Adapting an Evidence-Based Curriculum in a Rural Setting: Implementing Reducing the Risk in Kentucky

Publisher: Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation
Dec 14, 2015
Rachel Shapiro and Robert G. Wood

Key Findings:

  • Health educators implemented the adapted version of Reducing the Risk as intended. They received training on the curriculum and had strong support from the program directors in the two health departments. During the study period, health educators covered more than 90 percent of their planned activities.
  • Attendance was high; students in the study sample attended 93 percent of scheduled sessions. Based on classroom observations and focus group reports, students were receptive to the material, especially portions that involved interactive elements.
  • Students and health educators identified several ways the curriculum could be strengthened. During focus groups, students indicated that additional role-play exercises and interactive program elements would have kept them more engaged. Students also reported that the curriculum would have benefited from additional time devoted to discussing birth control methods.

Rural regions have among the highest teen birth rates in the nation. Even so, to date, little research has been done on adolescent pregnancy prevention programming designed to meet the needs of rural youth. To address this research gap, the Administration for Children and Families within the U.S. Department of Health and Human Services directed Mathematica Policy Research to collaborate with the Kentucky Department of Public Health to conduct a rigorous evaluation of an adapted version of Reducing the Risk in relatively low-income, mostly rural high schools. This programming was funded through the state’s Personal Responsibility Education Program grant, which it received in 2010.

For the evaluation, Mathematica partnered with two local health departments that serve a largely rural region with teen pregnancy rates substantially above the national average. Health department staff delivered the Reducing the Risk curriculum to students in area high schools as part of a required health class. Health district staff shortened the original 12-hour curriculum to 8 hours to fit within the time allotted by area schools for delivering the program. The revised curriculum the staff developed covers all the topics in the original Reducing the Risk curriculum but contains fewer role-play exercises and less repetition of material.

This report summarizes the experience that these local health departments had implementing this adapted version of Reducing the Risk during the 2013–2014 and 2014–2015 school years. 


Personal Responsibility Education Program (PREP)


U.S. Department of Health and Human Services, Administration for Children and Families

Time Frame


Senior Staff

Robert Wood
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