Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Bertram, Julie, PhD, RN


Fish, Anne, PhD, RN, FAHA, FAAN

Vandermause, Roxanne, PhD, RN

Werner, Kimberly, PhD


Rural pregnant women with substance use disorder (SUD) are an understudied vulnerable population that often experiences poor pregnancy outcomes (Higgins et al., 2019; Jumah, 2016; Kramlich et al., 2018; Shaw et al., 2015). Despite the high prevalence and high burden associated with SUD, rural women are less likely than non-pregnant women to seek addiction treatment and complete an outpatient treatment program during pregnancy (Shaw et al., 2015). This study aimed to give voice to rural Missouri women with SUD. The research questions explored the life experiences and motivations for seeking treatment using a qualitative, descriptive research design with grounded theory methods for data analysis. The research sample consisted of 17 participants from rural Missouri. Semi-structured interviews were audio-recorded using Zoom and analyzed. Four analytic categories were developed from the interview data: (1) onset of use, (2) dynamics of addiction, (3) moods of addiction, and (4) motivating factors. The participants described experiences with SUD from the first time they began using substances through the treatment and recovery process. This group of women began using substances during their teenage years as a way to cope with life-changing events such as death, trauma, abuse, and family problems. The pattern of substance abuse continued as a way to cope with daily life and family problems. Participants described negative thoughts, emotions, and behaviors and the neglect they perceived from healthcare providers during pregnancy. Experiences with incarceration, drug court, and Division of Family Services (DFS) were described. The findings suggest these women have unique healthcare needs, but there is a sense of disengagement from healthcare providers. This type of interaction perpetuates the negative views of self and loss of control that women with addiction may experience. When rural pregnant women with SUD are engaged in recovery, they exhibit a desire to regain their health, fulfill roles as mothers, restore family functioning, and live manageable, meaningful, and satisfying lives. By comparing the study findings to previous research and self-determination theory, new research questions and policy and practice recommendations were generated.