title: Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: analysis of a peer group training.
abstract: Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training was developed for Dutch occupational physicians (OPs) focusing on identifying barriers and addressing them. The aim of this study was to provide an overview of the barriers that OPs perceived in adhering to the Dutch guideline on mental health problems as well as their solutions to overcome them.
  
  
  
  A qualitative study was conducted using data from the peer group training. Thirty-two (6 groups of 4 to 6) OPs received a multiple-session interactive training over the course of a year, focusing on identifying and addressing barriers, using a Plan-Do-Check-Act approach. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers with a selection of 50 % (21 out of 42) of the transcripts to identify the perceived barriers and the suggested solutions, using AtlasTi 7.0.
  
  
  
  Knowledge-related barriers were perceived regarding the content of all parts of the guideline. Commonly perceived attitude-related barriers were a lack of self-efficacy to perform certain guideline recommendations and difficulties with changing habits and routines. External barriers that were commonly perceived were work-contextual barriers, such as a lack of time/work pressure, tight contracts between occupational health services (OHSs) and employers, and conflicting policy of and a lack of collaboration with other parties (e.g. employer, other healthcare providers). The most often tested solutions by OPs during the training were sharing information, experiences, tips and tricks and referring to existing tools, or developing new tools to facilitate guideline usage.
  
  
  
  Dutch OPs perceive a range of knowledge-related, attitude-related and external barriers in adhering to the guideline on mental health problems. The tested solutions during the training particularly seemed to focus on knowledge and attitude-related barriers. To optimally implement this or similar mental health guidelines, it may be important to complement guideline training and education of individual or groups of OPs, with interventions that address external barriers such as changing tight contracts, or improving communication and collaboration with other parties.
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands. m.lugtenberg@tilburguniversity.edu.|Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. m.lugtenberg@tilburguniversity.edu.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Lugtenberg
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Karlijn M
authors.initials: KM
authors.lastname: van Beurden
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Evelien P M
authors.initials: EP
authors.lastname: Brouwers
authors.affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.|Phrenos Centre of Expertise, PO Box 1203, 3500 BE, Utrecht, The Netherlands.|Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900 AH, Castricum, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Jac J L
authors.initials: JJ
authors.lastname: van der Klink
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Margot C W
authors.initials: MC
authors.lastname: Joosen
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006282:Health Personnel; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009786:Occupational Health Services; D010379:Peer Group; D010465:Perception; D036301:Qualitative Research
keywords: Barriers; Implementation; Mental health; Occupational medicine; Practice guideline; Solutions