Date of Award

2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology

Specialization

Clinical Psychology

Department

Psychology

First Advisor

Lynda Stein

Abstract

Women with a history of incarceration have greater rates of unintended pregnancy - over 80% compared to the national average of 50%; however, they only use contraception 66% to 72% of the time, despite its >99% effectiveness with perfect use. Although motivational interviewing (MI) has shown promise in increasing contraceptive use, evidence of its long-term effectiveness in this population remains limited. This study examined factors influencing the sustained efficacy of an MI-based treatment (CAMI) aimed at improving contraceptive use among women leaving incarceration. Secondary data were used from a randomized controlled trial (RCT) of 232 incarcerated women at risk for unplanned pregnancy (analytic sample: n = 219). Three analytic approaches assessed (1) longitudinal changes, (2) mediation effects, and (3) moderated mediation effects. While no significant mediation or moderated mediation effects were found, there was a marginally non-significant treatment effect on hormonal birth control (HBC) use over time (p = .07, OR = 1.42). Additionally, greater perceived importance of sexual health at 3-month follow-up significantly predicted higher odds of HBC use at last sex and consistent condom use (90-100%) at 6 months. Findings suggest that interventions for justice-involved women should emphasize changing attitudes and beliefs around contraception and prevention. Enhancing MI-based strategies - such as increasing self-efficacy, commitment to change, or providing additional sessions - may improve long-term outcomes, as suggested by previous research.

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Available for download on Tuesday, September 07, 2027

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