Adolescents' Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms

Elizabeth Kemigisha, Viola N Nyakato, Katharine Bruce, Gad Ndaruhutse Ruzaaza, Wendo Mlahagwa, Anna B Ninsiima, Gily Coene, Els Leye, Kristien Michielsen, Elizabeth Kemigisha, Viola N Nyakato, Katharine Bruce, Gad Ndaruhutse Ruzaaza, Wendo Mlahagwa, Anna B Ninsiima, Gily Coene, Els Leye, Kristien Michielsen

Abstract

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense-i.e., body image, self-esteem, and gender equitable norms-and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10-14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7-28) and median 22 (IQR: 19, 24, possible range: 5-25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11-44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.

Keywords: Uganda; body image; gender norms; self-esteem; sexual health; sexuality; young adolescents.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. World Health Organization (WHO) Report on Sexual Health: Report of a Technical Consultation on Sexual Health 28–31 January 2002, Geneva. World Health Organization; Geneva, Switzerland: 2006.
    1. Ketting E., Friele M., Michielsen K. Evaluation of holistic sexuality education: A European expert group consensus agreement. Eur. J. Contracept. Reprod. Health Care. 2016;21:68–80. doi: 10.3109/13625187.2015.1050715.
    1. Blum R.W., Astone N.M., Decker M.R., Mouli V.C. A conceptual framework for early adolescence: A platform for research. Int. J. Adolesc. Med. Health. 2014;26:321–331. doi: 10.1515/ijamh-2013-0327.
    1. Woog V., Kågesten A. The Sexual and Reproductive Health Needs of Very Young Adolescents Aged 10–14 in Developing Countries: What Does the Evidence Show? Guttmacher Institute; New York, NY, USA: 2017.
    1. Uganda Bureau Of Statistics (UBOS) Uganda National Population and Housing Census 2014. Provisional Results; UBOS; Kampala, Uganda: 2014.
    1. Uganda Bureau Of Statistics (UBOS) ICF . The Uganda Demographics and Health Survey 2016: Key Indicators Report. UBOS; Kampala, Uganda: 2017.
    1. World Health Organization (WHO) Measuring Sexual Health: Conceptual and Practical Considerations and Related Indicators. World Health Organization; Geneva, Switzerland: 2010.
    1. Russell S.T. Conceptualizing positive adolescent sexuality development. Sex. Res. Soc. Policy. 2005;2:4–12. doi: 10.1525/srsp.2005.2.3.4.
    1. Harden K.P. A sex-positive framework for research on adolescent sexuality. Perspect. Psychol. Sci. 2014;9:455–469. doi: 10.1177/1745691614535934.
    1. De Meyer S., Jaruseviciene L., Zaborskis A., Decat P., Vega B., Cordova K., Temmerman M., Degomme O., Michielsen K. A cross-sectional study on attitudes toward gender equality, sexual behavior, positive sexual experiences, and communication about sex among sexually active and non-sexually active adolescents in Bolivia and Ecuador. Glob. Health Action. 2014;7:24089. doi: 10.3402/gha.v7.24089.
    1. Winter V.R., Satinsky S. Body appreciation, sexual relationship status, and protective sexual behaviors in women. Body Image. 2014;11:36–42. doi: 10.1016/j.bodyim.2013.08.004.
    1. Ethier K.A., Kershaw T.S., Lewis J.B., Milan S., Niccolai L.M., Ickovics J.R. Self-esteem, emotional distress and sexual behavior among adolescent females: Inter-relationships and temporal effects. J. Adolesc. Health. 2006;38:268–274. doi: 10.1016/j.jadohealth.2004.12.010.
    1. Goodson P., Buhi E.R., Dunsmore S.C. Self-esteem and adolescent sexual behaviors, attitudes, and intentions: A systematic review. J. Adolesc. Health. 2006;38:310–319. doi: 10.1016/j.jadohealth.2005.05.026.
    1. Blum R.W., Mmari K.N., World Health Organization . Risk and Protective Factors Affecting Adolescent Reproductive Health in Developing Countries. WHO; Geneva, Switzerland: 2004.
    1. Bleidorn W., Arslan R.C., Denissen J.J., Rentfrow P.J., Gebauer J.E., Potter J., Gosling S.D. Age and gender differences in self-esteem—A cross-cultural window. J. Pers. Soc. Psychol. 2016;111:396–410. doi: 10.1037/pspp0000078.
    1. Rosenberg M. Rosenberg Self-Esteem Scale (RSE): Acceptance and Commitment Therapy. Volume 61. Measures Package; University of Wollongong; Wollongong, Australia: 1965. p. 52.
    1. Perry R., Charlotte B., Isabella M., Bob C. SPSS Explained. Routledge; London, UK: 2004.
    1. Cash T.F., Fleming E.C., Alindogan J., Steadman L., Whitehead A. Beyond body image as a trait: The development and validation of the Body Image States Scale. Eat. Disord. 2002;10:103–113. doi: 10.1080/10640260290081678.
    1. Galambos N.L., Petersen A.C., Richards M., Gitelson I.B. The Attitudes toward Women Scale for Adolescents (AWSA): A study of reliability and validity. Sex Roles. 1985;13:343–356. doi: 10.1007/BF00288090.
    1. Rasmussen A.R., Wohlfahrt-Veje C., de Renzy-Martin K.T., Hagen C.P., Tinggaard J., Mouritsen A., Mieritz M.G., Main K.M. Validity of self-assessment of pubertal maturation. Pediatrics. 2015;135:86–93. doi: 10.1542/peds.2014-0793.
    1. Vu L., Pulerwitz J., Burnett-Zieman B., Banura C., Okal J., Yam E. Inequitable gender norms from early adolescence to young adulthood in Uganda: Tool validation and differences across age groups. J. Adolesc. Health. 2017;60:S15–S21. doi: 10.1016/j.jadohealth.2016.09.027.
    1. Jewkes R., Morrell R. Gender and sexuality: Emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J. Int. AIDS Soc. 2010;13:6. doi: 10.1186/1758-2652-13-6.
    1. Rolleri L. Gender Norms and Sexual Health Behaviors. Research FACTs and Findings; ACT for Youth Center of Excellence; Ithaca, NY, USA: 2013.
    1. Bukenya D.L., Pfiffer B. Young Men’s Health in Uganda. Makerere University Columbia University (MUCU) Newsletter; MUCU; Kampala, Uganda: 2015.
    1. Martin C.L., Ruble D.N. Patterns of gender development. Annu. Rev. Psychol. 2010;61:353–381. doi: 10.1146/annurev.psych.093008.100511.
    1. McHale S.M., Crouter A.C., Whiteman S.D. The family contexts of gender development in childhood and adolescence. Soc. Dev. 2003;12:125–148. doi: 10.1111/1467-9507.00225.
    1. Silva R.N.A., van de Bongardt D., Baams L., Raat H. Bidirectional associations between adolescents’ sexual behaviors and psychological well-being. J. Adolesc. Health. 2018;62:63–71. doi: 10.1016/j.jadohealth.2017.08.008.
    1. Bachman J.G., O’Malley P.M., Freedman-Doan P., Trzesniewski K.H., Donnellan M.B. Adolescent self-esteem: Differences by race/ethnicity, gender, and age. Self Identity. 2011;10:445–473. doi: 10.1080/15298861003794538.
    1. Muhanguzi F.K., Ninsiima A. Embracing teen sexuality: Teenagers’ assessment of sexuality education in Uganda. Agenda. 2011;25:54–63.
    1. Muhwezi W.W., Katahoire A.R., Banura C., Mugooda H., Kwesiga D., Bastien S., Klepp K.I. Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda. Reprod. Health. 2015;12:110. doi: 10.1186/s12978-015-0099-3.
    1. Wheeler S.B. Effects of self-esteem and academic performance on adolescent decision-making: An examination of early sexual intercourse and illegal substance use. J. Adolesc. Health. 2010;47:582–590. doi: 10.1016/j.jadohealth.2010.04.009.
    1. Winter V.R. Toward a Relational Understanding of Objectification, Body Image, and Preventive Sexual Health. J. Sex Res. 2017;54:341–350. doi: 10.1080/00224499.2016.1190807.
    1. Taber K.S. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res. Sci. Educ. 2017:1–24. doi: 10.1007/s11165-016-9602-2.
    1. Membrilla J.A.A., Martínez M.C.P. Teenagers’gender differences in self-concept. Anal. Psicol./Ann. Psychol. 2000;16:207–214.
    1. Torres L.H., Mohand M.A.-L., Mohand L.M. Rendimiento escolar y autoconcepto en educación primaria. Relación y análisis por género. Int. J. Dev. Educ. Psychol. Rev. INFAD Psicol. 2017;3:315–326.

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