Adherence to mental health guidelines by Dutch occupational physicians

Background: In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems. Objectives: 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.