A process evaluation of the District of Columbia "Know Your Body" project.

A process evaluation was conducted of the effectiveness of the "Know Your Body" curriculum in reducing coronary heart disease risk factors among black elementary and junior high school students. The evaluation, part of a five-year longitudinal study, linked effectiveness of teachers' implementation with student outcomes and identified program weaknesses during implementation. Teachers with higher effectiveness scores had significantly more favorable student outcomes in systolic blood pressure, diastolic blood pressure, HDL cholesterol, HDL/cholesterol ratio, serum thiocyanate, and fitness. Of 82 teachers, 38 (46%) had scores reflecting effective teaching. Lack of time and commitment and inadequate use of the behavioral teaching approach demanded by the curriculum contributed most to implementation failure. Teachers as insufficient role models emerged as an important factor. Future research needs appropriate reinforcement of teacher participation and measurement of the environmental factors and personal teacher characteristics that may affect program implementation. School health education programs need an intensive training component that will enable teachers to adopt behavioral teaching approaches, promote teacher's examination and change of their personal risk factors, and stress the classroom dynamic of teachers as role models.