Unplanned pregnancies (defined as pregnancies that are either mistimed or unwanted) and sexually transmitted infections (STIs) are important and costly public health problems in the United States resulting from unprotected sexual activity. Women with a history of incarceration are at increased risk for these problems given the high rates of substance abuse and commercial sex work in this population. Highly effective (less than 2% annual failure rate with typical use) reversible contraceptive methods are readily available through Title X clinics. The Rhode Island Department of Corrections (RI DOC) has actively participated in the implementation and evaluation of a Title X program which provides contraceptive services to incarcerated women as well as transitional reproductive health services from the jail to the community. However, service utilization remains sub-optimal. This application is designed to evaluate an innovative intervention Motivational Interviewing with Computer Assistance (MICA) designed to improve contraceptive use for incarcerated women who do not want a pregnancy and are soon to be released into the community. We will utilize the Title X program which, in conjunction with RI DOC, provides reproductive health services in jail and then transitional services in the community after release. Building upon program experience and prior evaluations we have adapted CAMI, and plan to implement and evaluate MICA for increasing the initiation and continuation of highly effective contraceptive methods among women at risk for an unplanned pregnancy. We plan to recruit 400 women from the RI DOC women's jail and randomize them to two interventions: three sessions of personalized MICA or three sessions of Didactic Educational Counseling (DEC), both delivered individually by trained counselors. MICA is based on the principles of the Transtheoretical Model (TTM) and on Motivational Interviewing (MI), 3 an empirically supported counseling technique designed to enhance readiness to change targeted behaviors. The DEC provides didactic information about contraception, sexually transmitted infection (STI) prevention and abstinence, and is intended to control for the effects of assessment and attention. The two counseling interventions will be similar in length and timing, but will vary in content, counseling style and the individualized computer generated feedback that is reviewed with the counselor. Women entering jail usually have very brief periods of incarceration and are at high risk for unplanned pregnancies and STIs after release. We propose to evaluate an innovative motivationally based intervention in a randomized clinical trial of women entering jail in Rhode Island.
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