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Hum Reprod. 2005 Dec;20(12):3301-6. Epub 2005 Jul 29.

Barriers to physician adherence to a subfertility guideline.

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Department of Obstetrics and Gynaecology and Centre for Quality of Care Research (WOK), Radboud University, Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.



Guidelines aim to improve clinical practice but are not self-implementing. Insight into barriers to physician guideline adherence is crucial for development of effective implementation strategies. The study aim was to identify barriers to physician adherence to an intrauterine insemination (IUI) guideline of the Dutch Society of Obstetrics and Gynaecology.


We conducted a cross-sectional survey among all Dutch gynaecologists, residents and fertility physicians (n = 860), using written questionnaires that were based on information obtained in focus group discussions. We investigated barriers related to physicians' knowledge and attitudes, and external barriers.


The response rate was 65%. We used 344 questionnaires for analysis. Physicians' knowledge was adequate, with a median unfamiliarity rate with each of the 31 key guideline recommendations of 12%. Physicians' attitudes were generally positive, especially regarding guideline development and quality. Important attitude-related barriers included physicians' lack of self-efficacy regarding physician-patient communication and poor outcome expectancy. External barriers were mostly related to specific patient characteristics and associated with higher age of physicians and fewer consultations for fertility problems per week.


Multiple barriers impede physician adherence to subfertility guidelines, mainly physicians' lack of self-efficacy and low outcome expectancy. Both physicians and patients play an important role in future implementation interventions to optimize subfertility care.

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