Associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy in remote areas of Indonesia: An application of Social Cognitive Theory framework

Abstract

Teenage pregnancy remains a major public health challenge in Indonesia, particularly in remote settings where sociocultural norms strongly influence adolescent behavior. In Gayo Lues Regency, Aceh Province, Indonesia, adolescent pregnancy continues to occur within a context of early marriage, limited reproductive health access, and strong community norms. The aim of this study was to examine the associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy within the framework of Social Cognitive Theory. A quantitative cross-sectional study was conducted among female adolescents aged 10 to 19 years registered across four community health centers (Puskesmas) in Gayo Lues. Participants were selected using cluster random sampling. Data were collected through structured face-to-face interviews using a validated questionnaire. The associations were analyzed using simple and multiple binary logistic regression. A history of teenage pregnancy was reported by 29.5% of participants. Bivariate analysis showed that self-efficacy, outcome expectancies, and socio-structural factors were significantly associated with the history of teenage pregnancy. In the multivariate model, higher outcome expectancies were most strongly associated with lower odds of teenage pregnancy history (odds ratio (OR): 0.424; p<0.001), followed by higher self-efficacy (OR: 0.628; p=0.027), whereas socio-structural factors were not independently associated (OR: 0.810; p=0.318). These findings suggest that personal cognitive factors play a stronger role than socio-structural factors in this setting. Interventions to prevent teenage pregnancy should prioritize strengthening adolescents’ self-efficacy and shaping positive outcome expectancies through comprehensive reproductive health education and supportive social environments.