Social Diffusion and Peer Influence on Guideline-Adherent Tonsillectomy Prescribing in German Otolaryngologists: A Cross-Sectional Study.

BACKGROUND: Despite clear recommendations from evidence-based guidelines to restrict tonsillectomies for adult patients with infrequent tonsillitis, adoption among German otolaryngologists remains limited. Social influences, including opinion leaders and perceived social norms across peers, may shape practitioners' adherence to these guidelines. Therefore, this study examined how German otolaryngologists perceive peer social norms and opinion leaders regarding tonsillectomy guidelines and how these perceptions relate to their own guideline adherence. METHODS: In a cross-sectional online survey (N = 100), otolaryngologists reported their tonsillectomy practices, attitudes toward relevant guidelines, and perceptions of both peer and opinion leader behaviors. Guideline adherence was assessed via self-reported clinical decisions. Social influences were analyzed using ordinal logistic regression. RESULTS: While most otolaryngologists reported guideline-consistent attitudes and behavior, many perceived their peers and opinion leaders as less adherent. Guideline adherence was significantly associated with individual tonsillectomy attitudes (odds ratio [OR] = 0.18, P < 0.001) and perceived opinion leader attitudes (OR = 0.33, P = 0.013) but not with perceptions of the general peer group or demographics. LIMITATIONS: The study was cross-sectional and employed a convenience sample, limiting both causal inference and generalization. CONCLUSIONS: Otolaryngologists' perceptions of opinion leaders are significantly associated with their adherence to tonsillectomy guidelines, even beyond their own attitudes. Misperceptions about peer and leader practices may hinder guideline diffusion. IMPLICATIONS: Interventions targeting opinion leaders and correcting misperceptions may accelerate guideline adoption in clinical practice.