The Relationship between Knowledge, Intention and Self-Reported Use of Safer Sex Practices among Youth Aged 20-24 Years in Selected Districts in Botswana

Saturday, 7 November 2015

Mophuthi Liwambano, BNSc, RM, RN
School of Nursing, University of Botswana, Gaborone. Botswana, Gaborone, Botswana

     The youth aged 20-24 years account for 38% of the population in Botswana. (Adolescent Sexual Reproductive Health[ ASRH] Implementation Strategy, 2012-2016).The youth remain at increased risk of sexually transmitted infections (STIs), unintended pregnancies and increased fertility. Limited condom and other contraceptive use amongst this age group are prevalent despite their reported high knowledge of safer sex practices. (ASRH Implementation Strategy, 2012-2016).

     In a bid to respond to the International Conference on Population and Development’s Plan of Action (ICPD PoA, ICPD+5) of 1994 and 1999 respectively, the Millennium Development Summit, year, 2000 and the International Planned Parenthood Federation (IPPF) Maputo Plan of Action, the Botswana government placed various strategies in place. One common goal for these major strategic frameworks is the universal access to comprehensive Sexual Reproductive Health Services for all by 2015(Development Research and Policy Analysis Division, 2003). To this end Botswana incepted guidance and counseling in primary and secondary school curricula. The goal was to give students basic knowledge on issues of sexuality including, contraceptive use (Bennell, Hyde and Swainson, 2002).  Another strategy was integration and delivery of free Sexual and Reproductive Health and Rights (SRHR) services through the National SRHR Programme using a right based approach to scale up accessibility of SRHR services. This approach places SRHR services as a fundamental human right that facilitates free access of services by all (Ministry of Health, 2004).

     Various partnerships were engaged and documents were developed as guiding tools for the Botswana SRHR care delivery. such documents included amongst others; the National  Youth Policy, 1996, the Population Policy, 1997, the National Sexual and Reproductive Health Framework, 2002 and the Adolescent Sexual and Reproductive Health (ASRH) Implementation Strategy, 2003 (ASRH Implementation Strategy, 2012-2016). Amidst these strategic developments, an age specific fertility reflected  increased fertility rate and limited contraceptive use amongst Botswana youth aged 20-24 years (Central Statistics Office, 2009; Central Statistics Office and UNICEF, 2009), especially in rural than urban areas (Central Statistics Office, 2009; Central Statistics Office and UNICEF, 2009). This is despite the youth’s reported high knowledge and access to contraceptives (ASRH Implementation Strategy, 2012-2016).

    Though the general fertility rate in Botswana has dropped following implementation of the planned global strategies, an age specific fertility rate reflected increased fertility amongst age group 20-24 years (Abt Associates South Africa. Inc., 2002 and Central Statistics Office, 2009). This is despite reported 97% knowledge amongst the youth of at least one method of contraception and where to get it (ASRH Implementation Strategy, 2012-2016).  An assessment of knowledge and use of family planning also revealed knowledge of at least one method of contraception and use by participants across all age groups and gender. There was no data on dual protection or abstinence (Central Statistics Office, 2009).

    Childbearing in Botswana also starts as early as ages 15 -19 years and reaches peak by age 20-24 years (Central Statistics Office, 2009).  In most instances the pregnancies were unplanned or unintended. Limited condom and contraceptive use is reported to remain a reality among adolescents and youth in Botswana (ASRH Implementation Strategy, 2012-2016).  Occurrence of unprotected sex reflects increased risk of STIs and most of the records in health facilities reflect youth as the most common beneficiaries of STI treatment in Botswana. Population Services International ( PSI,2008) found high levels of STI among youth, both males and females reported concurrent and multiple sex partners in previous months. 

     The purpose of this study is to explore and describe the relationship between knowledge, intention and use of safer sex practices among youth aged 20-24 years in selected districts in Botswana. This is to identify gaps and guide appropriate interventions to promote safer sex practices amongst youth.

      The reported high knowledge of safer sex practices amongst youth in Botswana raises an assumption that it will correlate with increased use hence increased level of prevention of sexual risk.  The outcome behavior shows the contrary as it reflects limited contraceptive use and increased age specific fertility amongst this population (ASRH Implementation Strategy, 2012-2016; Central Statistics Office, 2006). This therefore reflects that the reported high knowledge is not translated in to practice. It is hence imperative to explore and describe the knowledge of safer sex practices that the youth are reported to have. The relationship between knowledge, intention to use safer sex practices and the reported actual use of safer sex practices will be determined. The studies that have reported on correlates or predictors of knowledge are more focused on HIV/AIDS knowledge only and  do not explicitly reflect other sexual reproductive health risks like increased fertility and STIs, e.g. Letamo (2011), Fako, Kanagara and Forcheh (2010).This  study will therefore identify  how knowledge, intention and actual self-reported use  interrelate to influence outcome behavior of youth in Botswana. 

The findings will be utilised to;

Guide Nursing Practice:The information will assist practitioners to identify specific problem areas hence develop relevant plan of action to promote adequate, consistent and correct contraceptive use and reduce the risk of unintended pregnancies and STIs amongst the population of youth aged 20 – 24 years in Botswana at health facility level.

Inform Policy and Programme Planning: The research will inform the existing strategies aimed at scaling up the sexual and reproductive health programmes for youth in Botswana. It will assist identify gaps in the existing strategies and hence guide programme policy planning and implementation through generation of appropriate protocols.

Research: This study will generate hypothesis for further research in the area to explore relationships on a larger scale regarding; factors that affect the youth’s knowledge, intention and use of safer sex practices and  provide  information that can benefit policy, education and practice.

Education:The findings will contribute to curriculum review to enhance teaching and learning through evidence based practice. This will benefit the National Sexual Reproductive Health Unit in their bid to scale up training of health personnel and the community on Sexual Reproductive Health issues with emphasis on youth.

      The Integrated Behavioral Model (IBM), also known as Integrative Model of Behavior Prediction (Montano and Kaspersky, 2008) will be used to explore and describe the youth’s knowledge and intention to use safer sex practices. IBM  considers correctness of knowledge  crucial for it to be able to influence a positive behavioral outcome and that the most determinant factor of performing a behavior  is intention. Triandis (1980) stated that, even if a person has intention to perform a behavior, they  require knowledge and skill to perform such behavior and that performance of behavior depends on absence of environmental barriers. The socio-demographic facilitators and barriers are  likely to influence knowledge, intention and the actual use hence  it is imperative for the researcher to determine the interactions of these components in health behavior planning and implementation (Montano and Kasprzyk, 2008) which is also the case in this study,

     The study will be a triangulation design (convergence model) consisting of cross-sectional survey with interpretive integration. Participants will be youth aged 20-24 years in selected settings in Botswana. They will be selected through purposive sampling based on selection criteria. Permissions will be sought from the Ministry of Health and Ministry of Education and Skills Development. Participants will be recruited from tertiary institutions and youth centers by trained recruiters and they will sign a written informed consent. Data will be collected at the point of recruitment.  Participants will complete a self-administered questionnaire for demographic and survey data.

      Descriptive statistics, cross- tabulation and multiple regression analysis will be used to determine the relationship between knowledge, intention and self-reported use of safer sex practices, and some demographic variables to determine predictors for intention and the use of safer sex practices. Qualitative data will be content analyzed to identify major themes, subthemes and related categories. The results will be presented in tables and narrative thematic descriptions.