basen-Engquist & Parcel 1992; Basen-Engquist et al. 1997; Villarruel et al. 2004; Collazo 2005; Cha et al. 2007).

Perceived behavioural control regarding abstinence from sexual intercourse was most strongly correlated with abstinence intentions. This finding is similar to other studies (Collazo 2005; Buhi & Goodson 2007) and implies that sexuality education programmes should focus on building adolescents' belief in and anticipation on their ability to abstain from sexual intercourse. This finding did not differ for male and female adolescents.

Past experience with sexual intercourse was the second important factor associated with adolescents' motivation to abstain. Relatively few studies have explored the influence of past experience with sexual intercourse on abstinence intentions of adolescents. These few studies, however, support the finding that lack of experience with sexual intercourse is an important predictor of adolescents' motivation to abstain (Basen-Engquist et al. 1997; Nahom et al. 2001). This finding suggests that sexuality education programmes need to consider adolescents' past behaviour to meet the needs of both sexually experienced and inexperienced adolescents.

Perceived supportive norms of peers were found to be strongly associated with adolescents' motivation to abstain, which is also shown in similar studies (Fisher et al. 1995; Cha et al. 2007). A similar pattern was found for a positive attitude towards abstinence. Previous research also shows positive and strong associations between a positive attitude and adolescents' motivation to abstain (Basen-Engquist & Parcel 1992; Basen-Engquist et al. 1997; Villarruel et al. 2004).

The study also showed that females are generally more motivated to abstain than males. This could be explained by the larger proportion of females with lack of experience with sexual intercourse, compared with larger proportion of males. In addition, younger female adolescents were more motivated than older female adolescents to abstain from sexual intercourse. The findings also indicated that the measured psychosocial variables were better applicable to predict males' motivation than females' motivation to abstain.

Males' attitudes and perceived peer norms seem to be relevant predictors of their motivation to abstain. However, peer norms are less relevant and a positive attitude is not relevant in predicting females' intentions, which is remarkable given the strong norms in Indonesian society that support adolescents' sexual abstinence until marriage, especially for females (Utomo 2003). This could be explained by the operationalisation of attitude and subjective norms in the present study. Attitudinal beliefs other than the beliefs measured in our study may be more relevant in shaping females' attitude and can be further explored. Subjective norms were operationalised by measuring perceived peer norms, whereas perceived sexual behaviour of peers, perceived norms of parents and other relevant adults were not included in this study, but could be relevant predictors of sexual behaviour/intention outcomes (Buhi & Goodson 2007). Future research can further explore relevant normative beliefs of females. The relatively low prediction of females' abstinence motivation by TPB variables can also be explained by external factors, other than those included in this study (Buhi & Goodson 2007).

Finally, the study indicated that perceived susceptibility and perceived severity of pregnancy, HIV infection and STI infection did not motivate Indonesian adolescents to abstain from sexual intercourse. This is also reported by other studies (e.g. Ruiter et al. 2001) and could be explained by the limited experience of adolescents with sexual intercourse and the relatively low prevalence of HIV, STIs and pregnancies among Indonesian adolescents (Simon & Paxton 2004; Statistics Indonesia & Macro International 2008). Another explanation could be that perceived susceptibility and perceived severity are strongly related to attitude and may indirectly, as attitudinal beliefs, influence adolescents' abstinence intentions (Fishbein 2000).

The study has both strengths and limitations. As far as we know, this is the first cross-sectional study in Indonesia that has explored theory-based psychosocial correlates of adolescents' intention to abstain from sexual intercourse. Another strength of the study is its large sample size. One of the limitations, however, was the non-randomised sample utilised in this study, limiting generalisability of the findings. Half of the respondents were from schools that intended to use WSWM, which negatively related to abstinence intentions. This may have resulted in biased results. The findings with regard to attitude and perceived peer norms have to be interpreted with care, as both measures showed relatively weak internal consistency and measured a limited number of beliefs. Future studies should invest in the development of scales to reliably measure attitude and subjective norms and could apply a mixed methods design to obtain a more elaborate overview of behavioural correlates. Finally, the study in this paper is limited by its single focus on correlates of abstinence intentions to inform sexuality education, whereas to develop effective sexuality education for adolescents, research is needed to explore Indonesian adolescents' motivation to have safe sex and use condoms.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

Our study confirms the conclusions of other studies in Indonesia that psychosocial frameworks can assist programme planners to explore correlates of behavioural intentions in Indonesia (Liem et al. 2009; Lock et al. 2011). The study has improved our understanding of the psychosocial correlates of adolescents' motivation to abstain from sexual intercourse in Indonesia and contributes to the evidence that is essential to be able to design theory- and evidence-based sexuality education programmes (Sumintardja et al. 2009). The present study demonstrates that sexuality education in Indonesia should consider adolescents' experience with sexual intercourse, perceived behavioural control, perceived social norms and attitudes towards abstinence and should take different beliefs of males and females into account.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References

This article is based on data derived from a survey conducted among secondary school students in Indonesia. The study was organised and implemented in close cooperation with Rutgers WPF Indonesia, Yayasan Pelita Ilmu (YPI) Indonesia, and the Center for Health Research (Universitas Indonesia). We would like to express our thanks to the respective organisations and to the management, students and teachers of all schools that participated in the study.

Note
  1. 1

    Explorative analyses of the data distributions for each study measure revealed that intention scores were strongly negatively skewed. Dichotomisation of the intention variable did not change the outcomes of the correlation and regression analyses. For ease of interpretation and higher information value, we therefore decided to use the ordinal intention variable in the analyses.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. References
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