16 CHAPTER 1 OUTLINE OF THIS THESIS Chapter 2 and 3: monitoring vulnerability The first two studies addressed the monitoring of vulnerability during pregnancy. The action program Solid Start specifically focuses on (future) parents and children in a vulnerable situation. Monitoring vulnerability at population-level requires more insight into the operationalization of vulnerability. We used various data-science techniques to gain insight into different vulnerability-classes with varying combinations of risk and protective factors (Chapter 2), and to identify if we could predict vulnerability at population-level using nationwide routinely collected data (Chapter 3). This led to the following overall research question: What is vulnerability during pregnancy, and how to operationalize vulnerability for monitoring? Chapter 4: indicators for local monitoring The action program Solid Start was quantitatively monitored at a national level right from the start of the program. Monitoring Solid Start for municipalities or coalitions at the local level may require different indicators, given the different context, informational needs and intended use. Therefore, Chapter 4 of this thesis describes how we used a Delphi approach in developing an indicator set to monitor the action program Solid Start on a local level. The research question was: Which indicators can be used to monitor the action program Solid Start on a local level? Chapter 5: developments and experiences with Solid Start and cross-sectoral collaboration The action program Solid Start was implemented at the end of 2018 with the aim to provide every child the best possible start in life. A key program element is to improve the collaboration between the medical and social sector by creating local coalitions Solid Start. Therefore, we aimed to describe the implementation of the action program Solid Start during the program’s own first thousand days (2019, 2020 and 2021) with a specific focus on cross-sectoral collaboration. We used both quantitative and qualitative research methods to answer the following research question in Chapter 5: What are the developments and experiences with the action program Solid Start, specifically regarding crosssectoral collaboration? Chapter 6: general discussion The separate and combined findings from the studies offer deeper insights into 1) the adoption of the action program Solid Start, 2) monitoring and 3) cross-sectoral collaboration. Chapter 6 discusses the main findings in light of these three elements, providing key lessons learned. The chapter proceeds with methodological considerations along with recommendations for research, a future outlook with recommendations for policy, practice and education, and concluding remarks.
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