Abstract
BACKGROUND AND AIM: Bacterial antibiotic resistance (BAR) has become one of the most urgent public health threats globally, primarily driven by antibiotic misuse, self-medication, and inadequate community awareness. Teachers, as influential figures in promoting health literacy, can play a critical role in fostering responsible antibiotic use. This study aimed to evaluate the effect of a health education program on teachers' knowledge and attitude regarding bacterial antibiotic resistance among high school teachers in Koya District, Iraq. METHOD: This quasi-experimental study was conducted from September 1st, 2024, to July 1st, 2025, among 106 high school teachers selected through convenience sampling and randomly divided into two groups: intervention (n = 53) and control (n = 53). Data were collected using a structured questionnaire consisting of four sections: sociodemographic information, antibiotic use behavior, knowledge, and attitude. Statistical analyses were performed using SPSS version 27.0, including descriptive statistics, paired-sample and independent t-tests, and multivariable linear and logistic regression to identify predictors of post-intervention knowledge and attitude improvement. RESULTS: The findings revealed that the health education program significantly improved both knowledge and attitude scores among teachers in the intervention group (p < 0.001). The intervention increased mean knowledge scores by 8.45 points (β = 0.52, p < 0.001) and enhanced positive attitude change nearly fivefold (AOR = 4.89, 95% CI: 1.98-12.08). Knowledge gain was a strong predictor of attitude improvement, explaining 62% of the model variance (Nagelkerke R (2) = 0.62). No significant associations were found with age, gender, or teaching experience. CONCLUSION: The educational intervention effectively enhanced teachers' knowledge and attitudes toward bacterial antibiotic resistance. Integrating structured antibiotic resistance education into school-based training programs can empower teachers to act as community advocates for rational antibiotic use and resistance prevention. Sustained implementation of such programs, combined with periodic refresher sessions, can further reinforce long-term behavioral change and promote a culture of responsible antibiotic use within educational and community settings.