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Health Educ Res. 1998 Sep;13(3):317-30.

Towards a psycho-social theoretical framework for sexual health promotion.

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  • 1MRC Medical Sociology Unit, Glasgow, UK.


Numerous interventions have been designed to promote safer sexual behaviour amongst young people. However, relatively few have proved effective, which is, at least partially, due to the lack of development of theoretically based programmes. An understanding of the origins and control of sexual behaviour can be derived from basic social science research. Unless this is applied to the design of behaviour-change programmes they are unlikely to target the most important determinants of young people's sexual behaviour and are, therefore, unlikely to be effective. This paper outlines some of the key theoretical insights which have been drawn upon in the development of a new sex education programme currently being tested in Scottish schools. The theoretical basis is intentionally eclectic, combining social psychological cognitive models with sociological interpretations, since we are not concerned to advance any particular theory but to find which are most useful in promoting sexual health. First, the social influences on sexual behaviour are considered, and then the way in which these translate into individual perceptions and beliefs. Finally, the paper attempts to develop a theoretical understanding of sexual interaction and the social contexts of sexual behaviour.


Numerous interventions have been designed to promote safer sexual behavior among young people, yet few have documented effectiveness. In part, this failure reflects a lack of understanding of the psychosocial determinants of young people's sexual behavior. A new sex education program currently being tested in schools in Scotland is addressing this weakness by combining social psychological models with sociological interpretations. The theoretical underpinnings of this program are the notions that sexuality is both learned and gender-specific, that the management of heterosexual relations depends on culturally maintained and individually learned gendered power relations, and that the perception of health risk is culturally defined and varies according to age, gender, and social class. Selection of both cognitions to serve as the targets of sex education programs and specific types of rehearsal and social skills for training requires an analysis of the types of interactions that lead to safe and risky sexual encounters. The most salient cognitions appear to be personal susceptibility to risk, perceived benefits of and barriers to an action, social approval, perceived self-efficacy, and intention formation and context-specific planning.

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