182 Summary SUMMARY In 2018, the nationwide action program Solid Start was launched by the Dutch Ministry of Health, Welfare and Sport, aiming to ensure the best possible start for all children during the first thousand days of life. The ‘first thousand days’ refer to the period from conception to a child’s second birthday, which lays the foundation for health and wellbeing in later life and across generations. Children’s development and opportunities during this period are influenced by medical factors, but also strongly depend on social risk and protective factors. Addressing health inequities and vulnerability in early life therefore requires integrated and preventive approaches which prioritize collaboration across the medical and social sector. The action program Solid Start promotes cross-sectoral collaboration and focuses particularly on (future) parents and children in vulnerable situations. Since 2019, the National Institute for Public Health and the Environment has been commissioned to monitor the action program Solid Start. This thesis forms the scientific basis of the monitor. In Chapter 1, the rationale, context and aims of this thesis are described in more detail. The main objective of this thesis was to provide insight into the adoption of the Dutch nationwide action program Solid Start, thereby focusing on monitoring and cross-sectoral collaboration. Three research questions guided our research: 1) What is vulnerability during pregnancy, and how to operationalize vulnerability for monitoring? 2) Which indicators can be used to monitor Solid Start on a local level? 3) What are the developments and experiences with Solid Start, specifically regarding cross-sectoral collaboration? Chapter 2 and 3 focused on monitoring vulnerability during pregnancy. Chapter 2 provided more insight into vulnerability by identifying classes of pregnant women with similar risk and protective factors, and studying the relation with adverse outcomes. Data were derived from routinely collected data sources in DIAPER (acronym for DataInfrAstructure for ParEnts and childRen) and self-reported data of the Public Health Monitor. Results showed five classes: multidimensional vulnerability, socioeconomic vulnerability, psychosocial vulnerability, high care utilization, and the healthy and socioeconomically stable-class. Women in the multidimensional vulnerability-class shared multiple risk factors in various domains (psychosocial, medical and socioeconomic risk factors) and lacked protective factors. These women in the multidimensional vulnerability-class more often had adverse outcomes, as compared to the healthy and socioeconomically stable-class. The three classes with risk factors in one domain and protective factors in others did not experience worse outcomes. These results point to the importance of considering the coexistence of multiple risk factors and protective factors that may act as positive exposures or buffering mechanisms promoting resilience. In Chapter 3, we explored the possibility to predict multidimensional vulnerability at population-level using solely nationwide routinely collected data (without self-reported data). Additionally, we reviewed the relevance of adding self-reported data, and identified the most important predictors. Results showed the feasibility of using readily available routinely collected data to predict vulnerability, providing a robust foundation for
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