Sexual Health Practices Self-Efficacy Scale

Abstract

The Sexual Health Practices Self-Efficacy Scale (SHPSES) is a comprehensive, 20-item psychometric instrument designed to evaluate an individual's perceived self-efficacy—defined as the integration of knowledge, behavioral skills, and subjective comfort—in executing essential sexual health practices. Developed by Patricia Barthalow Koch, Clinton Colaco, and Andrew W. Porter at The Pennsylvania State University, the instrument operationalizes the holistic conceptualization of sexual health advanced by the World Health Organization (WHO). Rather than restricting measurement solely to disease prevention or contraceptive compliance, the SHPSES assesses a broad behavioral domain through six empirically validated subscales: Sexual Relationships (5 items), Sexual Health Care (4 items), Sexual Assault (3 items), Safer Sex (4 items), Sexual Equality/Diversity (3 items), and Abstinence (1 item). Respondents rate their perceived confidence across items on a 5-point Likert-type scale ranging from 1 (Not at all Confident) to 5 (Extremely Confident), yielding total composite scores between 20 and 100.

Psychometric evaluation based on a normative cohort of 1,200 university students demonstrated strong internal consistency, characterized by an overall scale Cronbach's alpha of .89 and subscale coefficients ranging from .71 to .82. Construct and factorial validity were verified through principal component analysis (PCA) with varimax rotation, extracting a six-factor structure accounting for 65.9% of the total cumulative variance. The scale exhibits robust criterion-related and known-groups validity, successfully differentiating students completing targeted sexuality education coursework from controls, and significantly predicting both prospective safer-sex intentions and retrospective sexual risk-reduction behaviors. The SHPSES serves as a foundational measurement tool for health psychologists, public health researchers, sexologists, and clinical interventionists evaluating sexual health promotion programs across adolescent and adult populations.

Keywords

Sexual Health Practices Self-Efficacy Scale, SHPSES, self-efficacy, sexual health, Albert Bandura, social cognitive theory, safer sex, sexual assault prevention, sexual communication, psychometrics

Authors

The Sexual Health Practices Self-Efficacy Scale was conceptualized, developed, and psychometrically validated by researchers affiliated with the Department of Biobehavioral Health at The Pennsylvania State University:

• Patricia Barthalow Koch, Ph.D.: Professor of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802. Email: [email protected]. Dr. Koch is an acclaimed sexuality educator, researcher, and Fellow of the Society for the Scientific Study of Sexuality (SSSS).
• Clinton Colaco, M.S.: Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA.
• Andrew W. Porter, Ph.D.: Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA.

Purpose

The primary purpose of the Sexual Health Practices Self-Efficacy Scale (SHPSES) is to quantify an individual's subjective confidence in performing diverse, proactive health behaviors necessary to achieve and sustain sexual well-being. Historically, behavioral measurements in human sexuality focused disproportionately on negative outcomes, pathological states, or narrow clinical end-points, such as frequency of condom use, incidence of sexually transmitted infections (STIs), or rates of unintended pregnancy. Grounded in the broader public health paradigms established by the Pan American Health Organization (PAHO) and the World Health Organization, the SHPSES was formulated to capture sexual health as a multifaceted continuum encompassing physical, emotional, relational, and sociocultural competence.

Measurement Dimensions and Target Rationale

The instrument operationalizes behavioral self-efficacy not merely as theoretical knowledge or technical competence, but as the triadic integration of:

1. Knowledge: Cognizance of facts, biological mechanisms, risk factors, and procedural steps.
2. Skills: Behavioral dexterity, interpersonal communication capabilities, and technical execution.
3. Comfort: Affective ease, lack of inhibitory anxiety, and psychological readiness to execute the behavior in real-world interpersonal contexts.

By measuring self-efficacy across this triadic nexus, the SHPSES captures why individuals who possess accurate sexual health information may still fail to execute protective or health-promoting actions when confronted with emotional tension, partner resistance, or social embarrassment.

Clinical and Research Applications

The SHPSES was designed for versatile utilization across clinical, educational, epidemiological, and intervention contexts:

• Educational Program Evaluation: The scale functions as an outcome metric for secondary school and collegiate sexuality education programs. By measuring baseline and post-intervention self-efficacy, curriculum designers can evaluate whether pedagogical strategies translate into practical behavioral confidence.
• Clinical Assessment and Psychotherapy: In sexual and relationship therapy, the instrument helps clinicians identify specific domains where a client experiences acute performance deficits or communicative avoidance, such as negotiating safer sex, addressing sexual dysfunction, or discussing personal sexual history.
• Public Health and Epidemiological Research: Health psychologists utilize the scale to evaluate structural disparities, gendered differences in agency, and the psychosocial determinants of HIV/STI transmission.
• Interpersonal Violence Prevention: The inclusion of dedicated sexual assault prevention and response items enables campus health administrators and assault crisis advocates to assess students' readiness to mitigate high-risk situations, cope with trauma, and offer peer bystander support.

Psychological Construct

The SHPSES measures the psychological construct of domain-specific self-efficacy within the sphere of human sexual behavior. Originating within cognitive and behavioral psychology, self-efficacy refers to an individual's subjective belief in their capabilities to organize and execute the courses of action required to manage prospective situations. The scale treats sexual health practices self-efficacy not as a static, global personality trait, but as a contextualized, malleable constellation of competencies distributed across six primary behavioral dimensions.

1. Sexual Relationships (5 Items)

This subscale evaluates an individual's agency in establishing, maintaining, and navigating intimate relational dynamics. The dimension assesses the communicative competence required to discuss personal sexual histories with prospective partners (Item 8), address sensitive relationship conflicts (Item 13), and discuss potential or existing STIs (Item 12). Furthermore, it measures the capacity to foster an emotionally and physically fulfilling sexual bond (Item 7) and navigate sexual functioning difficulties, such as premature ejaculation or orgasmic dysfunction (Item 14). This dimension recognizes that interpersonal intimacy requires communicative transparency and collaborative coping.

2. Sexual Health Care (4 Items)

The Sexual Health Care dimension assesses proactive healthcare-seeking agency, capturing clinical behaviors that reduce disease burden. Specific behaviors include performing routine bodily surveillance via breast or testicular self-examinations (Item 1), seeking and completing laboratory testing for STIs (Item 2) and HIV (Item 3), and articulating concerns directly to healthcare professionals (Item 4). Self-efficacy in this domain requires individuals to overcome medical mistrust, stigma, and procedural anxiety in clinical encounters.

3. Sexual Assault (3 Items)

This dimension addresses confidence in navigating the spectrum of interpersonal sexual violence. It encompasses primary prevention—the ability to identify and preemptively de-escalate potential sexual assault environments (Item 15); tertiary self-care—the psychological efficacy to handle the medical, psychological, and legal aftermath if one is victimized (Item 16); and prosocial bystander intervention—the behavioral and emotional readiness to provide supportive crisis aid to an assaulted peer (Item 17).

4. Safer Sex (4 Items)

The Safer Sex subscale focuses on disease-preventive and contraceptive behaviors within partner encounters. It measures technical self-efficacy in applying external condoms (Item 9), using non-barrier contraception such as hormonal oral contraceptives or intrauterine devices (Item 10), and the communicative negotiation required to secure mutual adherence to safer-sex practices under conditions of interpersonal pressure (Item 11). Additionally, it encompasses global decision-making self-regulation regarding personal sexual engagement (Item 5).

5. Sexual Equality/Diversity (3 Items)

Reflecting structural and sociocultural facets of sexual wellness, this dimension measures the psychosocial efficacy to reject oppressive norms. It evaluates an individual's perceived capability to actively dismantle gender-based sexual double standards (Item 18), eliminate rigid gender stereotyping in daily life (Item 19), and cultivate an affirming, non-judgmental acceptance of diverse sexual orientations, including heterosexuality, bisexuality, and homosexuality (Item 20).

6. Abstinence (1 Item)

Represented by a single item (Item 6), this dimension measures the perceived agency to choose and sustain voluntary sexual abstinence. Acknowledging that sexual health includes the choice to refrain from sexual behavior, this factor captures an individual's confidence in asserting personal boundaries, resisting coercive or normative relational pressures, and sustaining celibacy when desired.

Theoretical Framework

The theoretical architecture of the SHPSES is grounded in Albert Bandura's Social Cognitive Theory (SCT; Bandura, 1977, 1986, 1997). Central to SCT is the principle of triadic reciprocal causation, which posits that human functioning is the product of continuous, dynamic interactions between cognitive/personal factors, environmental influences, and behavioral patterns.

Bandura's Self-Efficacy Mechanism

Bandura argued that self-efficacy represents the primary cognitive mediator of human agency. A person's beliefs regarding their capabilities determine whether behavioral actions will be initiated, the degree of effort that will be expended, and how long perseverance will be sustained in the face of obstacles, aversive experiences, or sociocultural friction (Bandura, 1977, 1982). Within SCT, self-efficacy is differentiated from outcome expectations: whereas an outcome expectation is the judgment of the likely consequence that a behavior will produce (e.g., “Using a condom prevents HIV transmission”), self-efficacy is the personal judgment of whether one can successfully enact that behavior under challenging circumstances (e.g., “I am confident I can negotiate condom use with a new partner who resists it”).

Bandura postulated four primary informational sources through which self-efficacy expectations are formed and modified:

• Mastery Experiences: Direct, successful past performance of a behavior provides the most authentic evidence of capability. In the SHPSES, repeated success in discussing sexual health or applying barrier contraception strengthens behavioral self-efficacy.
• Vicarious Experiences: Observing social models successfully execute actions without adverse consequences elevates observers' beliefs in their own capabilities. This process is utilized in comprehensive sexuality curricula through guided role-playing and peer modeling.
• Verbal Persuasion: Social encouragement, clinical counseling, and educational coaching convince individuals that they possess the capabilities to master challenging activities.
• Physiological and Emotional States: Individuals interpret somatic arousal, tension, and visceral discomfort as signs of vulnerability. By integrating subjective comfort into the definition of confidence, the SHPSES explicitly accounts for the dampening effect that autonomic anxiety exerts on perceived efficacy.

Integration with Health Behavior Models

The SHPSES also aligns with classic health behavior change paradigms that incorporate self-efficacy as an essential construct:

• The Health Belief Model (HBM): In the expanded HBM (Strecher et al., 1986), perceived susceptibility, severity, and benefits of action are insufficient to prompt protective health behaviors unless coupled with adequate self-efficacy to surmount perceived barriers.
• The Transtheoretical Model (TTM): Prochaska and DiClemente's Stages of Change framework identifies self-efficacy as a primary driver facilitating progression from Precontemplation and Contemplation into Action and Maintenance (DiClemente & Peterson, 1994).
• Information-Motivation-Behavioral Skills (IMB) Model: Developed specifically for sexual risk reduction by Fisher and Fisher, the IMB model identifies behavioral self-efficacy as the proximal determinant of preventive behavioral execution.

Validity

The psychometric validation of the SHPSES was conducted through extensive methodological procedures utilizing a developmental sample of 1,200 undergraduate students attending a major public research university in the northeastern United States between 2004 and 2008 (Koch, 2009).

Content Validity

Content validity was established through systematic curricular analysis. The scale developers conducted an exhaustive review of the sexual health content across 10 leading human sexuality university textbooks and analyzed the syllabi of 20 distinct undergraduate human sexuality courses taught across varied collegiate institutions in the United States. From this qualitative synthesis, an initial item pool was generated. This pool was subsequently submitted to an expert panel consisting of three independent sexuality researchers and educators who evaluated the items for clinical relevance, clarity, comprehensiveness, and redundancy, finalizing the 20-item instrument.

Construct and Factorial Validity

Construct validity was examined through exploratory factor analysis of the 1,200 validation surveys. Principal component analysis (PCA) with orthogonal varimax rotation and Kaiser normalization extracted six factors with eigenvalues greater than 1.0, converging in six iterations. These factors aligned with the proposed theoretical domains, explaining a combined 65.9% of the total variance:

• Factor 1: Sexual Relationships: Accounted for 15.4% of the explained variance, grouping items related to relational communication, intimacy, and managing sexual dysfunction.
• Factor 2: Sexual Health Care: Accounted for 13.4% of the variance, indexing self-examination, clinical testing, and healthcare communication.
• Factor 3: Sexual Assault: Accounted for 11.2% of the variance, clustering assault prevention, crisis management, and peer assistance.
• Factor 4: Safer Sex: Accounted for 10.1% of the variance, capturing contraceptive practices, condom use, and boundary negotiation.
• Factor 5: Sexual Equality/Diversity: Accounted for 10.0% of the variance, uniting items concerning gender double standards, stereotyping, and orientation acceptance.
• Factor 6: Abstinence: Accounted for 5.8% of the variance as a discrete single-item factor measuring self-efficacy in voluntary celibacy.

Known-Groups Validity

The SHPSES demonstrated known-groups validity by distinguishing between populations with differential exposure to comprehensive sexuality training. Koch (2009) demonstrated that university students who completed an academic course in human sexuality scored significantly higher on the SHPSES (total and subscale scores) compared to matched controls enrolled in non-health-related collegiate courses (p < .001).

Predictive and Convergent Validity

Criterion-related predictive validity was documented in empirical research conducted by Millstein (2006) among a sample of students at a major northeastern community college. Baseline scores on the SHPSES demonstrated significant positive correlations with participants' prospective intentions to practice safer-sex behaviors over the subsequent month. Furthermore, higher SHPSES scores demonstrated significant convergent validity by positively correlating with self-reported enactments of safer-sex practices during the preceding 30-day period.

Reliability

The internal consistency of the SHPSES was evaluated using the 1,200-student validation dataset (Koch, 2009). The total 20-item scale demonstrated high overall internal consistency, yielding a Cronbach's alpha coefficient of .89, well above the conventional .70 and .80 thresholds for research and screening tools.

Subscale Internal Consistency

Reliability analyses performed across the multi-item subscales revealed consistent internal coherence:

• Sexual Relationships (5 items): Cronbach's α = .82
• Sexual Health Care (4 items): Cronbach's α = .81
• Sexual Assault (3 items): Cronbach's α = .78
• Safer Sex (4 items): Cronbach's α = .71
• Sexual Equality/Diversity (3 items): Cronbach's α = .73
• Abstinence (1 item): Not applicable; as a single-item indicator, internal consistency reliability via Cronbach's alpha cannot be computed.

The subscale alphas between .71 and .82 demonstrate balanced homogeneity without item redundancy, indicating that each subscale reliably measures a distinct facet of sexual health practices self-efficacy.

Factor Analysis

The structural framework of the SHPSES was derived using exploratory factor analysis (EFA) via Principal Component Analysis (PCA) on data collected from the 1,200 respondents. Orthogonal varimax rotation with Kaiser normalization was chosen to maximize the variance of the squared loadings across components, facilitating interpretability of the latent dimensions.

Component Extraction and Variance Distribution

The factor extraction process yielded a clean, six-component structure that converged in six iterations. The cumulative variance accounted for by the six-factor solution reached 65.9%, distributed across the factors as follows:

Theoretical Consistency of Factor Loadings

The PCA supported the conceptual independence of communication, healthcare navigation, and personal prevention. Notably, items involving interpersonal dialogue with a partner concerning health or relationship challenges (Items 12 and 13) loaded onto Sexual Relationships rather than Safer Sex or Sexual Health Care. This distribution indicates that respondents view interpersonal partner communication as a facet of relational intimacy rather than clinical risk avoidance. Concurrently, technical implementation items (condom usage, alternative birth control methods) grouped cleanly onto Safer Sex.

Instrument / Measurement Tool

• Instrument Name: Sexual Health Practices Self-Efficacy Scale (SHPSES)
• Original Authors: Patricia Barthalow Koch, Ph.D., Clinton Colaco, M.S., and Andrew W. Porter, Ph.D. (The Pennsylvania State University)
• Assessment Type: Self-report psychometric rating scale / behavioral self-efficacy questionnaire
• Item Count: 20 items
• Factor/Subscale Structure:
  • Sexual Relationships: Items 7, 8, 12, 13, 14 (5 items)
  • Sexual Health Care: Items 1, 2, 3, 4 (4 items)
  • Sexual Assault: Items 15, 16, 17 (3 items)
  • Safer Sex: Items 5, 9, 10, 11 (4 items)
  • Sexual Equality/Diversity: Items 18, 19, 20 (3 items)
  • Abstinence: Item 6 (1 item)
• Response Format: 5-point Likert-type scale:
  • 1 = Not at all Confident
  • 2 = Slightly Confident
  • 3 = Moderately Confident
  • 4 = Highly Confident
  • 5 = Extremely Confident
• Administration Time: Approximately 5 minutes
• Scoring Procedures:
  • Total scale scores are calculated by summing the numerical ratings across all 20 items (range: 20 to 100).
  • Subscale scores are derived by summing the corresponding item responses: Sexual Relationships (5–25), Sexual Health Care (4–20), Sexual Assault (3–15), Safer Sex (4–20), Sexual Equality/Diversity (3–15), and Abstinence (1–5).
  • Mean domain scores may also be computed by dividing subscale sums by their respective item count, maintaining an intuitive 1 to 5 metric.
  • Higher scores represent greater perceived self-efficacy (knowledge, skill, and comfort) to perform healthy sexual practices. No items require reverse-scoring.
• Target Population: Adolescents and adults across diverse gender, cultural, and sexual orientation backgrounds.

Permissions & Fee and Test Year

The Sexual Health Practices Self-Efficacy Scale (SHPSES) was developed between 2004 and 2008 and formally presented at international scientific conferences in 2009 by Dr. Patricia Barthalow Koch at the World Congress for Sexual Health in Gothenburg, Sweden. The scale is protected under academic copyright held by the primary authors and The Pennsylvania State University.

The SHPSES is accessible free of charge for non-commercial academic research, pedagogical evaluation, and public health assessment purposes. Researchers and practitioners seeking to employ, adapt, or digitize the instrument should direct correspondence and permission inquiries to the primary author:

Patricia Barthalow Koch, Ph.D., Professor of Biobehavioral Health
The Pennsylvania State University
304B Health and Human Development Building East
University Park, PA 16802
Email: [email protected]

References

• 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. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122–147. https://doi.org/10.1037/0003-066X.37.2.122
• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman.
• DiClemente, R. J., & Peterson, J. L. (Eds.). (1994). Preventing AIDS: Theories and methods of behavioral interventions. Springer. https://doi.org/10.1007/978-1-4899-1193-3
• Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). Jossey-Bass.
• Koch, P. B. (2009, June). Promoting positive sexual health practices for university students: What works? [Conference presentation]. World Congress for Sexual Health, Gothenburg, Sweden.
• Millstein, S. (2006). The effects of a human sexuality course on students' confidence to engage in healthy sexual practices [Unpublished doctoral dissertation]. Widener University, Philadelphia, PA.
• Pan American Health Organization & World Health Organization. (2000). Promotion of sexual health: Recommendations for action. PAHO/WHO. http://new.paho.org/hq/index.php?option=com_content&task=view&id=847&Itemid=1047
• Sexuality Information and Education Council of the United States. (2009). Position statements. SIECUS. http://www.siecus.org/index.cfm?pageId=494
• Strecher, V. J., DeVellis, B. M., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13(1), 73–92. https://doi.org/10.1177/109019818601300108
• World Association of Sexual Health. (2008). Sexual health for the millennium. WAS. http://www.worldsexology.org
• World Health Organization. (2009). Working definition of sexual health. WHO. http://www.who.int/reproductive-health/gender/sexual_health.html

13. Items of the Scale (Questionnaire)