Work Package 5

Complex interventions

General aim

To develop, implement and evaluate intervention strategies at policy (macro level), environment (macro/meso level) and family/child level (micro level) that contribute to the maintenance and improvement of oral and metabolic health in the first 1,000 days.

Objectives

• To create, implement and evaluate interventions aiming to change public health policies (macro level) that change the (market) environment.
• To create, implement and evaluate interventions aiming to change (food) environments (macro/meso level) that promote healthy choices for parents (to be) and their families.
• To create, implement and evaluate interventions aiming to change the health and social care environment (meso level) by strengthening intersectoral collaboration in the promotion of oral and metabolic health in the first 1,000 days.
• To create, implement and evaluate interventions aiming to change health-related behaviors of parents (to be) and their families (micro level) that promote oral and metabolic health in the first 1,000 days.
• To conduct a developmental systems evaluation to provide insight in how the interventions developed in WP5 contribute to systems change.

Active period

Year 4-8

Members of WP5

Applicants

AUAS, Inholland, ACTA, VU, AUMC, UvA-FMG, UTwente, TNO Microbiology & Systems Biology.

Cooperation partners/co-funders

GGD, Sarphati Amsterdam, NVvK, Ivoren Kruis, Coop, Voedingscentrum, PANEL, Food4Smiles, MRN, NJi, Gezonde en Kansrijke Start, NCJ, JGZ, EVAA, SGF, NVD, Smallsteps/Partou.

Progress

December 2025

The results from our qualitative study on advertising bans in public spaces of several municipalities in the Netherlands are published in Food Policy. The study findings were also incorporated into an infographic, which was shared with Dutch municipalities, partners at the City Deal Healthy and Sustainable Food Environment, on social media (LinkedIn), and the MetaHealth website. 

In July 2025, Nine Droog was appointed as a junior researcher (under the supervision of Coosje Dijkstra) to organise, analyse and describe two Group Moden Building workshops with broader stakeholders in Amsterdam North. The aim was to gain insight into the complex system of factors underlying the persistently high prevalence of overweight/obesity and caries in children in the first 1,000 days of life in socio-economically disadvantaged neighbourhoods, and to identify potential leverage points for strengthening prevention efforts. Nine began by setting up a causal loop diagram (CLD) with the central question: ‘Why are the prevalence and incidence of overweight/obesity and caries in children in the first 1000 days not decreasing in Amsterdam neighbourhoods with low socio-economic status, despite existing preventive interventions? Originally, we planned to have two GMB sessions with stakeholders from Amsterdam North in November 2025 to discuss (and update) the CLD (session 1) and identify leverage points for further action (session 2). Originally, two GMB sessions with stakeholders from Amsterdam North were planned for November 2025 to discuss and refine the CLD (session 1) and to identify leverage points for further action (session 2). However, due to limited possibilities for Nine to build on the existing warm stakeholder network within MetaHealth, it proved challenging to organise the sessions as originally intended. For this reason, it was decided to adopt an alternative approach in which the CLD would be further developed and validated through in-depth stakeholder interviews. This interview-based approach has been applied successfully in previous projects, although it lacks the added value of direct interaction and network dynamics between participants that is characteristic of GMB workshops. 

To date, Nine has conducted eight interviews with a diverse group of professionals, including a debt counsellor, a youth health care nurse, a paediatric dietitian, a physical activity specialist, two dental hygienists, a social worker at a community centre, and a youth physician. The most recent interview led to the inclusion of an additional element in the CLD, while the previous two interviews mainly served to confirm and reinforce existing dynamics in the model. One additional interview with a youth health care nurse is still planned. Efforts are ongoing to establish connections with midwifery practices and childcare organisations, although this has proven challenging so far. The CLD has now been substantially expanded, and a draft final version is currently being prepared for internal discussion within the research team. A new stakeholder meeting is planned for early next year to jointly identify leverage points, using the QSEM tool. This tool will be used to support a semi-quantitative exploration of the system and to prioritise leverage points based on both potential impact and feasibility. From January onwards, Nine will continue with this work as PhD student at VU Amsterdam and Joreintje Mackenbach will also join Nine’s weekly PhD supervision meetings. 

Josine Stuber (postdoc WP5) returned from maternity leave in mid-October and has resumed her work for MetaHealth. She, Joreintje Mackenbach and Coosje Dijkstra have made an appointment with the Amsterdam Municipal Health Service (GGD Amsterdam) to discuss the details of a new project: a natural experiment focusing on the first 1,000 days of life, possibly targeting maternity care. Discussions with the RIVM about the evaluation of the NutriScore are still ongoing. 

Progress of December 2024