Skip to main content


Table 2 Possible barriers to adhering to guideline recommendations in practice based on the Cabana et al. model [13]*

From: Improving occupational physicians’ adherence to a practice guideline: feasibility and impact of a tailored implementation strategy

Knowledge-related barriers  
Lack of awareness/familiarity: OPs may be unaware of the (exact) content of the guideline recommendation
Attitude-related barriers  
Lack of agreement: OPs may disagree with the guideline recommendation due to a perceived lack or inadequate interpretation of evidence or due to a lack of applicability of the recommendations in general and more specifically to individual patients
Lack of self-efficacy: OPs may believe that they cannot perform the guideline recommendation because they lack appropriate training or experience
Lack of outcome expectancy: OPs may believe that even if they can perform the recommendation it will not affect patient outcomes
Inertia of previous practice/lack of motivation: OPs may not follow recommendations because of the difficulties of changing habits or old routines, or a lack of motivation
External barriers  
Patient factors: OPs may be unable to reconcile patient preferences and demands with the guideline recommendations, or they may believe that patients are unable to perform the necessary actions
Guideline recommendation factors: OPs may believe that the guideline recommendations are unclear or ambiguous, incomplete, or too complex
Environmental factors: OPs may be unable to overcome barriers in their practice environments, such as a lack of time (time pressure), a lack of resources/materials, a lack of reimbursement, and organizational constraints within their own practice, in other organizations (e.g., out-of-hours services and pharmacies), or between organizations (e.g., cooperation and arrangements with medical specialists and GPs)
  1. *Adapted version from Lugtenberg et al. [29]; OP = occupational physician.