Conceptual analysis is a systematic process that aims to break down a term, clarifying the critical attributes that distinguish it from comparable terms. The outcome is a collection of defining traits that enable a researcher to establish a precise definition of the concept, select suitable and effective measurement instruments, or ascertain the necessity for new tools, and recognize the concept in practical applications or research data (24). Various methods are utilized in concept analysis, including those proposed by Walker and Avant (25), Rodgers and Knafl (26), and Norris (23). This analysis employs the methodology established by Norris (23), which delineates five steps as follows:

After identifying the concept of interest, observe and describe the phenomenon repeatedly, and if possible, describe the phenomenon from the point of view of other disciplines.

The first author conducted the literature search for this analysis in the PubMed, CINAHL, and PsycINFO databases. Assistance was obtained from the medical librarian at the University of Rochester's School of Nursing to identify and finalize a comprehensive set of search terms. The key terms and phrases utilized in this search were adolescent, adolescence, teenager, teen, “sexual negotiation”, “condom negotiation”, or “condom negotiated” or “condom negotiates” or “condom negotiating”. These terms were used in various combinations to conduct a comprehensive search. The final search strategies are outlined in Table 1. From CINAHL, 104 sources were identified, 57 from PsycINFO and 102 from PubMed. The following inclusion criteria were applied in the literature search: peer-reviewed literature written in the English language and published between 1994 and 2025, specifically focusing on human subjects within the adolescent age range of 10 to 19 years old. The literature search publication timeline was set for the year 1994, as that year marked the first time adolescent sexual and reproductive health gained global attention (27). All searches yielded a total of 263 sources. One article (28) was frequently cited by other articles and was the first to give a clear definition of adolescent condom negotiation. Once the search was concluded, all sources were further evaluated using reference management software (EndNote, Clarivate) for a more comprehensive eligibility assessment. Among the 263, 102 (39%) were duplicates and were removed. The remaining 161 literature sources' titles and abstracts were screened in the next step, out of which 58 (36%) sources had no information on condom negotiation and were removed. Full texts of the remaining 103 sources were then retrieved for screening. Further eligibility screening led to the exclusion of 76 (74%) sources. These were excluded because they focused on older people or had a small representation of youth under 19 years (n = 71, 93%) and languages other than English (n = 5, 7%). The final literature source count was n = 27.

The concept of adolescent condom negotiation was identified across all texts; thereafter, data were extracted regarding its description, measurement, or application. The characteristics of the concept were extracted and structured into a raw data file of antecedents and outcomes (Table 2) and attributes (Table 3). The data were analyzed and reorganized to identify the primary attributes, antecedents, and outcomes of adolescent condom negotiation (Table 4).

The second step of the Norris concept analysis approach involves categorizing the distinct components of the descriptions of the phenomena (23). In this context, adolescent condom negotiation can be defined as the communicative skill employed by adolescent sexual partners, predicated on sexual self-efficacy, resulting in either the utilization or non-utilization of condoms. These observations mapped out the antecedents, attributes, and outcomes of adolescent condom negotiation. Multiple papers delineated the process of teenage condom negotiation as a protective competency aimed at preventing the acquisition of STIs or unintended pregnancies through condom use (19, 20, 43, 51). Articles addressing this primary objective of assessing condom negotiation (21, 33, 46) aimed to determine its impact on the consistent use of condoms during sexual intercourse among adolescents. Interestingly, unintended pregnancies and STI susceptibility less frequently prompted adolescents to negotiate for the use of condoms (21, 31, 49). All sources characterized teenage condom negotiation as a process of communication. This communication is recognized as a multifaceted activity that employs several strategies. These strategies encompass both verbal and non-verbal methods (28, 34, 38, 40). While communication generally indicated an acceptance of condom usage (32, 49), other authors noted that condom negotiation did not consistently result in actual condom use (33, 46).

Fear of communicating the desire for the use of condoms was also reported by some texts (31, 41, 44). These studies pointed to prior mental health problems experienced by girls, such as physical abuse and sexual coercion, depression, and the use of alcohol and drugs, serving as critical limiting factors against condom negotiation. On the other hand, some sources presented factors that served to promote adolescent condom negotiation. These included high HIV risk perception (40), communication with parents about sex (37, 38), higher gender equity perception (52), and communication with teachers about sexual health issues (39). These condom negotiation promotive factors served to increase sexual self-efficacy, particularly among girls, which helped to increase their confidence to request condom use with their partners.

Norris presents a distinct viewpoint compared to others regarding the formulation of an operational definition (53), which constitutes the third step in her analytical framework. An operational definition, as described by Norris, addresses the question of how to identify the concept in practice (22, 23). Other scholars emphasize the importance of measurement, which is absent from her approach (53). Adolescent condom negotiation is hereby defined as the proficient use of verbal and non-verbal communication strategies by adolescent sex partners to discuss condom use during sexual intercourse, aiming to reach a consensus on whether to use condoms or not. This skill is consistently preceded by the sexual self-efficacy of the partners, and less frequently by concerns regarding unintended pregnancies and sexually transmitted infections.

Lackey (22) posits that models enhance the understanding of data by facilitating generalizations regarding concepts and clarifying the relationships among categories, patterns, and hierarchies that have been established. The outcomes of concept clarification should be communicated more effectively through a well-structured model. In the fourth step of Norris' method, a model of adolescent condom negotiation was developed, detailing the relationships among the identified categories, antecedents, and outcomes of the concept. This model functions to convey information regarding the concept (22). Figure 1 represents the conceptual model of adolescent condom negotiation derived from this concept analysis of adolescent condom negotiation.

The final step of Norris' method involves formulating hypotheses to evaluate the concept. Lackey (22) states that the model and the resulting operational definition are utilized to formulate hypotheses. The subsequent directional hypotheses were formulated based on the model and operational definition of adolescent condom negotiation. (1). Increased sexual self-efficacy among adolescents is associated with a higher frequency of condom negotiation. (2). Sexual self-efficacy serves as a more significant predictor of condom negotiation compared to the fear of unintended pregnancy.

The purpose of this concept analysis was to identify an operational definition for adolescent condom negotiation. This was accomplished by repeatedly describing the concept, its attributes, antecedents, and outcomes, and eventually identifying the categories and common themes that emerged across the literature sources. The purpose was met, and results revealed an operational definition of adolescent condom negotiation, which was then graphically presented in a conceptual model.

This analysis identified that the concept of adolescent condom negotiation encompasses skills of verbal and non-verbal communication, which takes place in the context of sexual intercourse between adolescent sexual partners. It is preceded by sexual self-efficacy and, less frequently, the fear of unintended conceptions and STIs. Conceptually, adolescent condom negotiation resulted in either the use or non-use of condoms.

The literature on adolescent sexual health often purports that adolescent condom negotiation always has an outcome of condom use, but this is not always true. Other texts indeed have identified that while condom use was assumed, the contrary outcome was the reality (34). Therefore, it is essential for scientists to dispel this presumption.

Condom negotiation is a process that may or may not result in condom use. Power dynamics between partners, sexual communication and assertiveness, trust, perceived danger of STIs, and gender or cultural norms affect adolescent condom negotiation. Successful condom negotiation requires the ability to express desires and overcome condom stigma or rejection. Thus, condom negotiation must be understood as a process rather than a binary outcome in research measurement and to create interventions that improve communication, sexual autonomy, and safer sexual behaviors.

Gendered patterns and power imbalances were revealed, placing the female or weaker partner at the requesting end and the male or more powerful partner at the final decision-making end. Negotiation may be conceptually inadequate in such condom use contexts of gender and power imbalances. Negotiation requires reciprocal communication and shared decision-making power, yet in relationships with unequal gender dynamics, one partner may control condom use. When the more powerful person makes the ultimate decision, the less powerful partner has little agency and may be better understood through the lens of condom decision-making dynamics, power-mediated condom decision-making, or condom use communication. This phrase effectively conveys how structural and relational power disparities affect sexual health behaviors. Reframing condom negotiation in this way highlights the need for interventions that address communication skills and sociocultural and gendered power structures that limit real shared decision-making in sexual relationships.

Closely linked to gendered power imbalances is the fact that the most commonly used barrier method in sexual intercourse is the male condom, which places more control over its use on the male partner. Indeed, even though female condoms exist, none of the studies reviewed had a focus on them. It is important to consider the protection of girls through education and the promotion of female condom use among adolescents.

Furthermore, this conceptual work identified that the nuances in adolescent sexual relations, such as oral sex performance or receiving, are not frequently captured in research within this population. This lack of research attention to other forms of sexual acts besides penile-vaginal intercourse could be linked to adolescents' perceptions of engaging in less sexually risky behavior, yet having a consistently high incidence of STIs. Sexual health research in the adolescent population should inclusively examine oral sex behavior and the promotion of safe practices, such as the use of dental dams.

Additionally, this conceptual work identified condom negotiation to be a component of safer sex practices, which included both condom use and not engaging in intercourse if agreement is not reached to use condoms. However, a question that immediately arises is, how can a sexual activity be described as safe when it did not occur at all? Therefore, the authors recommend that condom negotiation should be viewed as a distinct concept, separated from abstinence, to facilitate more accurate measurement of the concept.

Lastly, this conceptual analysis identified that the measurement scale for condom negotiation was either the MCAS or the Sexual Communication Scale. Neither scale captures the concept as revealed in this analysis. Future research needs to include specific scale development using the operational definition and model developed in this concept analysis of adolescent condom negotiation.

To the best of the authors' knowledge, this concept analysis is the first one done on condom negotiation, specifically in the population of adolescents. This concept analysis of adolescent condom negotiation, therefore, contributes to the literature by providing a clear operational definition of the concept and clarifying its meaning, presenting it as a measurable phenomenon (22).

Additionally, this concept clarification could serve as background work or contribute to a theory that focuses on promoting condom negotiation, which is currently lacking in the literature. Also, more research should be conducted on how the fear of unintended conceptions and STIs contributes to adolescent condom negotiations. This is critical to establish the significance of the relationship between fear of unintended pregnancy and STIs and condom negotiation among adolescents.

Although Bergdahl and Berterö (54) argue that concept analysis should be discarded since it is not a component of a strong scientific approach, it can be counterargued that concept analysis, when done systematically and tied to the clinical problem under study, produces effective data for further research (55). Thus, this concept analysis has strictly followed a systematic and transparent process for literature search, data extraction, and analysis of findings to generate valid evidence that informs further data collection on adolescent condom negotiation and use.

This analysis has some limitations. Only English-language publications were included so that authors could clearly understand the content of each article in the analysis. However, articles from journals that publish in multiple languages were included in the search, potentially reducing linguistic bias through the inclusion of English translations that met all other inclusion criteria, as was the case in the paper authored by de Melo and colleagues (20). Furthermore, because the selection, data extraction, and analysis processes were conducted by a single researcher, there may be some bias in these areas. However, this bias was minimized by strictly following systematic procedures and through further checks by co-authors. Given the preliminary nature of the concept analysis findings, expert interviews are necessary to inform the conceptualization of adolescent condom negotiation, which may change as the researchers’ comprehension of the idea matures or evolves through further research (25).

Nevertheless, this concept analysis identified a significant gap in the clarity of a long-standing concept in published texts and contributes to the literature an operational definition of adolescent condom negotiation, along with subsequent hypotheses. These can be further explored in research, both qualitative and quantitative studies, for a more in-depth understanding of adolescent condom negotiation.

This paper aimed to conceptually analyze the concept of adolescent condom negotiation using Norris' (23) approach to derive an operational definition of the concept. The goal of this work was met with systematic and transparent procedures. The results of this work can be used as a contribution to the development and testing of an adolescent condom negotiation scale. The operational definition of the concept can also be utilized by researchers in the field of adolescent health for clarity in their studies.