139 Implementation and experiences of the Solid Start program that the program’s shift from managerial, policy and executive board levels to individual professionals in daily practice takes time and effort: “And we really still need to take the step towards the individual care provider who should work with it, because they are actually in direct contact with that family. [...] I think that’s maybe the most difficult thing, that it doesn’t just stay on those governance tables, but that it’s now transported to where it really needs to be.” - FGD, 2021 In this process, stakeholders suggested to focus on coalitions and professionals’ needs for guidance and support, and to further facilitate knowledge development and dissemination. One of the stakeholders proposed an increase in interactions between national and regional/local level to facilitate these objectives. Lastly, stakeholders commented that Solid Start should be considered in a wider societal perspective as the ultimate form of prevention to address health disparities and tackle poverty issues. This means that Solid Start should maintain its prioritization. Currently, the system is not entirely in alignment with the overarching mission. The underlying reasons for initiating Solid Start are deeply rooted, complicated and not easily resolved, which was why the stakeholders emphasized that a continuous focus is necessary: “I am incredibly happy with a program like Solid Start, because you can just work with many more people and many more municipalities, and extract the effective elements. [..] But if the Solid Start program only lasts four or five years, we haven’t tackled the problem, we’ve just become more aware, and hopefully we’ve been able to find each other better and hopefully there are people in many municipalities who want to continue being a driving force, but we haven’t solved the problem. And we have to get rid of that illusion [that we solve it in four of five years] somehow.” - FGD, 2020 DISCUSSION This study aimed to describe the implementation of the Dutch Solid Start program during 2019 - 2021. Questionnaires, interviews and FGDs revealed progress in crosssectoral collaboration over the years, with a growing number of municipalities forming Solid Start coalitions involving diverse stakeholders. Coalition development varied due to municipalities’ unique challenges, focus and historical contexts. According to the stakeholders, initiating the Solid Start program increased the sense of urgency for the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on care provision. Stakeholders appreciated the program’s local focus and opportunities for learning. However, they experienced that Solid Start is not yet fully incorporated into all professionals’ everyday practice. Most common barriers related to systemic integration at macro-level, including limited resources and collaboration-impeding regulations. Stakeholders emphasized the importance of ensuring Solid Start’s sustainability. 5
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