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

Completed

Conditions

Intervention / Treatment

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

Interventional

Enrollment (Actual)

106

Phase

  • 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

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
Intervention / Treatment
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

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

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)

September 1, 2024

Primary Completion (Actual)

May 1, 2025

Study Completion (Actual)

July 1, 2025

Study Registration Dates

First Submitted

January 19, 2026

First Submitted That Met QC Criteria

January 19, 2026

First Posted (Actual)

January 28, 2026

Study Record Updates

Last Update Posted (Actual)

February 3, 2026

Last Update Submitted That Met QC Criteria

January 30, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID 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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