14 CHAPTER 1 includes the implementation of interventions, including ‘Not Pregnant Now’ that supports professionals in sustaining the autonomy of vulnerable groups in making informed choices regarding pregnancy and contraception (94). Starting from 2019, the Ministry of Health, Welfare and Sport commissioned the National Institute for Public Health and the Environment (Dutch abbreviation: RIVM) to monitor the action program Solid Start. There are several reasons to monitor policy programs like the action program Solid Start. These reasons, for example, relate to accountability, learning and engagement (95, 96). Firstly, monitoring can be a tool to document actions and assess their alignment with predetermined plans or objectives. Secondly, monitoring for learning aims to provide insight into the approach (e.g. progress, facilitators, barriers) to allow reflection and make improvements. Thirdly, monitoring can facilitate the sharing of successes and small-wins, thereby keeping people engaged and enthusiastic. The monitoring efforts in relation to the action program Solid Start initially focus on gaining insight into how certain processes and outcomes develop over time, without determining causal effects. In order to start monitoring the action program Solid Start, decisions had to be made on how to operationalize certain concepts (e.g. vulnerability) and which data and indicators are useful. Considering the cross-sectoral approach, a cross-sectoral data infrastructure was considered beneficial in the monitoring endeavours. OBJECTIVE OF THIS THESIS The main objective of this thesis is to provide insight into the adoption of the action program Solid Start, thereby focusing on monitoring and cross-sectoral collaboration. In this thesis, the monitoring aspect relates to both the what and how to monitor, as well as the developments and experiences with the action program Solid Start. THESIS CONTEXT This thesis constitutes the scientific basis for the monitoring of the Dutch action program Solid Start that is conducted by the National Institute for Public Health and the Environment. The National Institute for Public Health and the Environment is a knowledge institute that conducts independent scientific research for commissioning partners. In the case of the action program Solid Start, this is the Dutch Ministry of Health, Welfare and Sport (97). The acquired knowledge is shared with the government, professionals and the general public to support a healthy population and environment. The organization is an agency of the Dutch Ministry of Health, Welfare and Sport. In 2019, the National Institute for Public Health and the Environment started to monitor the Dutch action program Solid Start at national level. This national monitor has quantitative
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