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

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)