143 Implementation and experiences of the Solid Start program 68, 69). The model is well able to capture cross-sectoral collaboration. However, as with any other model, the RMIC’s reliance on predefined domains and elements may overlook the complexity and variability of integrated care initiatives in practice. Nonetheless, the multilevel and multidimensional RMIC has a strong theoretical and empirical foundation, as it is based on extensive literature review (31, 38) and widely used in research, also in Dutch maternity care (70). For this study, using the model has provided greater insight into the significance of normative integration as a primary step in cross-sectoral collaboration, the dynamics among different layers, and the potential for improvement even in the presence of systemic-level barriers that should be addressed over time. In future endeavours, it may be valuable to explore the underlying cognitive processes influencing the implementation of the Solid Start program, for example as outlined by the normalization process theory (71). CONCLUSION This study shows that the Dutch Solid Start program has created a movement towards a more integrated and population health-based care and support system. Solid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration for early life, without major transformations of systemic structures. This study highlights several barriers and needs to address in order to ensure the program’s sustainability. Those include sustainable funding, supportive regulations, responsiveness to professionals’ and coalitions’ needs, ongoing knowledge development, and client involvement. In the near future, it is essential to monitor whether the follow-up approach effectively addresses the barriers and needs. Abbreviations FGD: Focus Group Discussion GP: General Practitioner Ministry of VWS: Dutch Ministry of Health, Welfare and Sport RIVM: Dutch National Institute for Public Health and the Environment RMIC: Rainbow Model of Integrated Care Acknowledgements The authors acknowledge and thank all stakeholders who participated in this study for their time and insights. Additionally, we appreciate all who have assisted in developing the questionnaire, collecting the data, data transcription, data analysis, editing the manuscript and preparing figures. Specifically, we would like to thank one of the experts-by-experience for her help in interviewing clients. Furthermore, we thank Tessa Roseboom, Marian Knight, Natascha van Vooren and Brigitta Keij for providing valuable feedback to draft versions of the manuscript. 5
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