99 Monitoring the Dutch Solid Start program: developing an indicator set for municipalities study from Sweden (26). In this Swedish study, the researchers developed indicators, subindices and a summary index in order to support municipalities with monitoring children’s health. In comparison to our study, they also mentioned both risk- and protective factors and also selected indicators related to poverty, smoking and low birth weight. Strengths and limitations A strength of this study is that the indicator set is developed based on the expertise of a heterogenic and balanced group of experts in policy, practice and research related to the first thousand days, who have an interest in using the set in daily practice (20). The focus of the indicator set to the first thousand days, involving both the social and medical sector, is necessary for programs aimed at reducing health inequities as health outcomes are directly and indirectly influenced by both social and medical factors (6, 9, 42). The experts exchanged information and expressed their views during two expert-meetings, as done in previous Delphi-studies (20). We organized a meeting to discuss and prioritize topics (Delphi round 2) and a final expert meeting. We considered this final moment of reflection on the (draft) indicator set very important to increase the support and future uptake of the indicator set in practice. However, this study also has several limitations. First, we selected indicators based on consensus without considering the scientific evidence for these indicators. This does not necessarily mean that indicators that were not prioritized are not valid and vice versa. For most indicators to monitor maternal and neonatal health, their level of evidence is not well described (25). In general, the rare availability of evidence is one of the reasons to (partly) select indicators based on experts’ opinions in a Delphi study (20). Another limitation was that not all indicators in the final set were the preferred option by experts as a consequence of limitations in data availability. Hence we included some ‘second best’ indicators and added the preferred indicators to the development agenda. Other limitations relate to the inclusion of experts. This depended on the availability and willingness of experts to participate within the study’s time period, and on the decisions of the researchers in how and who to invite. Moreover, we invited experts from practice, policy and research in both the social and medical sector. Making a clear distinction between and within those categories is not always possible, as multiple experts work at the intersection of the various fields of expertise (practice, policy and research) or in multiple sectors (medical and social). For example, managers of local coalitions can be categorized as working in both practice and policy, as well as within the medical and social sector. The inability to distinguish between the field of expertise and sector is however in line with the aims of the program (i.e. integrating service delivery across the medical and social sector). Therefore, we do not expect that this may have influenced the results. This is also reflected in our results, as the experts from different fields of expertise and sectors did not prioritize different topics and indicators. Additionally, some experts dropped out during the study period, but the three groups of experts from practice, policy and research were all well represented during the various rounds. In addition, we missed the perspective of parents themselves. Finally, due to the COVID-19 pandemic, we were unable to organize physical meetings. Our decision to organize three smaller online meetings hindered the exchange of information and 4
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