How To Build an Integrated Neighborhood Approach to Support Community-Dwelling Older People?
BACKGROUND
Although the need for integrated neighborhood approaches (INAs) is widely recognized, we lack insight into strategies like INA. We describe diverse Dutch INA partners' experiences to provide integrated person- and population-centered support to community-dwelling older people using an adapted version of Valentijn and colleagues' integrated care model. Our main objective was to explore the experiences with INA participation. We sought to increase our understanding of the challenges facing these partners and identify factors facilitating and inhibiting integration within and among multiple levels.


METHODS
Twenty-one interviews with INA partners (including local health and social care organizations, older people, municipal officers, and a health insurer) were conducted and subjected to latent content analysis.


RESULTS
This study showed that integrated care and support provision through an INA is a complex, dynamic process requiring multilevel alignment of activities. The INA achieved integration at the personal, service, and professional levels only occasionally. Micro-level bottom-up initiatives were not aligned with top-down incentives, forcing community workers to establish integration despite rather than because of meso- and macro-level contexts.


CONCLUSIONS
Top-down incentives should be better aligned with bottom-up initiatives. This study further demonstrated the importance of community-level engagement in integrated care and support provision.
Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
Hanna Maria
HM
van Dijk
Associate Professor, Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
Jane Murray
JM
Cramm
Professor, Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
Anna Petra
AP
Nieboer
community level; community-dwelling older people; informal support; integrated care and support; integrated neighborhood approach; the Netherlands