Effect of a Health Education Program on Teachers' Antibiotic Use Practices

January 30, 2026 updated by: Choman Abdulqahar Khudhur, Hawler Medical University

Effect of a Health Education Program on Teachers' Antibiotic Use Practices and Resistance Prevention: A Randomized Controlled Trial Among High School Teachers in Koya District, Iraq

Antibiotic resistance is a growing public health problem caused in part by inappropriate use of antibiotics. Teachers play an important role in shaping health knowledge and behaviors within schools and communities. This study evaluates the effect of a structured health education program on teachers' antibiotic use practices among high school teachers in the Koya District, Erbil City, Iraq.

In this randomized controlled trial, eligible teachers were assigned to either an intervention group that received a targeted health education program on appropriate antibiotic use and resistance prevention, or a control group that did not receive the program during the study period. Teachers' antibiotic use practices were assessed before and after the intervention using a structured questionnaire.

The goal of this study is to determine whether a health education program can improve responsible antibiotic use practices and reduce behaviors that contribute to antibiotic resistance. The findings may help inform future school-based health education strategies aimed at preventing antibiotic resistance at the community level.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Bacterial antibiotic resistance represents a major global health challenge driven largely by inappropriate antibiotic use, including self-medication, incomplete treatment courses, and misuse for non-bacterial illnesses. Educational interventions targeting key community members have been recognized as an effective strategy for promoting responsible antibiotic use. Teachers, as trusted role models, have the potential to influence health behaviors among students, families, and the broader community.

This study was designed as a pragmatic, individually randomized controlled trial to evaluate the effect of a health education program on teachers' antibiotic use practices among high school teachers in the Koya District, Erbil City, Iraq. Ten high schools were selected using a convenience sampling approach to ensure geographic representation across the district. Eligible teachers who consented to participate were randomly assigned in a 1:1 ratio to either an intervention group or a control group using a lottery-based randomization method.

The intervention consisted of a structured health education program focusing on appropriate antibiotic use, completion of prescribed treatment courses, avoidance of self-medication, and prevention of antibiotic resistance. The control group did not receive the educational program during the study period. Teachers' practices related to antibiotic use were assessed at baseline and after completion of the intervention using a validated questionnaire.

The primary outcome of the study was the change in antibiotic use practice scores from pre-intervention to post-intervention. Secondary outcomes included changes in knowledge and attitudes related to antibiotic use and resistance. Statistical analyses were conducted to compare outcomes between the intervention and control groups and to identify predictors of appropriate antibiotic use practices.

This trial was registered retrospectively due to delayed awareness of trial registration requirements. Participant recruitment, intervention delivery, and data collection were completed prior to registration. The authors confirm that the study protocol, outcome measures, and statistical analysis plan were not modified after data collection or analysis.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
106

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Iraq
    • Erbil Governorate
      • Erbil, Erbil Governorate, Iraq
        • High Schools in Koya District, Erbil City

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • High school teachers currently employed in Koya District, Erbil City, Iraq.
  • Available during the study period.
  • Willing to participate in the health education program and complete the study questionnaires.
  • Provided written informed consent.

Exclusion Criteria:

  • Teachers who previously participated in similar training programs related to antibiotic use or resistance.
  • Teachers involved in the pilot study.
  • Teachers who were absent during data collection periods.
  • Teachers who declined participation or did not complete the pre- or post-intervention assessments.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Intervention Group
Participants in this arm received a structured health education program focused on appropriate antibiotic use, completion of prescribed treatment courses, avoidance of self-medication, and prevention of bacterial antibiotic resistance.
Other: Behavioral

A structured health education program delivered to high school teachers, focusing on appropriate antibiotic use, risks of antibiotic misuse, completion of prescribed treatment courses, avoidance of self-medication, and prevention of bacterial antibiotic resistance. The program was delivered through interactive educational sessions supported by informational materials.

Other Name: Health Education Program on Antibiotic Use and Resistance

Other Names:
  • Health Education Program on Antibiotic Use and Resistance
No Intervention: Control Group
Participants in this arm did not receive the health education intervention during the study period and continued their usual practices without additional educational input.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in Antibiotic Use Practice Score
Time Frame: From baseline (pre-intervention) to post-intervention (approximately 8 weeks)
Change in teachers' antibiotic use practice score measured using the Antibiotic Use Practice Questionnaire, a validated 16-item self-reported scale assessing appropriate antibiotic use, completion of prescribed treatment courses, avoidance of self-medication, and behaviors related to antibiotic resistance prevention. Each item is scored on a 5-point Likert scale (1 = never to 5 = always), resulting in a total score range of 16 to 80, with higher scores indicating better and more appropriate antibiotic use practices.
From baseline (pre-intervention) to post-intervention (approximately 8 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Hawler Medical University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • World Health Organization. Antimicrobial resistance. Geneva: World Health Organization; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2024

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 1, 2025

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 1, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
January 19, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 19, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 28, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
February 3, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 30, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • HMU-AR-TEACHERS-RCT-2026
  • HMU-CON-ETH-249-2024 (Other Identifier: College of Nursing, Hawler Medical University, Erbil, Iraq)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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