Implementation of 'Healthy Children in Low-income Families' : An explorative study investigating the facilitating and impeding factors of a family-focused poverty intervention and recommendations for improvement

Background: In The Netherlands, an increasing number of households live in poverty. Families who live in poverty experience budget restrictions that influence the availability of material and immaterial resources. With material resources are meant for example books, toys or food. With immaterial resources are meant sources that cannot directly be linked to market value, such as the value of time, education or development of skills. Children who grow up in poor families, experience health and behavioral consequences due to living in poor circumstances. To limit the negative consequences of growing up in poverty, the Academic Collaborative Centre Youth Twente set up the family-focused poverty intervention ‘Healthy children in low-income families’ of which the aim is to increase the health and well-being of families living in poverty. The intervention consists of five meetings in which parents living in poverty become aware of their own, but also their children’s health. The intervention is part of a longitudinal intervention study in which the intervention is being developed, executed and evaluated. Within this study, experience has been gained by stakeholders in the implementation of the intervention. These experiences can be used to create starting points for improving the implementation. Therefore, the following two research questions were created: 1) “Which facilitating and impeding factors are according to stakeholders of influence in the implementation of ‘Healthy Children in Low-Income Families’? ” and 2) “What do stakeholders recommend for an optimal implementation of ‘Healthy Children in Low-Income Families’? ”. Method: To identify the factors and recommendations, interviews were conducted with the primary stakeholders of ‘Healthy children in low-income families’, who were involved in the implementation of the intervention in four municipalities in the region of Twente. The primary stakeholders were identified as the parents who participated in the intervention, the tandems of professionals and experience experts who lead the intervention, and policy officers of municipalities who are involved in the decision-making to adopt the intervention. Focus groups were conducted with the parents who participated, and interviews were conducted with the other primary stakeholders. Semi-structured topic lists were used to guide and analyze the interviews and were based on the Measurement Instrument for Determinants of Innovations. Results: A variety of facilitating and impeding factors were identified and recommended. Most stakeholders mentioned it was difficult to recruit parents to join the intervention. But to reach as many as possible potential participants, they recommended to use multiple communication channels to reach the parents and to use a personal approach. Before the tandems organized and executed the intervention, they followed a one-day training. Regarding this training, the tandems mentioned it clearly explained the content of HCLIF, but a lack of information was experienced on how to execute HCLIF as a tandem and it was experienced as disorderly. Nevertheless, the tandems found it clear how to organize and execute the intervention and it was found fitted with the problems the parents face in their daily life. The cooperation between the parents and the tandems was experienced as pleasant. Related to the organization of the intervention, stakeholders mentioned the implementation of the intervention cost little money, though time investment was mentioned as a facilitator and an impeder in the implementation. At last, it was mentioned that the intervention fitted the municipalities’ policy and the existence of similar kind of projects impedes the implementation of HCLIF. Regarding the recommendations, it is recommended to make the intervention accessible for people who cannot read Dutch, to adapt the title and add several subjects and materials. In the recruitment of the parents, a personal approach is recommended and using different communication channels. It is advised to involve the tandems in decision-making progress to implement the intervention and to change some aspects of the training they receive. In the organization of the intervention, a coordinator should be appointed, and the planning of the meetings should be adapted. At last, was recommended to secure the intervention within the policy of the organization or municipality where it the intervention is adopted. Conclusion: A variety of factors and recommendations were identified related to the implementation of ‘Healthy children in low-income families’. These factors and recommendations provide starting points for improvement of the implementation. They can be taken into account by the Academic Collaborative Centre Youth Twente in the implementation strategy of HCLIF for an optimal implementation of the intervention.