92 CHAPTER 4 Intermediate round Based on the final list of prioritized topics, we made a list of possible indicators for each topic. Indicators were derived from our previous list of possible indicators (prior to Delphi study) as well as suggestions made by experts during Delphi round 1 and 2. Indicators were reformulated or merged in case they were not clearly defined or overlapped, based on consensus between two researchers and in line with the other indicators (JM, IB). In the rare case that there was no indicator available in the mentioned sources for one of the topics, the researchers (JM, IB) formulated potential indicators based on comparable indicators (e.g. indicators for the same topic in other phases). For each indicator, we described its numerator, denominator, data source, and data availability. Delphi round 3: online questionnaire The third Delphi round consisted of an online questionnaire to select and prioritize indicators. The experts received a list of possible indicators (including numerator and denominator) for each topic and were encouraged to 1) select a maximum of three indicators they considered suitable to monitor Solid Start on a local level, and 2) indicate their number one preference. In case only one possible indicator was presented, experts were asked whether or not they considered that indicator suitable. The experts were also invited to add comments. For each indicator, we calculated the percentage of experts that selected the indicator within their top three or as their preference. The scores and comments were discussed by the researchers (JM, IB, JS) in order to select at least one indicator per topic. In this process, the following conditions were considered: 1) Is there a clear preference towards one indicator? 2) Is data available for this indicator in nationwide data sources for every municipality? 3) Is the indicator sufficiently operationalized? If all conditions were met, the preferred indicator was added to the draft indicator set. We additionally prepared a ‘development agenda’ for topics and indicators that were clearly preferred, but lacked data in nationwide data sources or a clear operationalization. In this case, a lower ranked indicator for this topic with data-availability and sufficient operationalization was added to the draft indicator set. Discussion: expert meeting In a final two-hour online expert meeting we presented the draft indicator set (including the ‘development agenda’) and asked experts for feedback. Specifically, we checked whether the set covers the various elements to appropriately monitor Solid Start on a local level. Experts were encouraged to share their thoughts in the meetings’ chatbox or by e-mail afterwards. Pressing issues were discussed directly. Based on the meeting minutes and written feedback, we finalized the indicator set. Ethical considerations Following the Dutch Medical Research Involving Human Subjects Act (WMO), ethical approval was not necessary for this study (http://www.ccmo.nl), as we did not conduct medical-scientific research and participants were not exposed to treatment or required to
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