166 CHAPTER 6 an ivory tower), but is instead increasingly driven by those who are directly affected by research, policy or practice. Therefore, an important aspect in future research and monitoring efforts is to truly involve experts-by-experience and individuals with experiential knowledge in all research phases. While this thesis partially achieved this inclusion in certain aspects, we were limited in others. For instance, an expert-by-experience was involved in organizing and conducting interviews with clients to gain insights into experiences with the action program Solid Start (Chapter 5). However, their perspective was missing in the development of an indicator set (Chapter 4). Experts-by-experience and (future) parents could have suggested and prioritized alternative indicators. Genuine involvement of experts-by-experience and individuals with experiential knowledge could be characterized by elements such as sufficient time and resources, shared responsibility, active listening, respect and a motivation to meaningful engagement. As articulated by Goedhart and colleagues (73), engaging citizens in vulnerable positions in research can involve several strategies, tools and methods that should be context-based and require a supportive cultural shift. Their paper provides a welcome overview of ways to address common concerns to engage citizens in vulnerable positions (e.g. moving beyond the ‘usual suspects’ with time and budget constraints, navigating predefined research questions, managing power dynamics and addressing diverse priorities). Experienced progress versus measurable effects This thesis provided insights in the developments and experiences with the adoption of the action program Solid Start and cross-sectoral collaboration. This thesis did not focus on the effects of the action program Solid Start on aims related to health, wellbeing and equity for parents and children. Stakeholders aspire more insights into early effects to inform ongoing monitoring efforts and to maintain support for the action program Solid Start. Especially policy makers may be seeking measurable outcomes to assess the tangible impact of the program. To address this need, we propose further research into the program’s early effects, employing methods such as Difference-in-Differences (DiD). DiD is a quasi-experimental study design in which the relation between policy changes and outcomes can be compared over time between participating and non-participating groups (in our case: municipalities) (74). DiD gained popularity with the increase of longitudinal data and has been successfully applied to assess policy interventions during the first thousand days in other countries (e.g. 75, 76). In a future DiD study, we can build upon the findings of this thesis by utilizing the operationalization of vulnerability to compare municipalities and study equity, and by including the selected indicators as outcome measures. DIAPER presents itself as a suitable data infrastructure for this purpose. Blindly staring at the measurable effects of the collaborative efforts however, fails to fully grasp the complexity of cross-sectoral collaboration. Despite widespread enthusiasm for cross-sectoral collaboration, there is currently little empirical evidence to suggest that cross-sectoral collaboration in itself is sufficient to improve health outcomes and health equity (30, 77, 78). Several potential reasons for this lack of evidence have been proposed.
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