title: A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care.
abstract: OBJECTIVE
  In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines.
  
  
  METHODS
  Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research.
  
  
  RESULTS
  CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation.
  
  
  CONCLUSIONS
  The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provided.
authors.affiliation: Departments of Health Technology and Services Research, Public Administration, University of Twente, Enschede, The Netherlands.
authors.forename: Annemieke A J
authors.initials: AA
authors.lastname: Konijnendijk
authors.forename: Magda M
authors.initials: MM
authors.lastname: Boere-Boonekamp
authors.forename: Riet M E
authors.initials: RM
authors.lastname: Haasnoot-Smallegange
authors.forename: Ariana
authors.initials: A
authors.lastname: Need
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000517:prevention & control*; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services; D036301:Qualitative Research; D011787:Quality of Health Care
keywords: child abuse and neglect; clinical practice guidelines; clinician decision making; focus groups; preventive child health care services; quality of care