Revising Cabana et al.'s [12] system, Espeland and Baerheim [current study] related barriers to* | Oxman and Flottorp [22] related barriers to | Thompson et al. [24] related barriers to | Grol [21] related barriers to | Mäkelä and Thorsen [23] related barriers to |
Knowledge | Knowledge and attitudes | Information management | Individual clinician | Professionals |
Lack of knowledge of the guideline | Clinical uncertainty | Clinical uncertainty | Knowledge | Knowledge |
Attitudes/feelings | Sense of competence | Sense of competence | Skills | Skills |
Lack of agreement with its decision criteria | Compulsion to act | Standards of practice | Attitudes | Attitudes |
Lack of outcome expectancy | Information overload | Financial disincentives | Habits | Patients |
Lack of process expectancy | Prevailing opinion | Administrative issues | Social context | Knowledge |
Lack of feelings expectancy | Standards of practice | Perception of liability | Patients | Skills |
Lack of self-efficacy | Opinion leaders | Patient expectations | Colleagues | Attitudes |
Lack of motivation/inertia of previous practice | Medical training | Authorities | Other resources | |
External barriers related to | Advocacy | Organisational context | Environment | |
Guideline (e.g., guideline unclear) | Practice environment | Available resources | Social factors | |
Patient (e.g., patient pressure) | Financial disincentives | Organisational climate | Organisational factors | |
Setting | Organisational constraints | Structures, etc. | Economic factors | |
- lack of time | Perception of liability | |||
- lack of other practice resources | Patient expectations | |||
- increased costs | ||||
- increased malpractice liability | ||||
- pressures in the health care system | ||||
- improper access to health care services |