Abstract
Background: Many integrated community care (ICC) approaches exist at the neighborhood level aiming to improve the health and well-being of inhabitants, yet their specific components, their way of implementation, and the similarities and differences remain unclear.
Approach: We conducted a multiple case study of ICC approaches in the Netherlands and Belgium, comprising a document study and expert interviews. Initially, we identified ICC approaches using expert suggestions and Google searches. The approaches had to meet at least three out of four criteria: 1) collaboration across multiple domains or sectors, including at least health and social care; 2) some form of citizen involvement; 3) a holistic approach to health; and 4) published scientific articles. We excluded approaches that focused on specific target groups rather than the entire population. For the document study, we included scientific articles, reports and grey literature. Semi-structured interviews were conducted with purposively selected experts, such as researchers, process facilitators, and others involved in these ICC approaches, to complement and validate findings from the document study. The data extraction and the interview topic list were based on the WHO Framework on Integrated, People-Centered Health Services (IPCHS) and included the topics: empowerment and engagement of people and communities; strengthening governance and accountability; reorientating the model of care; coordinating services within and across sectors; creating an enabling environment; and learning and monitoring. All qualitative data, from documents and interviews were thematically analyzed, guided by the WHO IPCHS Framework, to draw cross-case conclusions on the components, similarities, differences, and implementation of ICC approaches. Throughout the steps, we followed an iterative approach, enabling the identification of new approaches and inclusion of additional literature based on suggestions from the interviews.
Results: In total, seven ICC neighborhood-level approaches were identified, six in the Netherlands and one in Flanders, Belgium. Most approaches were conducted as pilot studies: while half were discontinued after the pilot, stakeholders in several regions managed to continue aspects of the approaches as part of regular practice. All approaches aimed to integrate not just health but also social care and housing, with inhabitants actively involved in the planning, implementation, and evaluation. The degree and form of citizen participation varied, from low to high involvement. In a few approaches, citizens themselves initiated and implemented interventions and activities in a bottom-up manner. Most approaches followed a systematic approach to implementation, often facilitated by one or more process facilitators, with structured steps using methods specifically developed for each approach. Common steps included, among others, creating a shared vision and mission and conducting a needs assessment of the neighborhood, serving as the foundation of the plans made for the neighborhood.
Implications: The results of our multiple case study contribute to the growing international interest in ICC, offering insights into how these approaches are applied in practice, along with their similarities, differences, and way of implementation. The results might be valuable to researchers, health and social care professionals, and other stakeholders involved in ICC, supporting the design, implementation and evaluation of ICC approaches across various contexts.