A nursing theory for anticipatory guidance of adolescents to resist peer pressure and coercion to sexual activity

Abstract

Introduction and background: Peer pressure and sexual coercion are driving adolescents to engage in early sexual activity. Adolescent risk behaviour that involves unsafe sexual practices remains a major concern for nurses, because it negates all progressive efforts to prevent the incidence of amongst others, unplanned pregnancies, sexually transmitted infections (Lansford, Dodge, Fontaine, Bates & Pettit, 2014:1742), unsafe abortions and childbirth complications (Fantasia, 2011:48; Van de Bongardt, De Graaf, Reitz & Dekovi? 2014:388). Emotional immaturity and vulnerability predispose adolescents to making irresponsible decisions regarding sexual activity with dire consequences, which is considered to be a worldwide concern (De Vries. Eggers, Jinabhai, Meyer-Witz & Sathiparsad, 2014:1087). Making such irresponsible decisions is also attributed to limited knowledge and information on Sexual Reproductive Health (SRH). Despite various initiatives specifically implementing targeted adolescent intervention programmes aimed at reducing the consequences of sex, such as HIV and adolescent pregnancies (Panday, Makiwane, Ranchod & Letsoalo, 2009:14), many South African adolescents are still having unprotected sex (Reddy et al., 2008:30; Rutherford, 2008:276) and even multiple sex partners (Ha, Kim, Christopher, Caruthers & Dishion, 2016:709; Mah & Shelton, 2011:2). Advanced approaches are required to assist adolescents to resist peer pressure and coercion and to not participate in sex for the sake of pleasing friends and peers. Purpose of the study: The aim of this study was twofold: firstly, to explore how peer pressure and coercion to sexual activity manifested among adolescents in Tshwane District, Gauteng Province, South Africa and, secondly, to develop a nursing theory for anticipatory guidance of adolescents to resist peer pressure and coercion to sexual activity. The Research Ethics Committee recommended the provision of an educational intervention with the aim of delaying the initiation of early sex, prevention of sexually transmitted infections, HIV and building the self-esteem of all the adolescent participants in the interviews. Methodology: A constructivist grounded theory was used to concurrently collect and analyse data (Coyne & Cowley, 2006:508; Moghaddam, 2006:53) to develop a nursing theory. The initial sampling involved 10 adolescents and nine nurses, followed by theoretical sampling of five health professionals working in clinics and health-related settings, who were interviewed. Constant comparative analysis was employed to analyse the data. Results: The study revealed parental incapability and ineffective parenting compounded by the non-conducive clinic environment making it difficult for adolescents to visit clinics for health information. Adolescents mistrust their parents and nurses. Five concepts emerged, namely: substituting for parental shortcomings; addressing negative peer pressure vulnerability of adolescents; addressing risk behaviour vulnerability; optimising nurse-adolescent interaction and enabling responsible decision making. Conclusion: SRH information is very important and adolescents should be provided with such information to help them make responsible choices in order to resist peer pressure. Thus, their health and well-being will improve, leading to a better future without suffering the consequences of early sexual activity. Recommendations: The anticipatory guidance could be applied in other settings outside the traditional clinic environment to provide more adolescents with valuable information. Other interested community volunteers could be trained to help with the provision of support to adolescents in the absence of their parents or guardians.