title: Adherence to mental health guidelines by Dutch occupational physicians.
abstract: BACKGROUND
  In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems.
  
  
  OBJECTIVE
  To examine predictors of adherence to this guideline by Dutch occupational physicians (OPs).
  
  
  METHODS
  Using the Theory of Planned Behaviour, a questionnaire was developed about self-reported guideline adherence of OPs and possible predictors of this behaviour. A total of 165 OPs were approached to complete the questionnaire and registration forms of first consultations of workers with mental health problems. Performance indicators based on the guideline were developed to calculate performance rates of guideline adherence by OPs.
  
  
  RESULTS
  Eighty of 165 (48%) OPs approached completed the questionnaire. Fifty-six OPs returned one or more registration forms, totalling 344 consultations. On a five-point Likert scale, ranging from never (1) to always (5), the mean score on self-reported guideline adherence was 2.35, compared to a mean score of 4.06 on the intention to comply with the guideline. The mean performance rate of OPs ranging from 0 to 2 was 1.27 on diagnosis and 0.60 on guidance. No relation was found between self-reported guideline adherence and performance rates. Self-reported guideline adherence correlated significantly with perceived behaviour control (r = 0.48, P < 0.05), subjective norms (r = 0.33, P < 0.05) and positive job stress (r = 0.35, P < 0.05).
  
  
  CONCLUSIONS
  Guideline adherence by Dutch OPs lags behind its acceptance. Further implementation efforts need to focus on diminishing barriers and enhancing social norms of OPs to work according to the guideline.
authors.affiliation: EMGO Institute, VU University Medical Centre, Public and Occupational Health, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands. d.rebergen@vumc.nl
authors.forename: David
authors.initials: D
authors.lastname: Rebergen
authors.forename: John
authors.initials: J
authors.lastname: Hoenen
authors.forename: Annemarie
authors.initials: A
authors.lastname: Heinemans
authors.forename: David
authors.initials: D
authors.lastname: Bruinvels
authors.forename: Arnold
authors.initials: A
authors.lastname: Bakker
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009787:Occupational Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic; D013315:Stress, Psychological / Q000453:epidemiology