Barriers and enablers to implementing teacher led tuberculosis education among school adolescents in southern Ethiopia

Abstract Background Background: Ethiopia is among the 30 high‑burden countries for tuberculosis. Adolescents are vulnerable due to overcrowded schools, social networks, and limited knowledge. Teacher‑led tuberculosis education is a contextualised intervention. This study explored barriers and enablers to implementing teacher‑led education in schools in the Gedeo Zone, southern Ethiopia. Methods A qualitative descriptive design with semi‑structured interviews was used with 22 participants, including teachers, principals, health workers, and heads of health and education offices, from May to July 2025. Data collection, coding, and analysis were guided by the Consolidated Framework for Implementation Research. Interviews were audio‑recorded, transcribed, translated verbatim, and analysed using directed content analysis. Results Results: Thirteen themes across four domains were identified, comprising eight barriers and five enablers. Barriers included suboptimal package design, weak collaboration between the health and education sectors, limited policy guidance, lack of structured workflows, competing workloads, inadequate financial and human resources, and insufficient teacher training on causes, symptoms, transmission, and prevention. Enablers included relative advantages over existing programmes, greater efficiency, sustained access, promotion of earlier health‑seeking behaviour, structural benefits, low complexity, ease of classroom integration, compatibility with the science curriculum, and a strong tension for change driven by the high community burden. Conclusions Teacher‑led tuberculosis education in southern Ethiopia is feasible and promising owing to its advantages, adaptability, low complexity, urgency, and compatibility. Implementation is hindered by weak collaboration, limited policy guidance, inadequate resources, and insufficient teacher training. For success, the design of teacher-led tuberculosis education interventions must first address the barriers identified at the pre-implementation stage.