Explaining the attitude-behaviour gap in adolescent sexual and reproductive health service utilization: A cognitive dissonance perspective from rural Uganda

Adolescents in low-resource settings hold positive attitudes toward sexual and reproductive health (SRH) services, yet fail to use them. This study presents a theoretical reinterpretation of mixed-methods data (N = 408 adolescents, aged 13–19) from Uganda’s Busoga region, through Festinger’s Cognitive Dissonance Theory. Quantitative findings showed health-seeking attitudes predicted SRH service utilization (β = 0.910, p < .001) and future intentions (β = 1.976, p < .001), but 52% of adolescents had no SRH service contact in past year, and mean uptake scores remained below 2.0 on a 5-point scale. Qualitative analysis of focus group discussions identified three dissonance-reduction strategies: avoidance of health facilities, rationalization through misinformation, and selective information-seeking from peers. The reinterpretation proposes four intervention strategies: barrier reduction, community norm campaigns, cues to action with immediate access, and targeted messaging for working and rural adolescents. Addressing psychological discomfort and structural barriers may help close the attitude-behaviour gap.