Background: Client-or woman-centred care has become a major focus in improving Western maternity care systems. In measures to increase client-centredness, the perspectives of maternity care professionals and policymakers often predominate. However, to put women at the centre of maternity care, insights into their perspectives are important. Therefore, the aim of this study is to analyze the perspectives of women on maternity care and to provide recommendations on how to achieve client-centred care. Methods: A qualitative study was conducted comprising six focus groups (N = 43) and 20 semi-structured interviews with women who had given birth less than one year ago in the NorthWest Netherlands region. For data analysis, a framework based on existing woman-centred care models and the patientcentred care model of Maassen et al. (2017) was applied. Findings: The issues women addressed, underlined the importance of all four dimensions of the framework (client, interaction, professional and organization). Although women were in general positive about the maternity care services, there were differences regarding client-centredness between communitybased primary care and secondary/tertiary hospital care. The latter was evaluated more negatively than primary care with regard to taking women's background into account, communicating openly, showing a caring attitude and providing continuous care by a cohesive team. Although primary care appeared to be better able than secondary/tertiairy care to adapt to clients' preferences, the women described various cases throughout the care process where they did not feel heard. Besides a lack of flexibility to override existing protocols, activities and roles and tokenism regarding the use of satisfaction questionnaires and the birthplan were mentioned. Conclusions and implications for practice: This study demonstrated that from women's perspective, clientcentred maternity care means being responsive to their wishes and needs across all four (client, interaction, professional and organization) dimensions. Current measures often focus on the organizational dimension, integrating different divisions of care. To achieve client-centred care, future measures should foster responsiveness on all four dimensions. This entails empowering maternity care professionals to have a reflective interaction with (especially less educated) women, by acquiring conversational and reflexive skills, within a flexible care system adjusting to specific wishes and needs.

Participatory research on health-related topics with children is promising but current literature offers limited guidance on how to involve children and falls short on the reporting impact. The purpose of this article is to heighten our understanding of the working principles and impact of participatory health research (PHR) with children. We completed a PHR project in two primary schools, which included children from a multiethnic, deprived neighborhood in the second largest city in The Netherlands over a period of three school years (2016–2019). The impact on the children’s subjective health has been measured via process evaluation using qualitative and quantitative methods from the perspectives of all involved (children, their teachers, parents, and community partners). The main working principles included: Experiential learning; addressing uncomfortable issues; stepping outside your environment; and keeping it simple. Participatory actions valued most by the children included: Walking tours, photovoice, foodlabs, sportlabs, and to a lesser extent: Making a newspaper, mindfulness, and Capoeira. The project reached and engaged many children, parents, teachers, and community partners into healthy lifestyles and broadened and deepened the children’s awareness and understanding of health behavior. ‘Sowing seeds’ is the metaphor that captures the broader impact of this project: Planting seeds to harvest healthier adults.

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Photovoice, a way of conducting research through pictures, is considered a child-friendly method to engage children in participatory research and social change but this practice can raise ethical dilemmas. These dilemmas have rarely been discussed in the literature. The aim of this article is to provide insight into the ethical dilemmas we faced using photovoice with children. It is grounded in a 4-year participatory health research project in two primary schools where we used photovoice alongside other creative and arts-based methods. We reflect critically on pressing ethical tensions and how we dealt with these dilemmas. Our logbooks and reflexive conversations were used as data sources. The findings reveal that everyday ethical dilemmas occurred throughout the project. These were sometimes anticipated but were often unexpected. Questions that arose included: ‘Who controls the outcome?’; ‘Photos to assess needs or to give voice?’; ‘Giving voice or aesthetics?’; ‘Who decides who is visible?’ and ‘Disrespectful and stereotypical representations?’ We conclude that ethical dilemmas in using photovoice with children deserve more attention to sensitize researchers and help them live up to the ideals of voice and empowerment.

AbstractImproving collaboration in Dutch maternity care is seen as essential to improve continuity of care and thereby safety, client satisfaction, and health outcomes. This study aims to monitor and evaluate whether the regional Maternity Care Network Northwest Netherlands (MCNNN) and its local multidisciplinary obstetric partnerships contributed to collaboration. This mixed-method study followed the methodology of reflexive monitoring in action. Data were collected from 2014 to 2016 through interviews (n=73), questionnaires (n=430), and reflection sessions (n=4) and analyzed inductively and deductively based on a model for interprofessional and interorganizational collaboration. The findings outline (1) MCNNN-activities, (2) experienced collaboration within obstetric partnerships, and (3) MCNNN as supporting structure. The findings showed improvements on both the relational and organizational level of interprofessional and interorganizational collaboration. The MCNNN’s meetings, products, and research projects facilitated knowledge development and dissemination and its obstetric partnerships fostered contact and deliberation among maternity care professionals. However, collaborative challenges were also experienced, including mistrust and difficulties in information sharing, influenced by lacking financial and organizational facilitation. The MCNNN could improve its supporting role in the system innovation toward integration in maternity care by means of a further transformation to a knowledge network that is focused on reflexively overcoming collaborative challenges at all levels in the maternity care system.

The authors wish to make the following corrections to the above-mentioned published paper [1]: During production, an error occurred in the layout of Figure 1 ‘Learning impact of KLIK, as self-assessed by the children’ on page 6 [...]