Introduction/Objective: to identify the obstacles to change confronting general practitioners (GPs) asked to implement guidelines for the management of patients with depression.

Methods: (1) Interviews with GPs who have been asked to implement the guidelines. The interviews were transcribed and analysed, drawing on psychological theories of behaviour change; (2) extraction of data from the records of 7 newly diagnosed patients per GP to determine compliance with the guidelines. This is part of a randomised controlled trial of the effects of selecting implementation strategies according to the prevailing obstacles to change.

Results: 36 GPs have been interviewed. There were a wide variety of obstacles to change. Some GPs were not genuinely prepared to change; others had concerns about their ability to change. A particular problem concerned skills - the choice of phrases to ask about suicide risk or to inform about medication. There were also a small number of GPs whose personal problems were obstacles to change.

Discussion: An interview and record review is one method for identifying the obstacles. There were a wide variety of obstacles to implementing guidelines for depression among GPs. The use of a single implementation strategy would not be appropriate to them all.