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Background There is a growing evidence base which shows that community development can make an important contribution to reducing health inequalities, but embedding community development as a mainstream approach into local systems is challenging. The literature relevant to the question of how to embed community development approaches is reviewed in this paper. Methods Using guidance from the Joanna Briggs Institute, a scoping review was carried out to identify relevant literature. Systematic searches were carried out across multiple databases, experts in the field were contacted and references of included studies were screened. Search results were screened against exclusion criteria. The Consolidated Framework for Implementation Research was used as a framework to identify factors hindering or supporting embedding. Findings The review identified thirty-five documents which described embedded, or attempts to embed, community development approaches in fourteen different countries. The most common community development approaches were strength-based or co-production. Four studies reported primary research on the embedding process or systems change. Several barriers and facilitators to embedding were identified including those related to funding arrangements, organizational and system culture, building trust with communities and the need for training and support for staff. Conclusion Using an implementation science framework, this scoping review has assessed the nature of the evidence base on how to embed community development. While the evidence base uncovered is currently limited, barriers and facilitators to embedding identified in the review can be used to both inform future attempts to embed community development and provide the building blocks for future primary research. [ABSTRACT FROM AUTHOR]

Background: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence‐based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision‐making and practices. Methods: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi‐structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. Results: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision‐making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision‐making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. Conclusions: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision‐making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence‐based practice and approaches to change need to take into account these different levels of influence. [ABSTRACT FROM AUTHOR]

Background: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices., Methods: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically., Results: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described., Conclusions: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence., (© 2018 the Authors. Birth published by Wiley Periodicals, Inc.)