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Table 2 Overview of perceived barriers to using the guideline on mental health problems among OPsa

From: Occupational physicians’ perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: analysis of a peer group training

1. Knowledge-related barriers
 - Lack of knowledge
  Lack of knowledge of (content of) guideline recommendations
  Lack of knowledge of availability of guideline-related tools (e.g. rumination exercise, metaphors)
2. Attitude-related barriers
 - Lack of agreement guidelines in general
  Lack of agreement with the concept of guidelines (e.g. perceiving them as too dogmatic, involving too much bureaucracy, too rigid to apply, not practical).
 - Lack of agreement with this specific guideline
  Lack of agreement with the guideline due to a lack of applicability of its recommendations in practice (e.g. perceiving practice as more complex than guideline and not being able to capture reality in the guideline).
 - Lack of self-efficacy
  Lack of believe that one can actually perform a behavior or guideline recommendation.
 - Lack of outcome expectancy
  Lack of believe that a given behavior will actually lead to a particular consequence.
 - Inertia of previous practice
  Experiencing difficulties with changing habits and routines in order to learn new things.
3. External barriers
 - Worker factors
  Perceiving worker factors as difficult in adhering to the guideline (e.g. worker preferences, demands, behavior).
 - Guideline factors
  Perceiving the guideline or its recommendations as difficult in adhering to the guideline (e.g. not clear, verbose, inconsistent, too complex of a terminology, not easy to read/readable).
 - Work-contextual factors
  Perceiving factors in the work-context of the OP as difficult in adhering to the guideline, such as:
   → Work pressure/Lack of time
   → Setting OPs operate in (e.g. difficult setting in terms of the role OPs have in assessments, questioning their independency towards the worker)
   → Organizational constraints
     Policy of OHS (e.g. policy with respect to work pressure)
     Non-user friendly computer systems (e.g. difficult to use/conflicting with one another)
     Lack of resources/practical constraints (e.g. not having tools available when working at several locations)
   → Contracts between OHSs and employers (e.g. too tight arrangements in terms of available time/reimbursement)
   → Conflicting policy of and lack of collaboration with other parties
     Employer policy (e.g. conflicting policy with respect to what is best for workers in terms of working/not working, the provided care, non-work-related problems)
     Collaboration with employer (e.g. no adequate arrangements in terms of roles and treatment).
     Policy of other disciplines (GP, psychologists etc.) (e.g. conflicting policy with respect to type and course of treatment, taking factor work into account)
     Collaboration with other disciplines (GP, psychologists etc.) (e.g. no adequate arrangements in terms of communication, reporting and feedback)
   → Fear of misuse of information/control by others (e.g. fear that medical practice data will be used for other purposes by disciplinary jurisdiction or by Dutch Institute for Employee Benefit Schemes) (UWV in Dutch) etc.)
  1. aFor which the framework of barriers of Cabana et al. [19] was used as a basis to classify the perceived barriers to guideline adherence
  2. OP(s) occupational physician(s), OHS(s) occupational health service(s), GP general practitioner, UWV Dutch Institute for Employee Benefit Schemes (UWV in Dutch)