119 Implementation and experiences of the Solid Start program METHODS Research design The first research question was answered by using quantitative data from questionnaires among municipalities. The second research question was answered with qualitative data from interviews and focus group discussions (FGDs). We had several rounds of data collection in subsequent years after the implementation of the nationwide Solid Start program in September 2018 (Figure 1). Study setting The national Solid Start program was launched by the Dutch government in September 2018. The Ministry of Health, Welfare and Sport facilitated various (supportive) measures, including the possibility for municipalities to request Solid Start funds at three time points (March 2019, October 2019 and April 2020) to start building or strengthening their local Solid Start coalition. The funds could be utilized at municipality level to start a local coalition, but municipalities could also choose to pool their resources and collectively work towards a (sub-)regional approach or coalition with other municipalities. Municipalities were in the lead to create coalitions of partners from the medical and social sector who jointly made agreements about care and support during the first thousand days and to families in vulnerable situations. Some basic elements of these coalitions were set (35). Municipalities received support from Pharos (the Dutch Centre of Expertise on Health Disparities) to build their coalition. Additionally, municipalities were able to use an analysis tool to map the current and envisioned situation, an inventory of effective interventions, key local, regional and national data, and inspiration from successful examples across the country. Appendix 1 provides a description of the Dutch care and support system during the first thousand days. This study was part of the national monitor of the Solid Start program that is conducted by the National Institute for Public Health and the Environment (Dutch abbreviation: RIVM) by commission of the Ministry of Health, Welfare and Sport. The RIVM monitors the implementation of the Solid Start program by collecting both quantitative data on process- and outcome indicators as well as qualitative data on experiences and developments. Since 2021, the RIVM also provides support to municipalities in monitoring their local approach. Appendix 2 provides an overview of the national and local monitor. 5
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