Rationale, aims and objectives 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. ResultsIn 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. There is thus a clear need for interventions to improve guideline adherence to obtain optimal care for the patients. However, to allow effective intervention strategies, first qualitative research is needed that addresses possible barriers and facilitators to guideline adherence in current care. 17 To date, barriers and facilitators have mainly been studied from the health care professionals' perspective. 18 However, patients play a crucial role in upgrading care to better guideline adherence as their experiences, preferences, concerns, and care management can substantially influence the decision-making process for optimal knee OA management. Conclusions 19-21Therefore, the aim of this study was to investigate barriers and facilitators in current care of knee OA from the patients' perspective.2 | METHODS | Study designTo identify barriers and facilitators in the management of knee OA, semistructured face-to-face interviews were conducted with patients.The interview script was based on the Belgian set of quality indicators. 16 This study was described in accordance with the consolidated criteria for reporting Qualitative Research (COREQ checklist). 22 | Study populationPatients with knee OA were recruited in 3 different settings: from the interviewers' (JD) general practice population, from the patient population of GP practices in the same region, and finally by an advertisement in the monthly magazine of the national federation for patients with rheumatic diseases. In the GP settings, a search was performed by the GP in the electronic health record to select eligible patients with a diagnosis of knee OA.The inclusion criteria for this study were as follows: (1) clinical and/or ra...