abstract: 'Objective To establish the views and experiences of healthcare

  professionals in relation to interventions targeted at them to reduce

  unnecessary caesareans.

  Design Qualitative evidence synthesis.

  Setting Studies undertaken in high-income, middle-income and low-income

  settings.

  Data sources Seven databases (CINAHL, MEDLINE, PsychINFO, Embase, Global

  Index Medicus, POPLINE and African Journals Online). Studies published

  between 1985 and June 2017, with no language or geographical

  restrictions. We hand-searched reference lists and key citations using

  Google Scholar.

  Study selection Qualitative or mixed-method studies reporting health

  professionals'' views.

  Data extraction and synthesis Two authors independently assessed study

  quality prior to extraction of primary data and authors''

  interpretations. The data were compared and contrasted, then grouped

  into summary of findings (SoFs) statements, themes and a line of

  argument synthesis. All SoFs were Confidence in the Evidence from

  Reviews of Qualitative research (GRADE-CERQual) assessed.

  Results 17 papers were included, involving 483 health professionals from

  17 countries (nine high-income, six middle-income and two low-income).

  Fourteen SoFs were identified, resulting in three core themes:

  philosophy of birth (four SoFs); (2) social and cultural context (five

  SoFs); and (3) negotiation within system (five SoFs). The resulting line

  of argument suggests three key mechanisms of effect for change or

  resistance to change: prior beliefs about birth; willingness or not to

  engage with change, especially where this entailed potential loss of

  income or status (including medicolegal barriers); and capacity or not

  to influence local community and healthcare service norms and values

  relating to caesarean provision.

  Conclusion For maternity care health professionals, there is a

  synergistic relationship between their underpinning philosophy of birth,

  the social and cultural context they are working within and the extent

  to which they were prepared to negotiate within health system resources

  to reduce caesarean rates. These findings identify potential mechanisms

  of effect that could improve the design and efficacy of change

  programmes to reduce unnecessary caesareans.'
affiliation: 'Kingdon, C (Corresponding Author), Univ Cent Lancashire, Sch Community
  Hlth \& Midwifery, Fac Hlth \& Wellbeing, Preston, Lancs, England.

  Kingdon, Carol; Downe, Soo, Univ Cent Lancashire, Sch Community Hlth \& Midwifery,
  Fac Hlth \& Wellbeing, Preston, Lancs, England.

  Betran, Ana Pilar, WHO, Dept Reprod Hlth \& Res, Geneva, Switzerland.'
article-number: e025073
author: Kingdon, Carol and Downe, Soo and Betran, Ana Pilar
author-email: ckingdon@uclan.ac.uk
author_list:
- family: Kingdon
  given: Carol
- family: Downe
  given: Soo
- family: Betran
  given: Ana Pilar
da: '2023-09-28'
doi: 10.1136/bmjopen-2018-025073
files: []
issn: 2044-6055
journal: BMJ OPEN
keywords-plus: 'OPTIMAL SEARCH STRATEGIES; VAGINAL BIRTH; MIXED-METHOD; CLINICAL

  PATHWAY; MATERNAL REQUEST; OBSTETRICIANS; DELIVERY; RATES; WOMEN; CHOICE'
language: English
month: DEC
number: '12'
number-of-cited-references: '89'
orcid-numbers: Kingdon, Carol/0000-0002-5958-9257
papis_id: a12bcccb4bec3e22b3a9377b58160bfc
ref: Kingdon2018interventionstargete
times-cited: '14'
title: 'Interventions targeted at health professionals to reduce unnecessary caesarean
  sections: a qualitative evidence synthesis'
type: Article
unique-id: WOS:000455309300158
usage-count-last-180-days: '1'
usage-count-since-2013: '6'
volume: '8'
web-of-science-categories: Medicine, General \& Internal
year: '2018'