Exploring condom use decision-making of adolescents: The role of affective and rational processes

Abstract Background Condom use remains the most effective behavioural method for the prevention of HIV and unplanned pregnancies. However, condom use remains inconsistent among young people. Exploring the condom use decision-making processes that adolescent engage in might provide information that would assist in the prevention of many challenges related to poor sexual and reproductive health outcomes. This study, therefore, aimed to explore the factors that influenced decision-making about condom use of adolescents from two schools in the Western Cape, South Africa. Methods A sample of 16 adolescents were selected using stratified random sampling. Data were collected using semi-structured, individual interviews. Thematic analysis was used to analyse the data generated. Results The link between sexual debut and affective processes were frequently discussed in condom use decision-making. Decisions about sexual debut were influenced by the belief that sex was a perceived symbol of ‘true love’ on the one hand, and respect for perceived parental expectations of age-appropriate sex, on the other. Condom use decision-making was shaped by adolescents’ concerns about their future and lack of stability in their lives. Adolescents fears of pregnancy, parenthood and disease shaped their condom use decision-making. It became evident that rational and affective decision-making in condom use choice were not mutually exclusive, but that these processes could happen simultaneously. Conclusions The study highlights the role of affective states as part of the process of examining alternatives when deciding to use a condom or not. Interventions are needed that examine both the role of affective and rational processes as part of the decision-making process to inform adolescent sexual and reproductive health outcomes.