Table 2 Barriers to adherence and suggested interventions to improve adherence to recommendations on diagnosing uncomplicated UTI

Barriers related to knowledge

No barriers

Not applicable

Barriers related to attitudes

Lack of agreement with recommendation

Lack of evidence:

Arguing supporting evidence for performing only the nitrite dipstick test (rather than combining it with leukocyte esterase dipstick test).

Lack of applicability:

Belief that benefits do not outweigh patients' discomfort due to time to wait for results of dipslide, particularly in case of serious complaints.

Small group education:

Provide detailed information on supporting evidence of recommendations and discuss recommendations in peer review groups.

External barriers

Environmental factors

Organisational constraints

Within organisation:

- Difficult to change routines of practice assistants.

- Not possible to apply the dipslide on Friday (nobody available to read the results on Saturday).

Outside organisation:

Difficult to apply dipslide in weekend in out of hour service, particularly on Sunday (nobody available to read the results on Monday).

Dealing with diagnosing UTI in out of hours:

- Develop regional protocols for weekend based on local agreements with hospitals.

- Provide method for arranging local agreements in national guideline.

- Adapt guideline recommendation to current practice by not recommending using dipslides in out of hour services.

Lack of/inconvenient resources/materials

Lack of availability/inconvenience:

Dipslides are inconvenient and difficult to apply in practice and not everywhere available.