Outcomes that matter through parent engagement in the development, implementation and evaluation phases of a 40 year family health promotion programme in a low-income neighbourhood in the Netherlands

Setting/problem
In the development, implementation and evaluation phases of health policy and programmes, the perspectives of people in a low education and low education situation often receive little attention. A 4-year Dutch programme aimed to improve family health in a low-income neighbourhood with parent engagement in all phases.

Intervention
Programme key elements:
• Participatory action research, mixed methods
- Development phase: Panel sessions (5, (bi)weekly, N=10 parents) to assess priorities for improving family health in this neighbourhood
- Implementation phase: Questionnaires (3, yearly, N=104 parents) primary outcome: neighbourhood child friendliness. Monitoring use of health enhancing activities by personal consult (4, yearly, N=8 providers)
- Evaluation phase: In-depth interviews with engaged parents (N=14) and professionals (N=14) on programme outcomes
• Cyclical learning (Observe, Reflect, Plan, Act)
- Discussing research results in work groups of parents and professionals (Observe and Reflect) and make work plans (Plan) half yearly, planning small steps (Act) in many work group meetings if needed
• Co-creation of parents and professionals
- Work groups on shared priorities of parents and professionals, guided by programme staff

Outcomes
Panel sessions: Parents prioritized solutions to reduce their financial stress, to provide a safe place for their children to meet and play and to establish good quality communication with authorities. By the end of the programme the mean assessment (10-point scale) of parents for neighbourhood child friendliness was significantly higher (7,17>7,60). 94 children used an arrangement for free swimming lessons for children from low-income families. The most important outcomes according to engaged parents were: the possibility to share their experiences and ideas, the work group results (swimming arrangement, children playground, neighbourhood breakfast) although road safety was not improved, and the fact that they got to know others and learned. Most important outcomes according to engaged professionals: the reach and the growth of parents in work groups, the activities resulting from work groups, the increased parent knowledge of activities and the signals they heard from parents.
Implications
We suggest policy and programme leaders to engage disadvantaged groups in development, implementation and evaluation phases for relevant outcomes for those engaged.