Table 3. Factors That Affect Physician Adherence to Preventive Service Guidelines.
| Factor | Number of Participants Reporting Each Factor | ||
|---|---|---|---|
| Rural (n=10) | Suburban (n=10) | Urban (n=9) | |
| Knowledge | |||
| Familiarity and awareness | 10 | 10 | 9 |
| Attitude | |||
| Agreement with specific guidelines | 10 | 10 | 9 |
| Cost-benefit analysis | 9 | 10 | 8 |
| Physician clinical and personal experiencesc | 8 | 6 | 7 |
| Evidence interpretation | 6 | 8 | 5 |
| Opinion on guideline developer | 6 | 4 | 6 |
| Societal priorities and normsc | 5 | 6 | 3 |
| Patient applicability | 3 | 2 | 1 |
| Outcome expectancy | 10 | 10 | 9 |
| Anticipated patient adherencec | 10 | 10 | 9 |
| Physician persistence | 10 | 7 | 9 |
| Motivation or inertia of previous practice | 9 | 10 | 9 |
| Habit or routine | 8 | 10 | 9 |
| Desire and ability to adaptc | 8 | 7 | 8 |
| Self-efficacy | 6 | 4 | 7 |
| Agreement with guidelines in general | 5 | 3 | 2 |
| Misperception about adherencec,d | 5 | 3 | 5 |
| Behavior | |||
| Patient factors | 10 | 10 | 9 |
| Patient willingness | 10 | 10 | 8 |
| Visit frequencyc | 10 | 9 | 9 |
| Patient knowledgec | 10 | 7 | 8 |
| Patient health statusc | 9 | 8 | 9 |
| Patient-physician relationshipc | 8 | 7 | 4 |
| Patient dishonestyc,d | 2 | 3 | 2 |
| Environmental factors | |||
| Time | 10 | 9 | 9 |
| Workload divisionc | 3 | 3 | 3 |
| Work flow: reliability and efficiencyc | 10 | 9 | 9 |
| Visit typec | 10 | 9 | 9 |
| Resources: in-house and external | 10 | 5 | 8 |
| Data: management and accessc | 8 | 8 | 9 |
| Reimbursement or payment | 8 | 5 | 5 |
| Care coordinationc | 5 | 8 | 6 |
| Medical legal | 4 | 3 | 2 |
| Peer pressurea | 3 | 5 | 2 |
| Guideline factors | 7 | 7 | 9 |
| Guideline complexityb | 6 | 5 | 8 |
| Agreement between guideline developers | 4 | 7 | 8 |
| Cross-cutting | |||
| Descriptive epidemiologyc | 10 | 7 | 8 |
| Performance feedback and public reportingc | 7 | 7 | 5 |
| Residency and trainingc | 7 | 2 | 4 |
| Media and information campaignsc | 3 | 3 | 5 |
a
Factors are classified according to the framework created by Cabana et al8 with additional sub-categories from Espeland,17
b
Lugtenberg,18
c
and this study.
d
Factors were discussed as both barriers and facilitators except for misperception of adherence and patient dishonesty, which were discussed only as barriers.