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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]

Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole. [ABSTRACT FROM AUTHOR]

We systematically reviewed school-based skills building behavioural interventions for the prevention of sexually transmitted infections. References were sought from 15 electronic resources, bibliographies of systematic reviews/included studies and experts. Two authors independently extracted data and quality-assessed studies. Fifteen randomized controlled trials (RCTs), conducted in the United States, Africa or Europe, met the inclusion criteria. They were heterogeneous in terms of intervention length, content, intensity and providers. Data from 12 RCTs passed quality assessment criteria and provided evidence of positive changes in non-behavioural outcomes (e.g. knowledge and self-efficacy). Intervention effects on behavioural outcomes, such as condom use, were generally limited and did not demonstrate a negative impact (e.g. earlier sexual initiation). Beneficial effect on at least one, but never all behavioural outcomes assessed was reported by about half the studies, but this was sometimes limited to a participant subgroup. Sexual health education for young people is important as it increases knowledge upon which to make decisions about sexual behaviour. However, a number of factors may limit intervention impact on behavioural outcomes. Further research could draw on one of the more effective studies reviewed and could explore the effectiveness of "booster" sessions as young people move from adolescence to young adulthood.

Objective: To examine the impact of single or dual component incentive schemes on health and social behaviours, in young people. Design: A systematic review. Method: Systematic and comprehensive cross-disciplinary searches were conducted to identify research. Following screening for relevance, included studies were quality assessed and data extracted. Both outcome and process evaluation studies were included in either a statistical meta-analysis or narrative synthesis. Results: Sixteen trials and seven process evaluations were included in the review. There is some evidence to show that incentives are effective in improving single health behaviours, but not complex health behaviours. Incentives had no impact on levels of reported effort, or attendance in education studies. Whilst viewed favourably by young people, incentives did not necessarily translate into improvements in targeted behaviours. Conclusion: Evidence suggests that incentives schemes do not provide policy makers or practitioners with a simple route to improving young people's health or other behaviours. However, there is evidence that incentives can be useful in encouraging positive health behaviour change where a simple or single action is required. (Contains 3 figures and 1 table.)

Purpose: The limited evidence of effectiveness of existing teenage pregnancy strategies which focus on sex education, together with growing evidence that factors such as poor school ethos, disaffection, truancy, poor employment prospects and low expectations are associated with teenage pregnancy, has increased interest in interventions which target these "wider" social determinants. This paper aims to identify promising interventions and priorities for future research and to make recommendations for policy and practice in the UK. Design/methodology/approach: This paper discusses the evidence regarding the potential of interventions which target determinants of teenage pregnancy relating to school disaffection and low expectations, drawing on recent systematic reviews and trials to consider future directions for research, policy and practice. Findings: High-quality research evidence illustrates the potential of two approaches to address determinants of teenage pregnancy relating to disaffection and low expectations. These are school-ethos interventions, which aim to facilitate a positive and inclusive school-ethos, strengthen school relationships and reduce disaffection and targeted, intensive youth work interventions, which aim to promote positive expectations, vocational readiness and self-esteem through vocational and life-skills education, volunteering and work experience. Practical implications: Two forms of intervention which address key social determinants of teenage pregnancy--school-ethos interventions and targeted youth work interventions--require more attention from researchers and policy-makers. Originality/value: This paper calls for a shift in the research and policy agenda. In addition to interventions that aim to address proximal, individual factors, such as sexual health-related knowledge, there should be a more complementary focus on socio-environmental as well as targeted individual-focused interventions wider social determinants of teenage pregnancy.