162 CHAPTER 6 number of studies seem to consider the combination of various risks across domains, rather than focusing on single risk factors, as also exemplified in a recent latent class study of Helmikstøl et al. (44). From a preventive and solution-focused perspective, it is important to consider factors that are modifiable, rather than concentrating exclusively on immutable factors for both risk and protective factors. This was also deemed important for monitoring efforts, as stressed in Chapter 4. 4. Monitoring requires longitudinal cross-sectoral data and indicators Chapter 2 and 3 showed that, in order to operationalize vulnerability among pregnant women, comprehensive data on a wide range of factors in different domains (e.g. socioeconomic, psychosocial and medical risk and protective factors) are necessary. Data within one sector alone cannot capture all relevant elements. Moreover, the indicators that were chosen to monitor the action program Solid Start (Chapter 4) reflected both social and medical aspects, and were not exclusively tied to a single profession or sector. Consequently, the findings in this thesis highlight the need for cross-sectoral data and indicators for longitudinal monitoring. This need aligns with previous literature (e.g. 18, 45). For example, several studies describe the potential of integrating data from various sectors to enhance a data-driven approach and internal-monitoring for population health and increased equity (10, 46), although the majority of PHM-initiatives rely on routine care data from one single sector or organization. In a wider perspective, incorporating data on the social determinants of health in daily care workflows is endorsed to support action (47, 48). Lastly, the linkage, storage and sharing of different data-sources (i.e. next to routine care data also data on the SDOH or patient-reported data) are frequently cited elements of LHS (18-20). In this thesis, we utilized DIAPER, which links individual level routinely collected data from the medical and social sector for parents and children on a national scale. Other examples of linked data infrastructures in the Netherlands include the regional Extramural LUMC Academic Network (ELAN), which supports the Healthy and Happy The Hague movement (46). Lessons learned in cross-sectoral collaboration Scientific literature emphasizes that cross-sectoral collaboration between the medical and social sector is needed to provide children the best possible start in life (4, 49-51). This statement finds support in the findings described in this thesis, as these point towards the cross-sectoral nature of a solid start and the need for cross-sectoral data and indicators for monitoring (Chapter 2, 3 and 4). Chapter 5 described the developments and experiences with the action program Solid Start and specifically cross-sectoral collaboration. Below, we present two lessons learned in cross-sectoral collaboration based on our findings. 5. Fostering normative integration is a fundamental first step to collaborate We learned that normative integration was a fundamental step to increase cross-sectoral collaboration. Normative integration includes the ‘softer’ aspects of integration, such as creating a shared vision, culture, trust, and mutual acquaintanceship (9, 23, 52). Our findings showed for example that the increased sense of urgency coupled with knowing each other provided a solid basis to initiate or intensify activities within the coalitions Solid
RkJQdWJsaXNoZXIy MTk4NDMw