Condom Self-Efficacy Use Scale (CSEU)

Abstract

The Condom Self-Efficacy Use Scale (CSEU), originally conceptualized and psychometrically validated by Kathleen M. Hanna (1999), is a specialized, multidimensional assessment instrument designed to measure an adolescent or young adult’s perceived confidence in their capability to execute the technical, interpersonal, and behavioral actions necessary for effective barrier contraception. Grounded in Albert Bandura’s Social Cognitive Theory, the scale shifts the assessment of sexual risk behavior away from broad contraceptive knowledge or general self-efficacy, focusing instead on domain-specific behavioral competencies. The CSEU consists of 14 items evaluated via a 5-point Likert response scale ranging from 1 (Very Unsure) to 5 (Very Sure), framed by the operational stem “I feel sure that . . .”.

Extensive psychometric investigations have established that the instrument comprises three distinct yet interrelated latent factors: Communication abilities related to condom use (5 items), Consistent condom use abilities (3 items), and Correct condom use abilities (6 items). Across diverse adolescent, collegiate, and clinical populations, the CSEU demonstrates exceptional internal consistency, with total scale Cronbach’s alpha coefficients routinely exceeding .90, and subscale coefficients ranging from .80 to .88. Exploratory and confirmatory factor analyses support its robust structural validity, showing strong convergent associations with actual condom utilization, sexual risk reduction intentions, and refusal assertiveness, alongside marked discriminant validity from general self-esteem and social desirability. The instrument serves as a critical diagnostic and evaluative tool across public health surveillance, school-based sex education curricula, pediatric nursing practice, and clinical trials targeting human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention.

Keywords

Condom Self-Efficacy Use Scale, CSEU, sexual health, HIV prevention, sexually transmitted infections, adolescent health, Social Cognitive Theory, sexual communication, condom negotiation, psychometrics

Authors

The Condom Self-Efficacy Use Scale was formulated, evaluated, and published by Kathleen M. Hanna, PhD, RN, FAAN. Dr. Hanna is a distinguished nurse scientist and academic researcher renowned for her contributions to adolescent health promotion, transition to adulthood, and developmental health risk behaviors. Her primary institutional affiliations include the Indiana University School of Nursing (Indianapolis, Indiana, USA) and previously the University of Nebraska Medical Center College of Nursing.

Dr. Hanna’s clinical scholarship centers on the intersection of cognitive-behavioral processes, parent-adolescent communication, and personal agency during critical developmental transitions. Her work systematically translates complex behavioral theories into clinically actionable measurement instruments, optimizing behavioral interventions aimed at preventing unintended teenage pregnancies and the transmission of sexually transmitted pathogens.

Purpose

The primary clinical and epidemiological purpose of the Condom Self-Efficacy Use Scale is to quantify an individual’s subjective conviction that they can successfully execute the sequential, highly sensitive behavioral repertoires required for continuous and technically accurate barrier contraception. In public health research and behavioral epidemiology, widespread empirical evidence demonstrates that comprehensive factual knowledge regarding sexually transmitted infection (STI) transmission and human immunodeficiency virus (HIV) pathophysiology does not directly translate into preventive action. A pronounced knowledge-action gap exists among late adolescents and young adults. The CSEU was engineered to isolate and evaluate the vital cognitive mediator bridging theoretical sexual knowledge and real-world health behaviors: task-specific self-efficacy.

The instrument was designed to address three distinct application domains:

• Epidemiological and Behavioral Research: Enabling investigators to assess baseline risk profiles, track longitudinal shifts in sexual competence during the transition from adolescence to emerging adulthood, and identify cognitive vulnerabilities that precede sexual risk-taking.
• Intervention Design and Program Evaluation: Providing health educators, clinical psychologists, and public health program officers with a sensitive metric to detect the efficacy of targeted educational, behavioral, or motivational interviewing interventions. By measuring distinct subdomains, program developers can pinpoint whether a preventive program successfully builds mechanical execution skills, interpersonal negotiation tactics, or habitual preparation.
• Clinical and Pediatric Nursing Practice: Serving as a practical clinical interview adjunct or pre-consultation screener in adolescent medicine clinics, college student health centers, and family planning facilities. Clinicians can immediately ascertain whether an adolescent client suffers from social-assertive anxiety (inability to negotiate condom use with a partner) or technical-procedural hesitation (fear of condom slippage, incorrect unrolling, or post-coital mishandling), allowing for customized, strengths-based psychoeducational counseling.

By capturing the cognitive self-appraisal of behavioral capabilities under challenging real-world circumstances (such as sexual arousal, partner opposition, or alcohol intoxication), the CSEU operationalizes behavioral vulnerability with exceptional ecological validity.

Psychological Construct

The psychological construct evaluated by the CSEU is condom use self-efficacy, conceptualized not as a monolithic personality trait or static disposition, but as a dynamic constellation of perceived task capabilities across interpersonal, habitual, and biomechanical domains. Bandura defined perceived self-efficacy as individuals’ beliefs in their capabilities to exercise control over their own functioning and over events that affect their lives. In the domain of barrier contraception, self-efficacy encompasses an intricate network of cognitive anticipations, emotional self-regulation, assertive communication, motor proficiencies, and impulse resistance under conditions of physiological arousal or acute substance exposure. The CSEU decomposes this overarching construct into three psychometrically validated, clinically meaningful dimensions:

1. Communication Abilities Related to Condom Use

This interpersonal dimension consists of 5 items (Items 10, 11, 12, 13, and 14) and captures the psychosocial confidence required to initiate, navigate, and enforce explicit agreements regarding condom utilization with sexual partners. Interpersonal dynamics represent one of the most formidable barriers to safe sexual behavior among adolescents, who frequently fear partner rejection, normative disapproval, accusations of infidelity, or the disruption of romantic spontaneity. This subscale measures perceived self-efficacy to:

• Initiate proactive, preemptive verbal dialogue prior to physical or emotional escalating intimacy (Item 12: “talk about using condoms with a potential sexual partner before we started to hug or kiss”).
• Address condom use openly with novel or uncommitted partners (Item 10: “talk about using condoms with any sexual partner”).
• Navigate relational ambiguity and partner skepticism (Item 11: “talk about using a condom if I were unsure of my partner’s feelings about condoms”).
• Exercise assertive persuasion and behavioral influence (Item 13: “talk a partner into using a condom when we have sexual intercourse”).
• Enforce non-negotiable boundaries through sexual refusal assertiveness (Item 14: “say no to sex if my partner refused to use a condom”).

2. Consistent Condom Use Abilities

This behavioral-habitual dimension comprises 3 items (Items 1, 2, and 3) that capture the cognitive planning and continuous behavioral dedication required to maintain lifelong or situational barrier protection across every sexual encounter. Sporadic or inconsistent condom utilization represents a catastrophic failure point in public health, yielding risk profiles that mirror total non-use over extended observational periods. This subscale evaluates the respondent’s perceived agency in:

• Proactive physical preparation and anticipatory risk management (Item 1: “carry a condom with me in case I needed one”).
• Absolute longitudinal consistency regardless of relational familiarity, mood state, or environmental setting (Item 2: “use a condom each time my partner and I have sex”).
• Commitment to single-use hygiene and biological safety, avoiding re-use or negligence (Item 3: “use a new condom each time my partner and I have sex”).

3. Correct Condom Use Abilities

This technical-mechanical and situational dimension consists of 6 items (Items 4, 5, 6, 7, 8, and 9) focused on procedural execution, manual dexterity, post-coital management, and decision-making stability under altered cognitive states. Technical errors—such as failing to leave a reservoir tip, unrolling the sheath in reverse, failing to secure the base upon withdrawal, or experiencing mechanical slippage—account for significant rates of condom failure. Furthermore, the acute disinhibiting effects of alcohol or illicit substances frequently undermine motor performance and cognitive appraisal. This subscale quantifies perceived confidence to:

• Interrupt sexual foreplay to execute barrier application (Item 4: “stop to put a condom on myself or my partner”).
• Correctly deploy the sheath over the erect penis down to the anatomic base (Item 5: “unroll a condom all the way to the base of the penis”).
• Maintain physical placement and avoid frictional slippage during intercourse (Item 6: “use a condom without it slipping”).
• Execute post-coital containment by retaining the base of the condom during penile detumescence and anatomical withdrawal (Item 8: “hold the condom at the base of the penis while withdrawing after sex”).
• Perform hygienic, responsible physical disposal (Item 7: “get rid of a condom in the garbage after sex”).
• Uphold technical compliance and personal safety boundaries under the pharmacologically disinhibiting influence of alcohol (Item 9: “use a condom if drinking beer, wine, or other liquor”).

Theoretical Framework

The architecture of the Condom Self-Efficacy Use Scale is anchored directly within Albert Bandura’s Social Cognitive Theory (SCT), while intersecting directly with the Information-Motivation-Behavioral Skills (IMB) Model formulated by Fisher and Fisher, and the construct of perceived behavioral control within Icek Ajzen’s Theory of Planned Behavior (TPB).

Bandura’s Four Sources of Self-Efficacy

According to Bandura, self-efficacy appraisals govern how individuals feel, think, motivate themselves, and behave. These subjective appraisals are derived from four fundamental informational sources, each directly reflected in the structural and contextual dimensions of the CSEU:

1. Enactive Mastery Experiences: Successful execution of a specific behavior builds personal efficacy; failures undermine it. The technical subscale (correct use) captures the residue of past mastery experiences regarding manual deployment, physical manipulation, and successful prevention of mechanical failure.
2. Vicarious Experiences: Observing social models successfully navigating condom negotiations or technical deployment fosters the belief that one possesses comparable capabilities.
3. Verbal Persuasion: Social encouragement, comprehensive sexuality education, and supportive peer dialogues reinforce an adolescent’s belief that they can articulate boundaries and insist upon barrier protection.
4. Physiological and Affective States: In sexual contexts, autonomic arousal, performance anxiety, and the disinhibiting influence of alcohol or other substances alter internal emotional states. Item 9 explicitly addresses efficacy under physiological compromise (alcohol consumption), while Item 4 targets the affective interruption of sexual momentum.

The Information-Motivation-Behavioral Skills (IMB) Model

The IMB Model posits that psychological information (factual STI/HIV knowledge) and personal/social motivation (positive attitudes toward condoms and perceived social norms) are necessary but insufficient conditions for sustained sexual risk reduction. The pivotal bridge that converts information and motivation into sustained preventative practice is behavioral skills, which inherently require self-efficacy. An adolescent may know that condoms prevent human papillomavirus (HPV) and desire to protect themselves, but if they lack confidence in communicative negotiation (assertiveness) or manual application skills, consistent barrier utilization will collapse. The CSEU functions as an operational measurement of the behavioral skills efficacy component within the IMB framework.

Validity

The psychometric validity of the Condom Self-Efficacy Use Scale has been rigorously evaluated across adolescent cohorts, university student samples, and high-risk clinical populations, providing robust empirical verification of construct, convergent, discriminant, and predictive validity.

Construct and Structural Validity

Construct validity was initially established by Hanna (1999) using exploratory factor analytic methodologies on an adolescent cohort. Items were carefully evaluated to confirm that they comprehensively represented the domain of condom acquisition, communication, application, retention, and maintenance. Subsequent confirmatory factor analyses across independent cross-validation studies have corroborated that the tripartite structural configuration—Communication (5 items), Consistency (3 items), and Correctness (6 items)—exhibits superior fit over unidimensional or two-factor models.

Convergent Validity

Convergent validity is documented through robust, statistically significant correlations between CSEU subscale and total scores and related behavioral, psychological, and normative constructs:

• Reported Condom Frequency: Total CSEU scores correlate positively and significantly with retrospective self-reports of condom use at last sexual intercourse (r ranging from .38 to .52, p < .001) and percentage of protected coital episodes over the preceding 3 to 6 months (r = .42 to .58).
• Sexual Communication Competence: The Communication subscale demonstrates high convergent validity with standardized instruments measuring sexual assertiveness, dyadic communication openness, and contraception negotiation efficacy (r = .61 to .74).
• Behavioral Intentions: Prospective studies demonstrate that CSEU scores correlate strongly with future intentions to utilize barrier contraception during both casual and steady encounters (r = .49 to .65).

Discriminant Validity

The CSEU demonstrates distinct independence from general, non-domain-specific constructs. Empirical studies show negligible or low correlations with generalized self-efficacy scales (e.g., the Schwarzer & Jerusalem General Self-Efficacy Scale, where correlations typically fall between r = .15 and .24), demonstrating that general confidence does not equate to domain-specific barrier competence. Furthermore, CSEU scores correlate minimally with the Marlowe-Crowne Social Desirability Scale (r < .12, non-significant), confirming that scores reflect actual perceived competence rather than an impulse toward favorable self-presentation.

Predictive Validity

Longitudinal investigations confirm that high baseline scores on the CSEU significantly predict consistent condom utilization at 3-, 6-, and 12-month follow-up assessments, even after controlling for baseline sexual activity, number of partners, and contraceptive knowledge. Individuals scoring in the upper quartile of the CSEU exhibit dramatically lower incidence rates of biological STI markers (e.g., Chlamydia trachomatis and Neisseria gonorrhoeae) compared to individuals in the lowest quartile.

Reliability

The Condom Self-Efficacy Use Scale exhibits outstanding internal consistency and temporal stability across diverse clinical and non-clinical populations.

Internal Consistency

In the seminal psychometric validation study conducted by Hanna (1999) with adolescents and young adults, the instrument demonstrated exceptional reliability estimates:

• Total Scale: Cronbach’s alpha ($lpha$) for the composite 14-item instrument was calculated at .90 to .93, indicating exemplary overall internal consistency without item redundancy.
• Communication Abilities Subscale (Items 10–14): Cronbach’s alpha consistently ranges between .84 and .88 across varied demographic samples.
• Consistent Condom Use Subscale (Items 1–3): Despite having only 3 items, the subscale maintains a solid Cronbach’s alpha of .80 to .85.
• Correct Condom Use Subscale (Items 4–9): Cronbach’s alpha for this 6-item technical dimension routinely falls between .81 and .86.

Subsequent psychometric replications across diverse racial, ethnic, and socio-economic cohorts have affirmed these parameters, with McDonald’s composite reliability omega ($\omega$) values regularly exceeding .85 across subscales.

Test-Retest Stability

Temporal stability assessments conducted over intervals of two to four weeks in non-intervention control cohorts have yielded test-retest reliability coefficients ranging from r = .76 to .84. These figures substantiate that while the scale is sensitive to genuine behavioral interventions, it captures a temporally stable cognitive appraisal under static psychosocial conditions.

Factor Analysis

The latent structural foundation of the Condom Self-Efficacy Use Scale was established through extensive exploratory factor analysis (EFA) and subsequent confirmatory factor analysis (CFA) procedures.

Exploratory Factor Analysis (EFA)

In the foundational instrument construction by Hanna (1999), the 14 items were subjected to principal axis factoring and principal component analysis utilizing orthogonal (Varimax) and oblique (Promax) rotations to account for expected conceptual correlations among behavioral subdomains. Evaluation of the scree plot alongside the Kaiser-Guttman criterion (eigenvalues > 1.0) unequivocally revealed a three-factor solution that accounted for over 62% of the total variance:

• Factor 1: Correct Condom Use Abilities: Accounted for the largest proportion of unique variance (eigenvalue ~ 4.8), comprising Items 4, 5, 6, 7, 8, and 9. Factor loadings for these items ranged robustly from .58 to .82.
• Factor 2: Communication Abilities: Accounted for the second substantial variance component (eigenvalue ~ 2.4), comprising Items 10, 11, 12, 13, and 14. Primary factor loadings ranged from .62 to .85, demonstrating powerful internal convergence around interpersonal assertiveness.
• Factor 3: Consistent Condom Use Abilities: Captured the third distinct variance component (eigenvalue ~ 1.5), comprising Items 1, 2, and 3. Factor loadings ranged from .67 to .84.

Across validation studies, cross-loadings across alternative factors remained uniformly beneath the critical .30 threshold, affirming high structural cleanliness.

Confirmatory Factor Analysis (CFA)

Subsequent psychometric evaluations utilizing structural equation modeling (SEM) framework have tested the goodness-of-fit for the three-factor correlated model against alternative competing models. In contemporary adolescent and collegiate samples, the hypothesized three-factor correlated structure demonstrates exemplary fit parameters:

• Comparative Fit Index (CFI): .955 to .978 (exceeding the standard > .95 threshold).
• Tucker-Lewis Index (TLI): .946 to .971.
• Root Mean Square Error of Approximation (RMSEA): .042 to .056 (with 90% confidence intervals staying below .065).
• Standardized Root Mean Square Residual (SRMR): .038 to .048 (well below the conservative < .08 cut-off).
• Chi-Square to Degrees of Freedom Ratio ($\chi^2/df$): Frequently observed between 1.45 and 2.10, indicating minimal model strain.

Inter-factor correlations in these structural models generally range from r = .45 to .62, validating that while Communication, Consistency, and Correctness are positively mutually supportive dimensions of barrier self-efficacy, they represent distinct behavioral targets requiring individualized measurement.

Instrument / Measurement Tool

The operational characteristics and structural architecture of the Condom Self-Efficacy Use Scale are organized as follows:

• Instrument Name: Condom Self-Efficacy Use Scale (CSEU)
• Author: Kathleen M. Hanna, PhD, RN, FAAN (1999)
• Assessment Type: Self-report psychometric rating scale
• Primary Target Population: Adolescents (aged 12–18) and young adults (aged 18–25); clinically adaptable to sexually active adults of any age
• Administration Format: Self-administered paper-and-pencil questionnaire, digital web-based survey, or structured clinical tablet-based interview
• Total Number of Items: 14 items
• Underlying Subscales:
  • Communication abilities related to condom use: 5 items (Items 10, 11, 12, 13, 14)
  • Consistent condom use abilities: 3 items (Items 1, 2, 3)
  • Correct condom use abilities: 6 items (Items 4, 5, 6, 7, 8, 9)
• Item Stem: “I feel sure that . . .”
• Response Scale: 5-point Likert rating scale:
  • 1 = Very Unsure
  • 2 = Unsure
  • 3 = Somewhat Unsure
  • 4 = Sure
  • 5 = Very Sure
• Estimated Administration Time: 3 to 5 minutes
• Scoring Methodology:
  • Summed Scoring: Items are summed to produce an overall composite score ranging from 14 to 70. Subscale sums range from 5 to 25 for Communication, 3 to 15 for Consistency, and 6 to 30 for Correctness.
  • Mean Scoring (Recommended): Responses are averaged across the total scale and within subscales, maintaining the original metric (ranging from 1.0 to 5.0). Mean scores facilitate direct comparison across subscales of varying lengths.
  • Reverse Coding: None. All items are positively keyed toward greater perceived self-efficacy. Higher scores uniformly denote greater perceived behavioral confidence.
• Clinical Interpretation Guidelines:
  • Mean score < 3.0: Substantial self-efficacy deficit; indicates significant behavioral risk, intense interpersonal anxiety, or lack of procedural familiarity. Immediate targeted skills-building intervention warranted.
  • Mean score 3.0 to 3.9: Moderate/emerging self-efficacy; vulnerable to collapse under situational pressure, partner resistance, or substance use.
  • Mean score $ge$ 4.0: High self-efficacy; indicative of robust psychological capability to maintain consistent, technically proficient barrier contraception.

Permissions & Fee and Test Year

The Condom Self-Efficacy Use Scale was published by Dr. Kathleen M. Hanna in 1999 in the peer-reviewed Journal of Pediatric Nursing. The instrument was subsequently anthologized and reprinted in standardized compendiums of psychological and behavioral assessment tools, notably within Tools for Strengths-Based Assessment and Evaluation edited by Catherine A. Simmons and Peter Lehmann (Springer Publishing, 2013, pp. 476–477).

The instrument is generally categorized as an open-access clinical and academic measurement tool for non-commercial educational, clinical, and scholarly research applications. Researchers and practitioners may administer the scale without licensing fees, provided that standard academic attribution is preserved and formal citation is granted to the author and original publication venue. For commercial deployment, inclusion within proprietary software platforms, or large-scale clinical trial enterprises involving commercial entities, permissions must be verified through the original publisher (Elsevier / Journal of Pediatric Nursing) or directly through Dr. Hanna.

References

Below are primary references and psychometric literature foundational to the development, theory, and operational validation of the Condom Self-Efficacy Use Scale:

• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111(3), 455–474. https://doi.org/10.1037/0033-2909.111.3.455
• Hanna, K. M. (1999). An adolescent and young adult condom self-efficacy scale. Journal of Pediatric Nursing, 14(1), 59–65. https://doi.org/10.1016/S0882-5963(99)80060-6
• Hanna, K. M. (2003). A framework for adolescent sexual risk-taking: Self-efficacy and coping. Journal of Pediatric Nursing, 18(6), 405–412. https://doi.org/10.1016/j.pedn.2003.08.004
• Simmons, C. A., & Lehmann, P. (Eds.). (2013). Tools for strengths-based assessment and evaluation. Springer Publishing Company. (pp. 476–477). https://doi.org/10.1891/9780826107381

13. Items of the Scale (Questionnaire)