An interventional study of WORTH Paths Digital Intervention and WORTH Paths Wellness Group in Substance Use Disorder (SUD), Sexual and Reproductive Health and Sexual Risk Behavior, sponsored by Fairleigh Dickinson University. Recruiting at 1 site in United States. Open to female participants aged 18 Years to 44 Years. Per ClinicalTrials.gov, last updated 2026-05-06.
Sponsored by Fairleigh Dickinson University · Not applicable, Interventional, and Health services research
Women in the criminal legal system are more likely to experience substance use disorders and unintended pregnancy than women in the general public. However, they often face barriers to accessing substance use treatment and sexual and reproductive health services.
This study tests the feasibility and acceptability of Women on the Road to Health (WORTH) Promoting Access to Treatment, Health, and Support (Paths), a digital intervention adapted from the evidence-based CDC Best Practice HIV prevention intervention, Women on the Road to Health (WORTH), originally developed at Columbia University School of Social Work. WORTH Paths is designed to help reproductive-aged women in the criminal legal system with substance use disorders and unmet need for contraception reduce drug use and improve contraceptive use.
Participants (N=50) will be randomly assigned to one of two groups:
WORTH Paths Intervention Group - Participants will attend three virtual group sessions with facilitated videoconference sessions and self-paced digital activities focused on reducing drug use and increasing contraceptive use. They will also receive guidance on how to access and navigate health services.
Control Group - Participants will receive a virtual general wellness program that includes education on substance use and sexual and reproductive health but does not include skills-based training related to these topics. The focus will be on general wellness and stress reduction.
Both groups will receive resources for substance use treatment and sexual and reproductive health services.
Researchers will track changes in drug use and contraceptive use over three months. Participants will complete surveys and provide urine samples to confirm changes in drug use.
Primary aims:
Feasibility: Measured by session attendance, treatment completion, dropouts, and reasons for termination.
Acceptability: Measured by participant ease of use, helpfulness, and satisfaction.
Primary behavioral outcomes:
Self-reported drug use confirmed by urine drug tests. Contraceptive use, including initiation and consistent use.
Secondary behavioral outcome:
Linkage to substance use disorder treatment (measured by appointments made and sessions attended).
Many women involved in the criminal legal system experience substance use disorders and unintended pregnancy but face significant barriers to accessing and utilizing substance use treatment and sexual and reproductive health services. These barriers include limited social support, intimate partner violence, and challenges with self-advocacy and decision-making regarding substance use treatment and contraception. The siloed nature of healthcare services also makes it difficult for women to receive integrated care that addresses both substance use and sexual and reproductive health needs.
While some existing programs for women in the criminal legal system focus on HIV prevention through condom use, fewer interventions take a comprehensive approach to sexual and reproductive health by addressing all forms of contraception while also integrating substance use treatment strategies.
This study tests WORTH Paths, a digital intervention designed to reduce drug use and increase contraceptive use. WORTH Paths builds on Women on the Road to Health (WORTH), an evidence-based CDC Best Practice HIV prevention intervention originally developed at the Columbia University School of Social Work. While WORTH has been effective in increasing condom use, this new adaptation expands its focus to a broader range of contraceptive methods and strategies to support women in reducing drug use.
Study Design
This study is a randomized controlled trial (RCT). Participants will be randomly assigned to one of two groups:
WORTH Paths Intervention Group
Participants in this group will receive the WORTH Paths program, a culturally tailored digital intervention designed to help women involved in the criminal legal system reduce substance use and improve contraceptive use. This intervention includes:
Participants in the control group will receive a general wellness program designed to provide support and education while excluding the behavioral skill-building components of the intervention. This program includes:
Assessments \& Data Collection
All participants will complete:
Eligibility Criteria
To participate, individuals must:
Exclusion Criteria:
Flyers and posters at community centers and shelters
Data Collection \& Safety Measures The study will use self-reported surveys and urine drug tests to measure changes in substance use.
Surveys will be completed securely online
Potential Benefits
While there is no guaranteed benefit, participants may:
Exclusion Criteria:
Participants will receive a culturally tailored program adapted for reproductive-aged women involved in the criminal legal system with substance use disorders and unmet contraceptive needs. The intervention consists of three facilitated group sessions over videoconference with digital interactive activities to support behavior change. Key components include: * Raising awareness about different contraceptive methods and substance use treatment options * Discussing personal motivations for reducing drug use and using contraception * Developing skills to identify and manage substance use and reproductive health triggers * Digital interactive activities to reinforce learning and skill-building * Practicing decision-making tools and goal-setting strategies * Addressing barriers related to safety including intimate partner violence * Creating a safety plan and strategies for maintaining progress * Resources for state and online substance use and sexual/reproductive health services
Behavioral: WORTH Paths Digital Intervention
Participants in this arm will receive the WORTH Paths Wellness Group, a wellness-focused intervention delivered via three facilitated group sessions over videoconference with digital interactive activities. Sessions cover general health, stress reduction, and navigating health services. Topics include education about substance use and sexual and reproductive health risks, guided meditation and mindfulness training, stress management techniques, and an overview of substance use and reproductive health services. Participants will also receive digital wellness resources, including recorded mindfulness exercises and links to online platforms for health services.
Behavioral: WORTH Paths Wellness Group
Participants in this arm will receive the WORTH Paths digital intervention, a culturally tailored program designed for women involved in the criminal legal system with substance use disorders and unmet contraceptive needs. The intervention consists of three facilitated group sessions over videoconference with digital interactive activities to support behavior change.
A wellness-focused intervention consisting of three facilitated group sessions over videoconference with digital interactive activities. Sessions cover general health, stress reduction, and navigating health services, including education about substance use and sexual/reproductive health risks, guided meditation, stress management techniques, and an overview of available health services. Participants also receive digital wellness resources, including recorded mindfulness exercises and links to online health service platforms.
Feasibility Measurement 1: Treatment Completion Rates
Percentage of participants who complete all three intervention sessions, which occur once per week over a three-week period. Completion is defined as attending all sessions and engaging in digital interactive components.
Time frame: Immediately after Session 3 (Week 3)
Feasibility Measurement 2: Session Completion Rates
Percentage of participants who complete each individual session. Completion is defined as attending the full session via videoconference and engaging with digital interactive activities.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Feasibility Measurement 3: Dropout Rates and Reasons for Termination
Proportion of participants who discontinue participation in the study. Participants who drop out will be asked to complete an exit survey detailing their reasons for withdrawal.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Feasibility Measurement 4: Technical Usability
Participants will report any technical difficulties they experienced during each session via a brief post-session survey. Measures include ease of use, ability to access materials, and time required to complete digital activities.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Feasibility Measurement 5: Qualitative Feasibility Assessment
Semi-structured qualitative interviews will be conducted to explore participant experiences related to feasibility. Participants will be asked about their ability to complete the intervention, challenges faced, technical usability, and factors influencing session engagement.
Time frame: 1 week after completion of Session 3 (Week 4)
Acceptability Measurement 1: Ease of Use
Participants will rate how easy it was to navigate the intervention, including videoconferencing and digital activities, using a Likert-scale survey (1-5). Mean scores will be calculated across sessions.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Acceptability Measurement 2: Helpfulness
Participants will assess how useful they found the intervention in supporting behavior change using a Likert-scale survey (1-5). Mean scores will be analyzed for trends across sessions.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Acceptability Measurement 3: Satisfaction
Overall satisfaction with the intervention will be measured through a Likert-scale survey (1-5), with mean scores reported across sessions.
Time frame: Immediately after each session (Week 1, Week 2, Week 3)
Acceptability Measurement 4: Qualitative Acceptability Assessment
Semi-structured qualitative interviews will be conducted to explore participant experiences related to acceptability. Participants will be asked about ease of use, perceived helpfulness, satisfaction with the intervention, and suggestions for improvement.
Time frame: 1 week after completion of Session 3 (Week 4)
Change from baseline in self-reported primary illicit drug use at 3 months
Participants will report the number of days they used their primary illicit drug (the drug they identify as most problematic) in the past 30 days using the Timeline Followback (TLFB) method. Changes from baseline to 3-month follow-up will be analyzed.
Time frame: Baseline and 3-month follow-up
Change from baseline in biologically confirmed illicit drug use at 3 months
Mail-in urine drug tests will be used to verify self-reported illicit drug use. Urine drug test kits will be mailed directly to participants' homes from Phamatech Lab and returned via mail directly to the lab. A positive drug test result will replace a negative self-report. Testing will screen for common substances, including opioids, cocaine, cannabis, and amphetamines.
Time frame: Baseline and 3-month follow-up
Change from baseline in the number of participants initiating a contraceptive method highly effective at preventing unintended pregnancy at 3 months
Participants will report whether they have obtained a prescription or started using a contraceptive method considered highly effective at preventing unintended pregnancy, including an implant, intrauterine device (IUD), injection, birth control pill, patch, vaginal ring, or diaphragm. Change from baseline will be assessed.
Time frame: Baseline and 3-month follow-up
Change from baseline in effective contraceptive use at 3 months
Participants will report the frequency and consistency of contraceptive use based on manufacturer guidelines. Measures will assess the proportion of sexual acts in which contraception was correctly used over the past 30 days.
Time frame: Baseline and 3-month follow-up
Number of participants linked to substance use treatment at 3 months
Linkage to treatment will be measured by the number of participants who report making an appointment for substance use disorder treatment and the number of sessions attended within the three-month follow-up period.
Time frame: Baseline and 3-month follow-up
Plan to share: No — Due to the sensitive nature of the data among a vulnerable population, as well as the small sample size (n=50), individual participant data (IPD) will not be shared. Participants are women involved in criminal legal systems with substance use histories, a vulnerable population facing heightened privacy risks. Even with de-identification, there is a concern about the potential for re-identification, particularly given the unique circumstances of participants and the detailed behavioral and health-related data (e.g., drug use) collected. Sharing this data could expose participants to unintended legal, social, or personal consequences. Given these ethical and confidentiality considerations, and in alignment with NIH's guidance on protecting sensitive data, IPD from this study will not be made available for external sharing.
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