title: Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective.
abstract: OBJECTIVE
  Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.
  
  
  METHODS
  Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software.
  
  
  RESULTS
  In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers.
  
  
  CONCLUSIONS
  Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-7900-7533
authors.initials: D
authors.lastname: Spitaels
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
authors.forename: Patrik
authors.initials: P
authors.lastname: Vankrunkelsven
authors.affiliation: Watertorenlaan 2, 1930, Zaventem, Belgium.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Desfosses
authors.affiliation: Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Luyten
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium.
authors.forename: Sabine
authors.initials: S
authors.lastname: Verschueren
authors.affiliation: Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.|Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium.
authors.forename: Dieter
authors.initials: D
authors.lastname: Van Assche
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.affiliation: Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.|IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Rosella
authors.initials: R
authors.lastname: Hermens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D015897:Comorbidity; D054626:Consumer Health Information; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000523:psychology* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012931:Social Environment
keywords: decision making; facilitators; implementation; knee osteoarthritis; nonadherence; qualitative research