The concept of responsible sexual behavior (RSB) gained popularity when it was introduced in Healthy People 2010 as a leading health indicator. The Healthy People initiatives organize the top health priorities and create guidelines for improving the health of Americans. Promoting RSB was intended to address problems such as unintended pregnancy and sexually transmitted infections (STIs), however the guidelines never conceptually define behavior that would be considered sexually responsible. Thus, the purpose of this dissertation research was to examine how responsible sexual behavior (RSB) was defined in the context of public health literature, collegiate women, and rural women with the intention to contribute to a clearer conceptual understanding of RSB. First, an evolutionary concept analysis was conducted to define the attributes of RSB and develop a conceptual definition of responsible sexual behavior (RSB) as it applies to women 18 years and older who have sex with men from a synthesis of lay and public health literature. According to the literature, RSB is a desirable and deliberative pattern of behaviors that promote sexual health, manage risk, and foster respect of sexual partners within the context of community influences. This study also concludes that a purposeful redefinition maybe necessary to maintain a concept that is useful for guiding and evaluating sexual behavior. Second, a secondary data analysis was completed to identify college women definition of “sexual responsibility.” Data came from interviews collected as part of a mixed methods study of college women and unintended pregnancy. A total of 35 interviews were analyzed using within and across case methodology to derive a working definition of RSB for collegiate women. Women in this sample described being sexually responsible as self-advocating through actions that were consistent with personal goals and values while being aware of consequences that could threaten those goals or values. Actions included mindful partner selection, communicating boundaries, and preventing pregnancy. Women’s academic goals were closely linked to women’s sexual health decision making. Third, an exploratory descriptive study was completed to identify how rural women who have sex with men define RSB and to understand the role of the rural context on definitions and enactment of RSB. A total of ten rural Iowa women aged 18-29 participated in phone interviews. Within and across case analysis was used to describe the contextual influences of how rural dwelling women defined and enacted responsible sexual behavior. For rural women in this sample, RSB is understanding the consequences of sex and taking action to manage risks by preventing pregnancy and STIs, mindfully selecting of partners, and seeking appropriate resources. The social context of the rural environment acted as both a facilitator and barrier for women to acquire information enact RSB. In conclusion, RSB was an accessible concept for college and rural women to define and understand. However, the collective research indicated that a new definition of RSB was necessary to maintain its purpose in improving sexual and reproductive health. Thus, being sexually responsible is having an awareness of consequences and managing risks in a way that is reflective of a woman’s personal experiences, beliefs, values, and goals. How BSR is defined is fluid and subject to redefinition based on personal experiences and movement through the lifespan. Future research should focus on understanding how other populations of women define and manage BSR and that public health interventions and policy support women’s ability to be sexually responsible.

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