141 Implementation and experiences of the Solid Start program Stakeholders have expressed other needs, which concern responsiveness to stakeholders’ needs, ongoing knowledge development, and client-centered care. Firstly, an increased focus to coalitions and professionals’ needs is required, as policy recommendations often fail to be implemented in practice without adequate support (49). Further developed partnerships require different types of support compared to those in early stages (45, 47). Additionally, professionals must be supported in adapting to their changing roles and responsibilities in daily practice, as behavioural change is difficult and influenced by multiple factors, including knowledge and skills development (50-52). Secondly, ongoing knowledge development and dissemination are vital to overcome collaborative challenges and stimulate learning. Many systemic barriers cannot be resolved by individual parties at local level and require changes at higher levels. More interaction between local, regional and national levels through intermediary partners, platforms or boundary spanners may help to create learning opportunities at all levels and to adequately collect and respond to different needs (21). An example is the RIVM’s local monitoring support program: various coalitions regularly discuss local challenges and successes for mutual learning, and pressing issues are shared with the Ministry of Health, Welfare and Sport to inform the policy agenda. Thirdly, stakeholders emphasized the importance of putting clients’ experiences and needs central in daily care and its organization. Although there has been progress, stakeholders felt that this required improvement. Client-centered care and participation (in decision-making) can improve the professional-client relationship, increase satisfaction and promote sustainable innovations by considering clients’ preferences, needs, strengths and weaknesses (53, 54). Our findings are in line with the needs and learning points described in both national and international papers on integrated care and cross-sectoral collaboration in other fields (41, 45, 55-57). For example, these papers also reported on the importance of interpersonal contact and mutual recognition of each other’s roles and expertise, engaging all stakeholders (including clients), ensuring sustainable finances, fostering learning cycles, adapting to new roles and skills, and having good governance and leadership throughout all levels of the system. Additionally, we identified comparable obstacles to collaborative efforts as documented within the medical maternity care sector such as fragmented structures and cultures, limited resources and impeding regulations (19-26, 30). Nevertheless, collaborating between sectors seemed to pose additional challenges, given the greater disparities in relational and organizational aspects. For example, the differences between municipal structures and the healthcare system required more investment to foster mutual understanding and familiarity with each other’s work environments and interests. Moreover, the financial system was more compartmentalized and governed by distinct regulatory frameworks, presenting challenges in financing preventive measures that are at the intersection of different laws. Lastly, we found that the perceived difficulties from developments within one sector (e.g. integrated birth care, youth care transitions) can complicate cross-sectoral collaboration. In 2022, the Ministry of Health, Welfare and Sport published the follow-up approach Solid Start 2022-2025 Strong parents, healthy children!, which aspires to create a structural 5
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