Key Social Norms Take-aways This study reinforces the importance of beliefs about what others expect and approve of as key predictors of condom use intentions among adolescents in sub-Saharan Africa. The findings highlight that in collectivist settings, social approval from peers and family may exert a stronger influence than individual attitudes. The results suggest that social norms, particularly those relating to gender roles and decision-making, are deeply embedded and can undermine intentions even when adolescents hold positive beliefs about condom use.
Objectives The study aimed to test whether attitudes, subjective norms, and self-efficacy predicted adolescents’ intentions to use condoms and actual condom use over time, and to assess whether these predictors function similarly across three different sub-Saharan African contexts.
Methods The study used longitudinal survey data from 1,166 sexually active students aged 11–18 across 38 schools in Cape Town (South Africa), Dar es Salaam (Tanzania), and Mankweng (South Africa). Structural equation modeling was employed to test the theory of planned behavior across these sites. Measurements included attitudes toward condoms, subjective norms, self-efficacy, intentions, and reported condom use at baseline and after six months.
Results Intentions to use condoms were predicted by subjective norms and self-efficacy in all three sites. Attitudes were only predictive in Cape Town and Mankweng but not in Dar es Salaam. The strength of the relationship between intention and actual condom use was significantly higher in Cape Town, where adolescents also reported higher self-efficacy and more supportive social norms. Across sites, girls reported lower confidence, fewer supportive norms, and weaker intentions to use condoms, suggesting that gendered norms limit agency. Only a small portion of actual condom use was explained by intentions, implying that environmental and contextual barriers—such as stigma, gender power dynamics, and access—may obstruct the translation of intentions into behavior.
Conclusions The theory of planned behavior offers a moderate but context-dependent explanation of condom use among adolescents in sub-Saharan Africa. The role of subjective norms is especially critical in settings where collective values dominate, but structural and cultural factors must also be addressed. The study concludes that future interventions should not only target individual beliefs but also tackle broader social and environmental constraints, incorporating social norms change strategies to be effective in influencing sexual and reproductive health behaviors.