Explaining the attitude-behavior gap in adolescent sexual and reproductive health service utilization: A cognitive dissonance perspective from rural Uganda
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Adolescents’ favorable attitudes toward sexual and reproductive health services do not necessarily translate into use when stigma, anticipated judgment, misinformation, and peer influence reinforce non-use. The discussion emphasizes that social norms interact with psychological and structural barriers: fear of being labeled promiscuous or irresponsible can justify avoiding services, while reliance on peers may reinforce misinformation. Multi-level approaches should therefore reduce structural barriers while normalizing adolescent service use and addressing misinformation through community and peer networks.
Objectives To reinterpret mixed-methods data from adolescents in Uganda using Cognitive Dissonance Theory to examine the gap between positive attitudes and sexual and reproductive health service use, identify strategies sustaining non-use, and propose strategies to increase utilization.
Methods This secondary analysis used data from a convergent mixed-methods study in Bugweri and Iganga districts. The quantitative component included 408 adolescents aged 13–19 and assessed health-seeking attitudes and uptake of 12 sexual and reproductive health services using descriptive statistics, ordered logistic regression, and structural equation modeling. Four focus group discussions with 38 adolescents were reanalyzed using directed content analysis. Social norms were explored qualitatively through anticipated provider/community judgment, stigma, peer influence, misinformation, and preferred information sources rather than a dedicated quantitative norms scale.
Results Despite favorable attitudes, 52.5% reported no sexual and reproductive health service use in the previous year, and mean uptake across services was 1.68 on a five-point scale. Favorable attitudes predicted past utilization (coefficient=0.910, p<.001) and future intentions (coefficient=1.976, p<.001), but attitudes alone explained relatively little behavior. Qualitative findings identified avoidance due to anticipated judgment and confidentiality concerns, rationalization through misinformation, and selective information-seeking from peers. Conclusions: Positive attitudes alone are insufficient to increase service use. Interventions should reduce access barriers, normalize adolescent service use through community norm campaigns, counter misinformation, provide immediate opportunities for service access, and target working and rural adolescents.
Norms Addressed
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