142 CHAPTER 5 Solid Start approach in every municipality (58, 59). The approach aligns with the needs expressed in our study. There is a continuous focus on cross-sectoral collaboration at local and regional level, and extra focus to client involvement, facilitating professionals and strengthening informal networks. The approach outlines a commitment to sustainable funding, supportive regulations, governance agreements, a learning infrastructure, monitoring and retain a sense of urgency. Some specific actions have been defined to attain these intentions, while others will be developed. The follow-up approach highlights embedding Solid Start in wider prevention policies and linking it with other policy themes (e.g. poverty) to ensure its sustainability. Given that changes can take decades or span generations (40), during which leadership and contextual circumstances will inevitably change, we need long-term plans beyond the time horizons of a few years to reduce inequities and improve health and well-being (45, 60, 61). This study offers relevant insights to future policy developments and collaborative practices, and contributes to the knowledge base on cross-sectoral collaboration. Multiple other countries started programs to reduce health inequities by stimulating cross-sectoral collaboration in early life. Examples are the First 1000 days-program in Massachusetts (US) (11), Sure Start in England (12), Strong Start and Healthy Start in the US (13, 62), Strong Start in Australia (14) and Germany’s Early Childhood Intervention program (63). Future research should synthesize learning points from successes and failures across these programs and countries. Monitoring processes and outcomes on an ongoing basis can support learning for continuous improvements, consistent with the concepts of reflexivity and reflexive monitoring (49, 64, 65). The importance of monitoring applies to both national and local (municipality) level (66). Future research should also focus on the effects of Solid Start on health outcomes and utilization. Strengths and limitations Strengths of this study were the extensive data collection over multiple years and the inclusion of a wide mix of stakeholders, including clients and experts-by-experience. Our data collection seemed to have reached saturation. However, the perspectives of some important parties such as GPs, health insurers and councillors were missed and could have given additional insights. Also, municipalities that did not request Solid Start funds responded less to questionnaires, and we may have involved a selective group of more active and motivated stakeholders in interviews and FGDs. This may have led to more positive findings, although we noticed that our approach provided a good understanding of barriers to implementation at various levels as well. The approach in which we combined FGDs, interviews and questionnaires contributed to the credibility of our results (67). Quantitative data increased our understanding of Solid Start implementation nationwide, and qualitative data provided detailed, contextualized insights. Using the RMIC as analytical framework for our qualitative data was considered useful to better understand collaboration across professionals, organizations, levels and sectors. The RMIC is one of the theoretical models and definitions on collaboration, integrated care and Population Health Management that sought to outline its important elements (e.g. 31, 56,
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