15 General introduction and qualitative components. For the quantitative component, a Delphi study with experts from policy, practice and research was conducted to develop a set of fifteen indicators (98). Indicators reflect both processes (e.g. percentage of municipalities with a local coalition Solid Start) and outcomes (e.g. percentage of children born prematurely and/or with a low birth weight for gestational age). Together, these indicators provide insight in both the progress of program implementation, as well as developments or trends in health and its underlying factors for parents and children (98). Several data sources are used to quantify the indicators, including questionnaires among municipalities, inquiries among national or regional organizations (e.g. among those implementing interventions), and the nationwide population-based data infrastructure DIAPER (99). DIAPER (acronym for Data-InfrAstructure for ParEnts and childRen) combines routinely collected data from three major Dutch nationwide sources: 1) Perined - the Dutch perinatal registry that collects routine care data during pregnancy and childbirth on care use and health outcomes (100), 2) Vektis – the healthcare information centre that compiles data on medical spending under the Healthcare Insurance Act (101), and 3) Statistics Netherlands (Dutch abbreviation: CBS), which collects and publishes linkable data on societal aspects, including health, welfare, income, education, and employment (102, 103). DIAPER provides a suitable source to study the action program Solid Start and its related elements, because cross-sector data is considered essential in order to gain a comprehensive understanding of cross-sector collaboration. The qualitative component includes yearly focus group discussions and interviews with those involved in the action program Solid Start, including representatives from care and support organizations (e.g. managers and care providers), Solid Start project leaders and advisors, municipal officials, representatives of national knowledge institutes and professional associations, researchers, and experts-by-experience and clients. All results of the monitor are publicly available and presented in yearly factsheets or notes addressed to the Ministry of Health, Welfare and Sport (104-107). A scientific advisory committee oversees the monitoring activities. In 2021, the National Institute for Public Health and the Environment was also commissioned to support municipalities in monitoring their local approach within the ‘learning local monitor Solid Start’. The support program centralizes learning and knowledge sharing between and within local coalitions Solid Start. It aims to encourage both starting and more developed local coalitions Solid Start to use monitoring as a tool to reflect on and design their local Solid Start approach. To do so, the National Institute for Public Health and the Environment organizes regular learning sessions with eleven local coalitions Solid Start in which participants share best practices, challenges and needs for monitoring. Those needs are addressed in thematic sessions for a wider audience, open to all who are involved or interested in monitoring or implementing the action program Solid Start at the local level. 1
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