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However, the impacts of such complex and challenging programmes are not yet clear. This study aims to show the impact of a participatory multilevel family health promotion programme in a low-income neighbourhood at intrapersonal, interpersonal, organisational, community and policy level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods design was used to monitor and assess output and outcome realisation by parents and professionals from multiple sectors in a 4-year programme. Output realisation was monitored and reported half-yearly. Parents\u2019 knowledge, parent and child health (behaviours), social support and perceived neighbourhood child friendliness were measured through a cohort study in three successive years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Changes found: Multiple activities were implemented, such as swimming lessons free of charge for children in low-income families. Parents\u2019 assessment of neighbourhood child friendliness increased significantly as well as their knowledge about financial, social and healthy diet support, particularly among parents (n=13) who had been actively engaged in the programme. Social support decreased significantly. Municipal policies addressed more of the needs of people in a disadvantaged SEP, such as low-cost sports possibilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study revealed multilevel impacts of the programme: health-enabling activities for low-income families were realised, used and sustained at the organisational and policy level, which focused on contributing to neighbourhood child friendliness (community level). The engaged stakeholders took steps on the long pathway towards improved parent and child health in a disadvantaged SEP (intrapersonal level). Constant stakeholder investment is needed at all levels in the community and at the national policy level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Netherlands Trial Register (NL7738) Marissa Traets<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001979","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T14:10:12Z","timestamp":1756390212000},"page":"e001979","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Long way to impact health: outputs and outcomes of a four-year multilevel participatory family health promotion programme in a low-income neighbourhood"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5511-6404","authenticated-orcid":false,"given":"Gerda","family":"Wink","sequence":"first","affiliation":[{"name":"Academic Collaborative Center AMPHI, Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands"},{"name":"Research, Programmes & Academic Training, Wink Works for Health, Wageningen, Gelderland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7052-6769","authenticated-orcid":false,"given":"Gerdine","family":"Fransen","sequence":"additional","affiliation":[{"name":"Academic Collaborative Center AMPHI, Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4002-3413","authenticated-orcid":false,"given":"Koos","family":"van der Velden","sequence":"additional","affiliation":[{"name":"Academic Collaborative Center AMPHI, Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"van den Muijsenbergh","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1212-6888","authenticated-orcid":false,"given":"Annemarie","family":"Wagemakers","sequence":"additional","affiliation":[{"name":"Health and Society Group, Social Science Department, Wageningen University & Research, Wageningen, Gelderland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"2026010703062830000_3.2.e001979.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61506-7"},{"key":"2026010703062830000_3.2.e001979.2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1800028115"},{"key":"2026010703062830000_3.2.e001979.3","unstructured":"Broeders DWJ , Das HD , Jennissen RPW , et al . 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