Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Degree Program

Nursing, PhD

Committee Chair

Hutti, Marianne

Committee Co-Chair (if applicable)

Crawford, Tim

Committee Member

Crawford, Tim

Committee Member

Hines-Martin, Vicki

Committee Member

Logsdon, M. Cynthia

Committee Member

Theriot, Nancy

Author's Keywords

adolescents; positive deviance; contraception; contraceptive self-efficacy: birth control use


Unintended pregnancy is an issue that impacts women of all ages, ethnicities, and socioeconomic statuses. It also impacts the child that results and the society in which they live. In the United States, adolescents experience unintended pregnancy more than adolescents in other countries. The purpose of this dissertation was to explore the factors that contribute to successful contraceptive use among adolescent females (ages 13-18) seeking reproductive health services at a local family planning clinic. The theoretical framework of contraceptive self-efficacy (CSE) was used to frame this understanding. The exploration was conducted in three ways: a critical review of the literature on contraceptive self-efficacy; an examination of contraceptive self-efficacy in adolescent females seeking reproductive health care services at a local family planning clinic; and a qualitative exploration of adolescent girls who had consistently used birth control for at least one year without the experience of an unintended pregnancy (positive deviants). The critical review of the literature demonstrated that additional research on CSE as a predictor of contraceptive use has the potential to improve contraceptive use among adolescent girls. The Contraceptive Self-Efficacy Scale (CSS) has not been used comprehensively in the past, and further research using the CSS is needed to explore the variance in contraceptive use left unexplained. In the next manuscript, the CSE of adolescent females seeking reproductive health services at a local family planning clinic was evaluated along with the psychometric properties of the CSS. This study showed that CSE is impacted by demographic and medical variables, and is minimally influenced by social desirability. Factor analysis of the CSS suggested additional research is needed to explore the appropriateness of using a shortened version of the CSS. In the final manuscript, the characteristics of positive deviants seeking reproductive health care at a local family planning clinic were examined to determine how they navigate external influences to become successful contraceptive users. Study results revealed that positive deviants have consistent characteristics that assist them in being successful contraceptive users. These characteristics need further exploration. The findings of this dissertation support previous research that has identified the importance of CSE as a variable influencing birth control use. Contraceptive self-efficacy is influenced by demographic and medical variables and the use of the CSS is recommended for future studies of CSE. Additionally, positive deviants in the reproductive health realm have consistent characteristics that, if developed and taught to adolescent girls, may increase their contraceptive use. Interventions aimed at improving CSE among adolescent females and teaching characteristics such as assertiveness, responsibility, and career planning may improve contraceptive use, thus decreasing the unintended pregnancy rates among adolescent and adult females alike.