Table 2.

Overview of perceived barriers to using the guideline on mental health problems among OPs^a

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.)

^aFor which the framework of barriers of Cabana et al. [19] was used as a basis to classify the perceived barriers to guideline adherence

OP(s) occupational physician(s), OHS(s) occupational health service(s), GP general practitioner, UWV Dutch Institute for Employee Benefit Schemes (UWV in Dutch)