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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.
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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.