Table 4.

Barriers to implementation of clinical practice guidelines.

Category	Barriers	Total Number of Mentions
Healthcare professional	Lack of awareness of the existence of guidelines	2
	Lack of familiarity with CPGs recommendation	3
	Disagreement with the recommendations of the CPG	3
	Doubts about the positive impact of CPGs on outcomes	2
	Preference for experience over CPGs	1
	Lack of effective communication, research, and self-learning skills	1
	Lack of healthcare professional motivation	3
Guidelines	Lack of clarity or complexity	4
	Outdated guidelines	1
	Guideline trustworthiness (i.e., evidence quality, content, and developer)	6
Patients	Language and literacy problems	1
	Lack of motivation, compliance, and knowledge to follow the recommendations	4
	Patient comorbidities, mobility problems, polypharmacy, and self-empowerment capacity	2
	Patients’ financial situation and occupational status	5
Environment	Lack of protocols and processes of dissemination and implementation	7
	Lack of resources (staff, equipment, and beds)	7
	Lack of time	2
	Lack of clinical audit and feedback	4
	Difficulties with availability of medicines or test	2
	Lack of financial incentives	3
	Lack of training	4
	Insurance does not cover recommendations	1
	Lack of regulation and supervision	1
	Lack of evidence-based culture and education	2
	Lack of policy makers supports	1
	Deficiencies in the referral of patients to services	1