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Background Scientific research and innovation can generate societal impact via different pathways. Productive interactions, such as collaboration between researchers and relevant stakeholders, play an important role and have increasingly gained interest of health funders around the globe. What works, how and why in research partnerships to generate societal impact in terms of knowledge utilisation is still not well-known. To explore these issues, the Netherlands Organization for Health Research and Development (ZonMw) initiated an exploratory research-on-research study with a focus on participatory knowledge infrastructures (PKIs) that they fund in the field of public health and healthcare. PKIs are sustainable infrastructures in which knowledge production, dissemination and utilisation takes place via committed collaboration between researchers and stakeholders from policy, practice and/or education. Examples are learning networks, academic collaborative centres, care networks and living labs. The aim of the study was twofold: to gain insights in what constitutes effective collaboration in PKIs; and to learn and improve the research governance, particularly of ZonMw as part of their dissemination and implementation activities. Methods During 2020–2022, we conducted a literature review on long-term research partnerships, analysed available documentation of twenty ZonMw-funded PKIs, surveyed participants of the 2021 European Implementation Event, interviewed steering committee members, organized a Group Decision Room with lecturers, and validated the findings with key experts. Results We identified eight mechanisms (‘how and why’) that are conditional for effective collaboration in PKIs: transdisciplinary collaboration; defining a shared ambition; doing justice to everyone’s interests; investing in personal relationships; a professional organisation or structure; a meaningful collaborative process; mutual trust, sufficient time for and continuity of collaboration. Several factors (‘what’) may hinder (e.g., lack of ownership or structural funding) or facilitate (e.g., stakeholder commitment, embeddedness in an organisation or policy) effective collaboration in research partnerships. Conclusion To use the study results in policy, practice, education, and/or (further) research, cultural and behavioural change of all stakeholders is needed. To facilitate this, we provide recommendations for funding organisations, particularly ZonMw and its partners within the relevant knowledge ecosystem. It is meant as a roadmap towards the realisation and demonstration of societal impact of (health) research and innovation in the upcoming years.

Intersectoral collaboration between health care, social care and other sectors has been widely advocated to improve population health outcomes. Similarly, the active role of citizens as coproducers is increasingly described in the literature as an important element for improving people’s health and well-being. Yet, there is little understanding of the role of coproduction in intersectoral collaboration, particularly in neighborhoods with low socioeconomic scores (SESs). In this empirical study, we analyze two aspects of coproduction that potentially drive positive health outcomes in intersectoral collaboration: How do coproducers in neighborhoods with low socioeconomic scores actively contribute to intersectoral collaboration, and what role does the relationship between professionals and citizens play in shaping these contributions? The study was conducted in a low-SES neighborhood in The Hague, the Netherlands. In this study, we explored the team ‘the Connectors’, an intersectoral collaboration of professionals and citizens with various (professional) backgrounds, focusing on accessible support for mental health services. The cause of mental health problems in low-SES neighborhoods varies; therefore, intersectoral collaboration is required in the approach to addressing these mental health problems. Using an action research approach, we demonstrated the importance of a reciprocal relationship between coproducers and professionals. We also found that ‘boundary spanners’ can help to improve this relationship, regardless of whether they are professionals or coproducers. We conclude that citizens in a low-SES neighborhood can not only benefit from coproduction, but can also contribute to it, because they have a high incentive to improve their neighborhood together with professionals in the intersectoral collaboration.

IntroductionHealth inequalities remain resistant to interventions that primarily target individual behaviour. Although systems approaches are increasingly promoted, their application in practice is often not well grounded in real-world settings. In this protocol paper, we present the approach we will take in an overarching project that synthesises the combined insights of four ongoing systems-based research projects on system-based approaches for reducing health inequalities in the Netherlands. By bringing together and comparing findings across diverse contexts, populations and interventions, we aim to generate an empirically grounded understanding of what works, for whom, in what contexts and why, and to derive actionable strategies for systemic change to reduce health inequalities.Methods and analysisWe use a realist approach to synthesise insights from the four ongoing projects. The design involves four iterative steps: (1) Identifying cross-cutting themes from project proposals and literature, (2) Developing and refining context–mechanism–outcome (CMO) configurations through literature review and Slow Science meetings, (3) Engaging Critical Friends to co-develop actionable strategies and (4) Assessing and validating these strategies across diverse contexts. Iterative feedback loops ensure continuous refinement, integration of stakeholder perspectives and exploration of emergent challenges. This design enables theory-informed, practice-based strategies to support sustainable system change in reducing health inequalities.Ethics and disseminationEthical approval for the four underlying projects has been obtained from the relevant institutional review boards, and the way their data is used for this overarching project falls within their approved scope. Dissemination will be ongoing and co-created with stakeholders, including policy briefs, factsheets, educational tools and academic publications, to support uptake of strategies for systems change.

BackgroundThe increase of adolescent multimorbidity in welfare states is a major concern for current and future population health. However, current health interventions remain insufficient. Syndemic research among adolescents in high-income countries could improve understanding of mechanisms contributing to social and health inequalities.This study explores the existence of clustered health conditions among adolescents aged 10–19 registered at general practices in two average Dutch cities: The Hague and Leiden. We examine which social and contextual factors are associated with these clustered health conditions and to what extent these clusters relate to healthcare use and costs.MethodsThis cross-sectional study used general practitioner registration data on diagnoses from the Extramural Leiden University Medical Centrum Academic Network database to explore multimorbidity based on the 2-year prevalence of 20 health conditions among adolescents (n=10 841). Latent class analysis was applied to distinguish multimorbidity classes. Statistics Netherlands provided information on factors at the individual (eg, country of origin), family (eg, divorced parents) and household (eg, income) levels. Multinomial logistic regression analysis was applied to identify multimorbidity class differences in these social contextual factors, healthcare use and costs.ResultsIn 2018 and 2019, 25.7% (n=2781) of adolescents had at least two health conditions. We identified four classes characterised by a high probability of health conditions: ‘asthma-skin conditions’ (n=442), ‘skin conditions-pain’ (n=794), ‘externalising behavioural disorders and skin conditions’ (n=565) and ‘gastrointestinal conditions, internalising disorders and pain’ (n=980). Adolescents in classes characterised by externalising or internalising conditions combined with physical and somatic health conditions were most often linked to several more prominent adverse social contextual factors, such as early school dropout. Increased healthcare use and costs across all classes indicated a higher disease burden for adolescents with clustered health conditions compared with those with one or no health conditions.ConclusionsDisease clusters are prevalent in adolescents living in Dutch cities, driven by social contextual factors at the individual, household and parental levels, and show increased healthcare use and costs. Our results support the need for integrated preventative strategies focusing on multi-level aspects.

This study examined social and physical environmental exposures, health, and healthcare utilization among children aged 0–12 in urban areas. A population-based cross-sectional design was used, incorporating general practitioners’ data (2018–2019, n = 14,547), and societal and environmental data. Latent class analysis identified three distinct classes based on child and family demographics: ‘Dutch-origin two-parent household’ (n = 7267), ‘households with diverse countries of origin’ (n = 4313), and ‘single-parent household’ (n = 2967). Binary and multinomial logistic regression examined associations with environmental factors and child health outcomes. Children from the Dutch-origin class most often had favorable family demographics, neighborhood conditions, and health outcomes. Children from the diverse countries of origin class most often faced adverse neighborhood conditions, had higher rates of physical or somatic health conditions, and higher healthcare costs. Children from the single-parent class more often had less favorable family demographics, a higher likelihood of mental health problems, more frequent general practitioner visits, and were often in contact with youth care. This study highlights how child and family demographics and social and neighborhood conditions impact child health and healthcare utilization. Future approaches should focus on strategies to build and strengthen family and community resilience and adopt family-centered, context-sensitive interventions.

Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk. The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups. Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness. This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities.

IntroductionDespite extensive policy interventions, health inequalities persist. Local networks increasingly play an important role to combat inequalities. The aim of this study is to gain more insight into the governance characteristics that determine the successful establishment and early survival of a local collaborative network. Specifically, we will focus on which structural and relational characteristics of collaborative governance facilitate or hamper the initiative during the starting phase, and why.MethodsWe analyze the illustrative case of Healthy and Happy The Hague, a collaborative network in one of the larger cities in the Netherlands. Data collection consisted of three elements: retrospective, semi-structured interviews with participants of the network were conducted, re-occurring meetings were observed, and policy documents were systematically analyzed. An abductive analysis approach was used.ResultsThe most important structural characteristics contributing to the establishment of collaborative networks are multilevel collaboration, context-governance fit and adequate resources. Besides, the most important relational governance characteristics consist of incentives and commitment to collaborate, personal leadership, communication, and knowledge acquisition.ConclusionThis study shows the importance of governance characteristics when building local collaborative networks. We describe both structural and relational governance characteristics from the collaborative governance literature relevant for starting and continuing local and regional initiatives, such as our illustrative case study.

This explorative study aims to contribute to the debate about citizen involvement in (complex) medical and social issues. Our research goals are: (1) to explore the main opportunities, threats and challenges to co-producing healthcare in vulnerable communities from the perspective of professionals, co-producers (i.e., citizens with a volunteering role) and service users (i.e., patients); (2) to distil lessons for public managers concerning the main issues involved in designing co-production initiatives. We studied co-production initiatives in the Dutch city, The Hague. These initiatives were part of a broader, unique movement named 'Healthy and Happy The Hague', which aims to change the way healthcare/social services are provided. Two intertwined research projects combine insights from interviews, focus group meetings and observations. The first project analyzed a variety of existing co-production initiatives in several neighborhoods; the second project involved longitudinal participatory action research on what stakeholders require to engage in co-production. The two research projects showed similarities and differences in the observed opportunities/treats/challenges. The study found that empowering citizens in their role as co-producers requires major changes in the professionals' outlook and supporting role in the communities. It illustrates the potential of synergizing insights from healthcare governance and public administration co-production literature to benefit co-production practice.

Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.

SamenvattingPatiëntbetrokkenheid is een belangrijk thema in de zorg. Cliëntenraden vervullen hierin een belangrijke rol. Tegelijkertijd is er nog weinig bekend over hun rol bij de besluitvorming tijdens crises, en wat we van deze ervaringen kunnen leren. De coronacrisis liet echter zien dat wanneer besluitvorming plaatsvindt in interorganisationele netwerken, en sterk top-down en gecentraliseerd is, er weinig ruimte overblijft voor patiëntbetrokkenheid. Wij stellen dat zowel bestuurders als cliëntenraden meer werk moeten maken van patiëntbetrokkenheid in interorganisationele netwerken en tijdens crisissituaties.