Citation: Kisaakye, P.; Bukuluki, P.; Wandiembe, S.P.; Kiwujja,V.; Kajungu, C.; Mugwanya, W.; Nabakooza, S.; Anyii, C.; Anena, C.; Kaikai, F. How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda. Adolescents 2023, 3, 404–415. https://doi.org/10.3390/ adolescents3030028 Academic Editor: Monit Cheung Received: 4 March 2023 Revised: 6 June 2023 Accepted: 30 June 2023 Published: 4 July 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Article How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda Peter Kisaakye 1, * , Paul Bukuluki 2 , Symon Peter Wandiembe 3 , Victor Kiwujja 4 , Christine Kajungu 4 , Wilberforce Mugwanya 4 , Shakira Nabakooza 4 , Cyprian Anyii 4 , Cinderella Anena 4 and Fiona Kaikai 4 1 Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala P.O. Box 7062, Uganda 2 Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala P.O. Box 7062, Uganda 3 Department of Statistical Method and Actuarial Sciences, School of Statistics and Planning, Makerere University, Kampala P.O. Box 7062, Uganda 4 United Nations Population Fund, Kampala P.O. Box 7184, Uganda * Correspondence: pkisaakye@gmail.com Abstract: Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior. Keywords: sexual behavior; sexual health; prevention; young people; self-efficacy; agency; Uganda 1. Introduction The recent 2016 Uganda demographic and health survey estimated that about 44% of births among women below the age of 20 and 36% of birth among women in the age group of 20–24 years were unwanted [1]. Yet, unwanted births among young people have been associated with pregnancy complications [2], pregnancy-related deaths [1,3], and unsafe abortion complications [4]. Moreover, unwanted births compromise education attainment among young people which consequently leads to poverty and increases vulnerabilities [5]. Adolescents 2023, 3, 404–415. https://doi.org/10.3390/adolescents3030028 https://www.mdpi.com/journal/adolescents