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

June 2026

The PI of the WP5 has joined monthly meetings of the MetaHealth steering committee since the start of the project. As from January 2026, WP5 has monthly meetings as well.  

Qualitative data collection and analyses on advertising bans in public spaces of several municipalities in the Netherlands is completed. The results are published in Food Policy and 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 addition, Joreintje Mackenbach presented the results at the ‘Regionale Voedseldag Vlaanderen’.  

In July 2025, Nine Droog was appointed as a junior researcher (under the supervision of Coosje Dijkstra) to organize, analyze and describe two Group Model Building (GMB) workshops with broader stakeholders in Amsterdam North. The aim was to gain insight into the complex system of underlying mechanisms that persistent the high prevalence of overweight/obesity and caries in children in the first 1,000 days of life in neighborhoods with a lower socio-economic position, and to identify potential leverage points for strengthening prevention efforts. Nine began, in collaboration with WP1, 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 neighborhoods with low socio-economic status, despite existing preventive interventions? Originally (also part of WP1), 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). Due to the limited opportunities for Nine to build on the existing warm stakeholder network within MetaHealth, it proved challenging to organize the sessions as originally intended. For this reason, and to reduce the burden on stakeholders, an alternative approach was adopted in which the CLD was 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 (https://doi.org/10.1186/s12916-025-04360-z).  

To date, Nine has conducted twelve 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 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 will be scheduled for early 2026 to jointly identify leverage points using the Qualitative Systems Exploration Model (QSEM) tool. This tool will be used to support a semi-quantitative exploration of the system and to prioritize leverage points based on both potential impact and feasibility on a local level. From January 2026 onwards, Nine continued 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 had a meeting with the Amsterdam Municipal Health Service (GGD Amsterdam) to discuss the details of a new project. Through the healthy and promising start for vulnerable families (Gezonde en Kansrijke Start), the personal contribution for maternity care will be subsidized. WP5 will perform a mixed methods study to evaluate this arrangement. Does the subsidy indeed lead to an increase in the uptake of maternity care in Amsterdam-Zuidoost, and what are the experiences of professionals and parents (via professionals)? The research plan and pre-registration will be completed in April. As the number of families that have registered for the subsidy is still limited, the actual evaluation will take place later.  

  An MSc student, under supervision of Joreintje Mackenbach, is currently collecting data on the nutritional quality of baby- and toddler foods in supermarkets. The supermarket environment has an important influence on parental choices on what they feed their children in the first 1000 days, and this quantitative descriptive study will provide input on the challenges parents encounter when they want to choose healthy options.  

 The evaluation of the NutriScore, in collaboration with RIVM, has been postponed until at least 2027, as RIVM currently has insufficient data on the implementation of the NutriScore.  

Dionne van Tatenhove started 1 June, 2026  PhD-candidate. 

Progress of December 2024