Impact of educational videos on maternal anxiety caused by children's heart surgery.

BACKGROUND: Mothers of children undergoing surgery for congenital heart disease experience significant stress. Therefore, finding a strategy to decrease this is vital. AIMS: To examine whether adding educational digital video discs to routine education can reduce maternal anxiety and depression when their children undergo heart surgery and when surgical or post-surgical complications occur. STUDY DESIGN: In a teaching hospital, 120 mothers whose children underwent elective heart surgery were randomly and equally divided into two groups: mothers receiving routine education plus a digital video disc before surgery and mothers receiving only routine education. Mothers' anxiety and depression levels were compared before education, after education (before surgery), and on discharge day. The effect of watching the digital video disc on maternal anxiety and depression on discharge day was evaluated for the participants whose children had surgical or post-surgical complications. RESULTS: Compared with only routine education, mothers' anxiety after education and on the discharge day decreased more if digital video disc was added. Depression decreased more after education, but no difference was found on the discharge day. Anxiety levels of mothers whose children had surgical or post-surgical complications on the discharge day decreased more if they watched the digital video disc, compared with those receiving only routine education (Beck anxiety inventory score 3.4 ± 1.9 and 6.1 ± 2.4 respectively; p-value .001). CONCLUSIONS: Compared with only routine education, adding digital video disc could decrease mothers' anxiety, and until the day of discharge. Compared with only routine education, adding digital video disc could decrease mothers' anxiety on the discharge day if their child had surgical or post-surgical complications. RELEVANCE TO CLINICAL PRACTICE: Adding educational digital video disc to routine education could decrease mothers' anxiety until the day of discharge. It could also decrease mothers' anxiety if their child had surgical or post-surgical complications.

Effects of Problem-Based Learning Strategies on Undergraduate Nursing Students' Self-Evaluation of Their Core Competencies: A Longitudinal Cohort Study.

To respond to patients' increasing demands and strengthen nursing professionals' capabilities, nursing students are expected to develop problem-solving skills before they enter the workforce. Problem-based learning (PBL) is expected to provide effective simulation scenarios and realistic clinical conditions to help students achieve those learning goals. This article aims to explore the effects of PBL strategies on nursing students' self-evaluation of core competencies. This longitudinal cohort survey study evaluated 322 nursing students attending Chung Shan Medical University, Taiwan, in 2013 and 2014, where PBL teaching strategies are used in all four undergraduate years from freshman to senior. Based on their undergraduate academic levels, students were categorized into three groups- one-year PBL exposure, two-year PBL exposure, and three-year exposure. A core competency questionnaire was administered twice to ask participants to self-assess five professional competencies: learning attitude, problem identification, information analysis, execution, and life-long learning. The results showed that students with the longest exposure to PBL (Group 3) had higher self-evaluated scores for all core competencies than the other groups, except for the execution competency. The mean total competency score increased by 0.12 points between the pre-and-test. In addition, the mean score increased significantly more in Group 3 than in Groups 1 and 2. These trends were consistent for the information analysis, execution, and life-long learning competencies. In conclusion, the changes in the self-evaluated scores between groups indicate PBL strategies effectively improve nursing students' core competencies. The longest exposure group reported higher self-evaluated core competency scores than the other groups, especially for the information analysis, execution, and life-long learning competencies.

Mental Health Nurses' Tacit Knowledge of Strategies for Improving Medication Adherence for Schizophrenia: A Qualitative Study.

Non-adherence to medication among patients with schizophrenia is an important clinical issue with very complex reasons. Since medication administration is an essential nursing responsibility, improving strategies for patient medication compliance must be fully understood. This study aimed to explore the strategies mental health nurses (MHNs) implement in clinically improving patients with schizophrenia and to describe the nurses' tacit knowledge of application strategies. A qualitative study with purposeful sampling was used. Twenty-five experienced MHNs in a psychiatric hospital in central Taiwan were given an in-depth interview. The texts were content-analyzed using NVivo 12 Pro software. MHNs promote medication adherence among patients with schizophrenia using the following strategies: establishing a conversational relationship, overall assessment of non-adherence to medication, understanding the disease and adjusting the concept of medication, incorporating interpersonal connection feedback, and building supportive resources. This study explored the strategies of MHNs that incorporated knowledge in managing treatment adherence in patients with schizophrenia. The findings add knowledge to clinical nursing practice about medication adherence among patients with schizophrenia.

Effects of Rehabilitation Models on Self-Stigma among Persons with Mental Illness.

Social stigma is inevitable for mentally ill patients, but how patients treat themselves is a priority for rehabilitation and an important buffer mechanism. This study thus aimed to measure the effectiveness of rehabilitation models for improving self-stigma. This quasi-experimental research design applied purposeful sampling. The participants (n = 250) were persons with mental illness who received rehabilitation treatment in central Taiwan. They were divided into community- (n = 170) and institution-based (n = 80) rehabilitation groups. The Internalized Stigma of Mental Illness Scale was evaluated at the time of recruitment, and a follow-up was conducted after 1 and 3 months. A generalized estimation equation was used in data analysis to measure whether self-stigma improved with the rehabilitation model and time, and to test the effect of different rehabilitation models on participants' self-stigma improvement. The study found that the self-stigma of patients receiving CBR improved more than that of those receiving IBR when behavioral problems, education, OT level, sex, and first-time self-stigma were controlled. Returning to the community is the goal of rehabilitation for patients with mental illness, but IBR still dominates the rehabilitation model in Taiwan. Thus, it is necessary to continue promoting CBR plans for future mental health policies.

Effects of an ethical decision-making reasoning scheme in nursing students: A randomized, open-label, controlled trial.

BACKGROUND: Previous research suggests that, to design a program to help students to develop ethical decision making, competence and courage to confront ethical dilemmas should be critical components. PURPOSE: This study examines the effect of an ethical decision-making reasoning scheme in ethical decision making and communication self-efficacy in nursing students. METHODS: This study was a prospective and randomized, open-label, controlled trial design. Nursing students from a medical university served as participants. Students were randomly assigned to an intervention group (IG), which received the ethical decision-making reasoning scheme intervention, or a control group (CG), which received a standard general course. The effect was measured with the Ethical Decision-Making Scale-Revised and the Self-efficacy for Communication Scale. Analysis of covariance (ANCOVA) was used to measure between-group differences, and paired t-tests were used to measure pre- and post-IG/CG differences. RESULTS: A total of 101 nursing students were included and randomly assigned to the IG (n = 50) and CG (n = 51), and 41 IG and 43 CG students completed all aspects of the study. The findings show that there was significant improvement in self-efficacy in communication (t = 2.341, p = .024) and a decrease in difficulty in communication (t = 2.330, p = .025) in the IG. Ethical decision-making competencies improved more in the IG compared to the CG (F = 4.856, p = .034). Ethical decision-making competencies increased in both males and females, but there were no significant differences between males and females at the end of study (F = 0.264, p = .610). CONCLUSION: These findings suggest that ethical decision-making training can improve students' confidence in communicating with patients and may help to improve students' more complex ethical decision making.

Job stress and occupational burnout among clinical nursing teachers: A cross-sectional study.

BACKGROUND: Clinical nursing teachers face conflicts and challenges while instructing nursing students in the clinical setting. They may be under job stress, which can lead to occupational burnout. PURPOSE: This study investigated the current state and relationship between job stress and occupational burnout, as well as explore the significant predictors of occupational burnout among clinical nursing teachers. METHODS: A cross-sectional study design and convenience sampling was conducted. A total of 205 clinical nursing teachers from 43 nursing schools in Taiwan. Used the Chinese version of the job content questions and occupational burnout inventory to collect data. Multiple linear regression was used to determine the predictors of occupational burnout. RESULTS: The degree of perception of life stress by teachers was moderate, and occupational burnout was mild to moderate. Multiple regression analyses showed that perceived life stress and job stress were significant predictors of occupational burnout; perceived life stress was the strongest predictor of occupational burnout, explained 26.4% of the variance; and the workload explained 16.6% of the variance. CONCLUSION: Perceived life stress and job stress influence occupational burnout. This study results may help administrators recognize the vulnerability of clinical nursing teachers to different stressors and develop strategies to improve occupational burnout.

[The Reliability and Validity of the Chinese Version of the Experienced Level of Existential Emptiness].

BACKGROUND: Psychiatric patients are affected by diseases and mental symptoms that may worsen their ability to adjust emotionally. Being unable to respond to the emptiness, increases the risk of suicidal behaviors. PURPOSE: This study was designed to translate the Experienced Level of Existential Emptiness (ELEE) scale, developed by Hazell in 1984, from the original English into Chinese and then to test its reliability and validity. METHODS: This research adopted a cross-sectional design and collected data using convenience sampling and a structured questionnaire. The subjects of this study were psychiatric outpatients in the acute and chronic wards of a psychiatric hospital in Taiwan. The instruments used in this research included a demographic datasheet; the ELEE; the University of California, Los Angeles Loneliness Scale, version 3; the Beck Depression Inventory-II; the State-Trait Anxiety Inventory Y form; and the Oxford Happiness Inventory. After the data were obtained, the reliability and validity of the Chinese-version scale was tested. RESULTS: Three hundred subjects were surveyed. The content validity index value of the ELEE was between .88 and 1, and the retest reliability and intrinsic consistency were good. From the analysis of criterion-related validity, a higher degree of emptiness was shown to correlate with more-obvious feelings of loneliness, depression, and anxiety. Conversely, a higher sense of happiness was shown to correlate with less-obvious feelings of these three variables. After the construct validity test, which used confirmatory factor analysis and regarded the co-variation coefficient of association and model fit index as the basis of consideration, the scale was reduced to two sub-scales of seven questions each. After the deletion of items, the scale retained good retest reliability and intrinsic consistency, supporting the retention of the 14 questions in the scale. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study support using the Chinese version of the ELEE to measure emptiness in patients with mental illness and then providing appropriate medical assistance based on the measured results.

Gender Differences in the Attitudes of Parents Living with Adult Children with Schizophrenia.

BACKGROUND: This paper explored the gender differences in the attitudes of parents toward taking care of their adult daughters or sons with schizophrenia, and focused on how parents define and think about the roles of their children, and how they cope with fulfilling the expected roles. METHODS: Qualitative research design and purpose sampling were used to enroll parents who had adult patients with schizophrenia at a medical center in central Taiwan. Semi-structured in-depth interviews were conducted and content analysis was used to analyze the data. RESULTS: Seven main themes emerged from the data provided by ten parents living with adult children with schizophrenia. Three themes that focused on gender difference are listed: parents continue to expect their sons with schizophrenia to carry on the family name; society as a whole expects males to be the "head of the family"; male family members are supposed to assume the responsibility of caring for siblings with schizophrenia. CONCLUSIONS: The results of the study could help clinical professionals to understand and have greater empathy with regard to the difficulties for families and the concerns of parents taking care of their children with schizophrenia in the specific context of Chinese culture, and to provide more efficient and responsive assistance.

The effect of a situation model nursing education action program on gender-bias awareness and gender-friendliness barriers in novice nursing students.

AIM: This study presents a workshop on the Situation Model Nursing Education Action program, examines how to promote gender awareness and decrease barriers related to differences in gender friendliness through the implementation of this program and tracks the trends of the relevant variables. DESIGN: Pre- and post-observations and a cohort study were conducted. METHODS: A total of 58 nursing students (42 females and 16 males) were included. Nursing students were offered a gender-care intervention as two 90-minute workshops and surveys that measure gender awareness and gender friendliness were administered. RESULTS: The results concerned gender-bias awareness and gender-friendliness barriers scores across the four weeks of the program intervention, with the generalized estimated difference score compared with the Week 1 baseline. Mean student scores showed that gender-bias awareness was significantly decreased at Week 2 (p < .001) and Week 4 (p < .001) and that mean gender-friendliness barrier scores significantly declined at Week 4 (p < .001). CONCLUSIONS: The findings indicate that a faculty professional learning community workshop that facilitates intentional behavioral change can help faculty to become aware of gender bias, which can improve students' gender awareness through clinical case discussion and lead to a decline in barriers to students' gender friendliness.

A preliminary study on the effectiveness of a stress management program for healthcare-related undergraduates with at-risk mental state.

PURPOSE: This study aimed to examine the effects of a stress management program on stress perception and coping strategies for healthcare-related undergraduates with at-risk mental state (ARMS). DESIGN AND METHODS: A randomized experimental design with pretest and posttest was used. Of the 2812 students screened, 65 were identified as having ARMS, 52 enrolled in the study, and 49 (75%) completed the study. FINDINGS: Significance was found for subjects with schizotypal traits in emotion expression and problem-avoidance coping strategies. Subjects with trait anxiety improved significantly in interpersonal deficits after the program. PRACTICE IMPLICATIONS: Students with different trait risks reported benefits in different stress-coping strategies from the program.

Modeling the relationship between nursing competence and professional socialization of novice nursing students using a latent growth curve analysis.

Professional skill development and socialization require appropriate guidance and learning. We aimed to examine the effect of self-appraisal of the clinical simulation care task (CSCT-SA) action program on the self-learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization of novice nursing students. This study has a single-group longitudinal research design. Five measurement variables, including students' self-learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization, were assessed at the baseline, middle, and termination points of the study. The generalized estimating equation and a latent growth curve model were used to examine research hypotheses. A total of 92 students (22 male and 70 female students) completed three point surveys. Students' learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization presented a positive growth trajectory throughout the CSCT-SA action program series. In addition, latent growth curve analyses indicated that the levels of nursing competence and professional socialization, as well as the changes in these variables, were positively associated with each other. Findings support the key role played by nursing competence in enhancing students' professional socialization, which suggests that such competence should be improved to promote professional socialization.

Modeling the antecedents of clinical examination performance: Task characteristics and psychological state in nursing students.

BACKGROUND: Objective structured clinical examinations can be used to understand students' care skill performance and to evaluate courses. Thus, identifying antecedents to improved skill performance in these examinations is crucial for improving students' future care ability. OBJECTIVES: This study examined the antecedents of clinical skill performance in nursing students and determined whether perceived task load and anxiety mediate the relationships between task characteristics and skill performance. METHODS: A quantitative approach was conducted. The questionnaire for this study was comprised of five measures: Simulation Learning Effectiveness Scale, Task Characteristic Subscale, Task Cognitive Loading Scale, State-Trait Anxiety Inventory, and a clinical practice examination. FINDING: Structural equation modeling revealed that students' simulation learning effectiveness was positively associated with three task characteristics (task autonomy; task variety, identity, and significance; and task feedback) during clinical examinations. Further, the effect of learning effectiveness on task feedback was greater than on task autonomy, variety, identity, and significance. In addition, task load mediated the relationship between task variety, identity, and significance and clinical examination performance, whereas anxiety mediated the relationships between all three task characteristics and clinical examination performance. CONCLUSION: Promoting nursing students' simulation learning effectiveness is crucial for improving feedback in regard to the task. Further, those who perceived the task as having more variety, identity, and significance were more likely to perceive the task as having a higher cognitive load and to experience anxiety, which, in turn, led to poorer performance. Interventions should, therefore, managers' aim to reduce students' perceived load and anxiety before they participate in clinical skill examinations.

Development of the Chinese-version of the exercise self-regulatory efficacy scale for patients with chronic obstructive pulmonary disease.

BACKGROUND: A valid and reliable instrument for assessing exercise self-regulatory efficacy (Ex-SRE) is lacking in Taiwan. OBJECTIVE: To develop and validate a Chinese-version of the Ex-SRE scale (Ex-SRES-Chinese). METHODS: Published guidelines were followed for cross-cultural adaptation of Ex-SRES-Chinese. Psychometric testing was conducted in 76 subjects with chronic obstructive pulmonary diseases (COPD). RESULTS: Ex-SRES-Chinese achieved clarity, culture appropriateness, and functional equivalence for measuring Ex-SRE. The scale-level content validity index of the Ex-SRES-Chinese was 0.99. The internal consistency reliability (Cronbach's α) was 0.925. Factor analysis identified a single factor with a high eigenvalue of 7.6 accounting for 47.5% of the total variance. The construct validity of Ex-SRES-Chinese was supported by higher Ex-SRE in subjects who exercise regularly in the past than those who did not (p = 0.033). In addition, Ex-SRE was positively associated with weekly exercise time (r = 0.58; p < 0.0001). CONCLUSIONS: Ex-SRES-Chinese is a useful cross-culturally adapted instrument with good psychometric properties for measuring Ex-SRE in COPD patients in Taiwan.

The mediating effect of self-reflection and learning effectiveness on clinical nursing performance in nursing students: A follow-up study.

The effectiveness of simulation learning and the effects of anxiety in the simulated situation have been understudied. In addition, research on the association between learning effectiveness and students' clinical care performance in the hospital setting is very limited in Taiwan. The aim of this study is to examine the mediating effect of self-reflection and simulation learning effectiveness on the clinical nursing performance of nursing students. A Prospective, longitudinal, and correlational design was used. The study was conducted from December 2014 to July 2015. Participants were 293 nursing students in southern Taiwan. A structural model was specified and tested using partial least squares structural equation modeling to examine the relationships between the variables. The results revealed that the model was robust in terms of its measurement quality (reliability, validity, and goodness of fit), with the data's explaining 38.3% of variance in nursing competence. As self-reflection and learning effectiveness were added into the structural model, the effect of anxiety on nursing competence was still significant, but the regression coefficient (ß) estimate of -0.41 (p<0.05) changed to ß=-0.15 (p<0.050),indicating that self-reflection and learning effectiveness mediated the relationship between anxiety and nursing competence. Nursing competence was negatively affected by anxiety and positively affected by self-reflection (ß=0.49, p<0.05) and simulation learning effectiveness (ß=0.10, p<0.05). The teacher's encouraging learning can have a positive influence on students' self-reflection and learning effectiveness, which then decreases the effect of anxiety on nursing competence and further promotes students' clinical care ability.

Testing of the factor structure of the Sexual Health Knowledge Measure with young adolescent Taiwanese girls.

Knowledge of sexual health is an important indicator of the development of healthy adolescent sexuality. An evaluation instrument in nursing school practice, whose results can lead to improved sexual health in adolescents, is needed. We conducted this study to undertake rigorous testing of the Sexual Health Knowledge Scale (SHKS) as a means to ensure a reliable and valid quantitative measure of sexual health knowledge among young adolescent females. A panel of experts assessed the content validity of the 40-item measure. Initial testing involved 481 female adolescents (12-14 years old), using principal component factor analysis with varimax rotation and the determination of Cronbach's alpha coefficients. Confirmatory factor analysis (CFA) was conducted using data from an additional sample of 234 female adolescents (12-14 years old). Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 43.40% of the variance. As a result of the analysis of the scale, 22 items were deleted, resulting in an 18-item scale. The CFA identified a second-order factor termed "sexual health knowledge." Goodness-of-fit indices showed an acceptable fit overall with the full model (χ(2)/df (131) = 1.69, RMSEA = 0.054, RMR = 0.013, CFI = 0.92, and GFI = 0.99). We determined that the SHKS is a reliable and valid measure, with good composite reliabilities and goodness-of-fit indices.

Predicting the likelihood of suicide attempts for rural outpatients with schizophrenia.

AIMS AND OBJECTIVES: To explore suicide predictors in rural outpatients with schizophrenia. Background. Suicide is a major cause of mortality in patients with schizophrenia. Evidence indicates that patients in rural areas are at high risk for inadequate health care services. However, information is limited on suicide risk in outpatients with schizophrenia in rural areas. DESIGN: Cross-sectional survey. METHODS: Data were collected on individuals enrolled in the 2007 Taiwan National Health Insurance program as diagnosed with schizophrenia, ≥ 18 years, and living in a rural county. Eligible individuals (n=1655) were assessed by 12 community-based nurses at 12 public health centres. Participants' personal information was retrieved from National Health Insurance records using a personal data sheet, and treatment experiences were obtained by interviewing patients with a 10-item risk-assessment inventory. Data were collected over 18 months (2007-2008) and analysed by descriptive statistics and regression analyses. RESULTS: Risk of suicide attempt in the previous year had four significant predictors: number of self-harm incidents during the previous year, violent incidents towards others during the previous year, number of follow-ups by mental health clinics and number of involuntary hospitalisations during the previous year (R(2) = 0.337, adjusted R(2) = 0.334, F=133.19, p=0.000). CONCLUSION: Health care providers should assess rural outpatients with schizophrenia for suicidal thoughts by asking simple questions to evaluate for a history of self-harm and violence and by comparing this information with health system data on follow-ups by mental health clinics and involuntary hospitalisations. RELEVANCE TO CLINICAL PRACTICE: Community-based health providers may use these results to prioritise assessments when they have a high case load of patients with schizophrenia. Community-based nurses need to be trained to recognise these four predictors to increase their sensitivity to suicidality among patients with schizophrenia.

A Chinese version of the Caring Assessment Report Evaluation Q-sort scale for measuring patients' perception on nurses' caring behaviours: reliability and validity assessment.

A reliable and valid instrument for understanding patients' perceptions of nurses' caring behaviour as well as assessing the quality of nursing care is necessary. The purpose of this study was to assess the reliability and validity of a Chinese version of the Caring Assessment Report Evaluation Q-sort (CARE-Q) Scale for the measurement of patients' perceptions of nurses' caring behaviours. The study sample comprised 250 patients from a medical centre in central Taiwan. Content validity, construct validity, internal consistency and stability reliability were assessed. The Content Validity Index of the Chinese version of CARE-Q was 0.90. Cronbach's alpha indicated good internal consistency reliability. Stability reliabilities for the six subscales ranged from 0.83 to 0.92. The results reveal that the Chinese version of the CARE-Q scale for the measurement of patients' perceptions on nurses' caring behaviours indicates high reliability (internal consistency and stability) and good content validity.

[Associations between stigma perception and stigma coping behavior and quality of life in schizophrenic patients treated at a community rehabilitation center].

BACKGROUND: Quality of life (QOL) is a critical issue in mental health care. The associations between quality of life and schizophrenia patients' stigma perception and stigma coping behavior are not well understood. PURPOSE: This study investigated quality of life in schizophrenia patients. METHODS: We used a cross-sectional, correlational research design; enrolled 119 individuals diagnosed with schizophrenia as participants; and used instruments including a demographics datasheet, perceived stigma scale, stigma coping behavior scale, and the World Health Organization quality of life scale, brief version to collect data. Data were analyzed using SPSS 12.0 for Windows software. RESULT: (1) Participants had an average QOL index score of 62.40, indicating moderate quality of life; (2) Long working hours, holding rehabilitation-related employment, and receiving social welfare support correlated with lower QOL; (3) Marital issues had the greatest impact on quality of life, with participants who chose secrecy ÷ concealment reporting generally better QOL; (4) Social welfare support, number of working hours, stigma perception, stigma coping, level of job satisfaction, and level of salary satisfaction together accounted for 48.8% of total QOL variance. CONCLUSIONS: Findings increase our understanding of the influence of socio-demographics, stigma perception, and stigma coping behavior on quality of life in individuals with schizophrenia. Greater community involvement in schizophrenia treatment programs can enhance patient satisfaction with their jobs and lives.

The effect of sexual self-concept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls.

AIM: The purpose of this study was to examine whether normative beliefs would act as a moderator of the main relationship between sexual self-concept and sexual heath behavioural intentions. BACKGROUND: Sexual self-concept has been defined as an individual's evaluation of his or her own sexual feelings and actions. Research has shown that sexually related behaviours are associated with sexual self-concept and perceived parental/peer approval of sexual behaviour. METHODS: We conducted cross-sectional research, using face-to-face interviews, to assess sexual self-concept, normative beliefs and sexual health behavioural intention. This study was conducted with 534 adolescent female participants, aged 12-15 years, in Taiwan. Data was collected between September and December 2009. We conducted structural equation modelling to examine the proposed conceptual model. FINDINGS: We found that individuals with a high score on sexual self-concept (i.e. who had stronger erotic feelings) were less likely to believe that they would behave in ways that would protect their sexual health (i.e. low behavioural intention, ß = -0·44, t = -8·43, P < 0·001). The hypothesized moderating role of normative beliefs was also supported. Those with a greater tendency to believe that their parents/peers approved of sex (i.e. normative beliefs) were more likely to have a positive sexual self-concept (ß = 0·57, P < 0·001), and were less likely to protect their sexual health (ß = -0·19, P < 0·01). The findings showed that, together, normative beliefs and sexual self-concept accounted for 24·9% of the variance in girls' sexual health behavioural intentions. CONCLUSIONS: We recommend that interventions that target sexual health behavioural intentions for this population would be more effective if such interventions targeted normative beliefs and helped adolescent females to clarify their sexual self-concept.