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STI Disclosure Self-Efficacy in Adolescent Females

L. Lowery, B. Glass, P. Parham, & J. Ellen Johns Hopkins University School of Medicine Division of General Pediatrics and Adolescent Medicine. STI Disclosure Self-Efficacy in Adolescent Females. Background. Adolescents are at higher risk for STIs Disclosure integral part of STI counseling

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STI Disclosure Self-Efficacy in Adolescent Females

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  1. L. Lowery, B. Glass, P. Parham, & J. Ellen Johns Hopkins University School of Medicine Division of General Pediatrics and Adolescent Medicine STI Disclosure Self-Efficacyin Adolescent Females

  2. Background • Adolescents are at higher risk for STIs • Disclosure integral part of STI counseling • Variable rates of disclosure • Disclosure may lead to decrease STI • Previous literature • Self-efficacy, barriers to disclosure, partner type • Correlated with disclosure and intent to refer partner

  3. Correlates of Disclosure • Individual-level factors • Self-efficacy • Perceived barriers • STI-related stigma • History of an STI • Relationship-level factor • Type of sex partner- Main vs. Casual

  4. Self-Efficacy • A person’s belief about their capacity to perform a specific behavior/task in a specific situation • Higher levels correlated • Intention for less risky health behaviors • Partner notification

  5. Stigma • An undesirable attribute in a person that is viewed as setting that person apart from the rest of society • Affected STI-related health care seeking • Perceived reactions to disclosure to health care providers • Concern cited by females after diagnoses

  6. Objectives • To describe self-efficacy, perceived barriers, and STI-related stigma in sexually experienced adolescent females • To describe whether partner type and history of an STI influence attitudes around self-efficacy, perceived barriers, and STI-related stigma

  7. Hypotheses • Adolescent females with a history of an STI have less self-efficacy, perceive more barriers and perceive higher STI-related stigma • Adolescent females have more self-efficacy and perceive more barriers related to disclosure to a main partner compared to a casual partner

  8. Design • Cross-sectional study • One time face to face interview • Recruited adolescent females participating in larger ongoing longitudinal study • Eligibility for study • 14-19 years old at entry into longitudinal study • English speaking • Living within the local metropolitan area • Vaginal or anal sex within the preceding 6 months

  9. Measures • Individual Characteristics • Age • Self-efficacy for disclosure • Perceived barriers to disclosure • STI-related stigma • Partner Type • Mainvs. Casual

  10. Self-Efficacy • Belief about capacity to disclose an STI to a sex partner in specific situations • Nine items • Adapted from Fortenberry et al.1997 & Nuwaha et al.2001 • Main/Casual specific- Sample Items • “How confident are you that you could tell your main partner(s) that you had an STD?” • “How confident are you that you could tell your casual partner(s) that you had an STD?”

  11. Barriers to Disclosure • Eight items assessing partner-specific barriers to disclosure • i.e. violence, ending the relationship, blame for the infection, concern of partner treatment, disclosure of infection to others • Adapted from Nuwaha et. al • Main/Casual specific- Sample Items • “If I told my main partner(s) that I had an STD, he would break up with me.” • “If I told my casual partner(s) that I had an STD, he would break up with me.”

  12. Stigma • Assess how stigmatizing she believed having an STI would be for her in the context of her relationship with her sex partner • Six items • Adapted from Cunningham et al. • Sample Item • “If I had an STD, my sexual partner(s) would think that I was unclean.”

  13. STI History • Described as either • STI at baseline of longitudinal study • Incident STI during longitudinal study prior to being enrolled in this study

  14. Participants • N= 140 • Mean age: 20.2 years (SD=1.3) • History of an STI 120/139= 86% • African American females that lived in urban area

  15. Scales

  16. History of STI & Individual Level Characteristics

  17. Comparison of Main vs. Casual

  18. Summary • History of an STI • Lower level of self-efficacy for disclosure for casual partners • Lower level of perceived barriers for casual partners • STI-related stigma was not associated with a history of an STI • No difference in means for partner types

  19. Limitations • Generalizability • Instrument not previously validated

  20. Conclusion • Adolescents had a moderate level • Self-efficacy • Perceived Barriers • History of STI not associated with stigma • Potential normalization of having STI • Lack of difference • May relate to rapid serial monogamy among adolescents

  21. Policy Implications • Better understanding of self-efficacy related to disclosure, barriers to disclosure, and STI-related stigma • Programs to improve disclosure by affecting self-efficacy; disclosure and partner referral; and decreasing STI-related stigma

  22. Acknowledgements Special Thank You to Shang-en Chung, ScM and Omolara Olaniyan, MD

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