MI: Empowering Women to Make Contraceptive Choices While Incarcerated

描述（由申请人提供）：计划外怀孕（定义为不合时宜或不想要的怀孕）和性传播感染（STIs）是美国由无保护的性活动引起的重要且代价高昂的公共卫生问题。鉴于这一人群中药物滥用和商业性工作的高发率，有监禁史的妇女出现这些问题的风险更高。高效（典型使用的年失败率低于2%）的可逆避孕方法可以通过第十章诊所随时获得。罗德岛惩教署积极参与了《第十章》方案的实施和评估，该方案向被监禁妇女提供避孕服务，并从监狱向社区提供过渡性生殖健康服务。然而，服务利用率仍然不是最优的。本应用程序旨在评估一种创新的干预措施，即计算机辅助动机访谈（MICA），旨在改善不想怀孕并即将被释放到社区的被监禁妇女的避孕药具使用情况。我们将利用第十章方案，该方案与国际惩教署合作，在监狱中提供生殖健康服务，然后在释放后在社区提供过渡服务。在项目经验和先前评估的基础上，我们调整了CAMI，并计划实施和评估MICA，以增加有意外怀孕风险的妇女开始和持续使用高效避孕方法。我们计划从国际扶轮DOC女子监狱招募400名妇女，并将她们随机分配到两种干预措施中：三次个性化的MICA或三次教学教育咨询（DEC），均由训练有素的咨询师单独提供。MICA基于跨理论模型（TTM）和动机性访谈（MI）的原则，动机性访谈是一种经验支持的咨询技术，旨在提高改变目标行为的准备程度。DEC提供关于避孕、性传播感染预防和禁欲的说教信息，目的是控制评估和关注的效果。这两种咨询干预在长度和时间上是相似的，但在内容、咨询风格和与咨询师一起审查的个性化计算机生成的反馈方面会有所不同。进入监狱的妇女通常被监禁的时间很短，释放后意外怀孕和性传播感染的风险很高。我们建议在罗德岛州的一项随机临床试验中评估一项创新的基于动机的干预措施。

DESCRIPTION (provided by applicant): 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.