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Publication Optimizing the implementation of integrated health promotion packages: an analysis in the context of intersectoral health policymaking in 34 Dutch projects of the governmental program Gezonde Slagkracht(Maastricht University, 2023) Grêaux, KimberlyThere are significant public health issues worldwide resulting from non-communicable diseases primarily caused by unhealthy behaviours such as poor diet, prolonged sitting, and excessive alcohol and drug use. A modern approach to addressing these issues seems to be intersectoral health policymaking. This requires collaboration with various partners from different sectors, in addition to public health, to implement integrated health promotion packages targeting both personal and environmental behavioural determinants. These interventions include various change methods (e.g. educational, regulation, or adjustments in the physical environment) situated in various settings (e.g. schools, supermarkets, and community centres). The aim of this research was to contribute to optimizing the implementation of integrated health promotion packages in local intersectoral health policymaking. In total, 34 project leaders and involved policy network partners and implementers of these intervention packages.Publication Does partnership diversity in intersectoral policymaking matter for health promoting intervention packages’ composition? A multiple-case study in the Netherlands(Oxford Academic, 2021) Grêaux, Kimberly; de Vries, N.K.; Bessems, K.H.H.; Harting, Janneke; van Assema, P.Intersectoral policymaking to improve public health includes integrated health promotion (HP) intervention packages that address a variety of health behavior determinants. The involvement of different partners is assumed to be necessary to implement such integrated packages. We examined how partnership diversity was associated with the composition of intervention packages implemented in Dutch municipalities. In a longitudinal multiple-case study (2012–14), we collected questionnaire data among 31 project leaders and 152 intervention implementers in 31 (alliances of) municipalities. Package composition was assessed in terms of intervention strategies, implementation settings and targeted behavioral determinants. Partnership diversity during the adoption and implementation phases was assessed in terms of the actors and sectors, as well as private partners and citizens involved. The association between partnership diversity and package composition was examined using crosstabs. Almost all packages integrated multiple strategies, but mostly education, facilitation and case finding, in multiple, but mostly health and public settings, such as schools. The packages targeted diverse behavioral determinants, although mainly personal and social environmental factors. A variety of partners from multiple sectors was involved, during both adoption and implementation of the packages. However, partners from the health, welfare and education sectors were mostly involved. More partnership diversity, especially during implementation, was associated with more integrated intervention packages. In intersectoral policymaking, investment in diversely composed partnerships seems worthwhile for implementing integrated intervention packages. However, investments in other conditions, like framing health issues and network management, are also needed to make environmental determinants of health behavior the object of HP.Publication Patterns in bottlenecks for implementation of health promotion interventions: a cross-sectional observational study on intervention-context interactions in the Netherlands(BMC Part of Springer Nature, 2023) Grêaux, Kimberly; van Assema, P.; Bessems, K.M.H.H.; de Vries, N.K.; Harting, JannekeBackground: From a complex systems perspective, implementation should be understood as the introduction of an intervention in a context with which it needs to interact in order to achieve its function in terms of improved health. The presence of intervention-context interactions could mean that during implementation particular patterns of crucial interaction points might arise. We examined the presence of – and regularities in – such ‘bottlenecks for implementation’, as this could create opportunities to predict and intervene in potential implementation problems. Methods: We conducted a cross-sectional observational study against the background of municipal intersectoral policymaking in the Netherlands. We asked implementers of health promotion interventions to identify bottlenecks by rating the presence and importance of conditions for implementation in a range of intervention systems. We used descriptive statistics to characterize these systems (by their behaviour change method, health theme and implementation setting) and the conditions that acted as bottlenecks. After stratifying bottlenecks by intervention system and the system’s characteristics, we tested our hypotheses by comparing the number and nature of the bottlenecks that emerged. Results: More than half of the possible conditions were identified as a bottleneck for implementation. Bottlenecks occurred in all categories of conditions, e.g., relating to the implementer, the intervention, and political and administrative support, and often connected with intersectoral policymaking, e.g., relating to the co-implementer and the co-implementer’s organization. Both our hypotheses were supported: (1) Each intervention system came across a unique set of – a limited number of – conditions hampering implementation; (2) Most bottlenecks were associated with the characteristics of the system in which they occurred, but bottlenecks also appeared in the absence of such an association, or remained absent in the presence thereof. Conclusions: We conclude that intervention-context interactions in integrated health policymaking may lead to both regularities and variations in bottlenecks for implementation. Regularities may partly be predicted by the function of an intervention system, and may serve as the basis for building the capacity needed for the structural changes that can bring about long-lasting health improvements. Variations may point at the need for flexibility in further tailoring the implementation approach to the – mostly unpredictable – problems at individual sites.Publication Breastfeeding and food pattern in overweight children in the Caribbean(Taylor & Francis Online, 2013) Grêaux, Kimberly; Schwiebbe, Luuk; Renders, Carry, M.; Doak, Colleen M.; Visser, Richard; Kist-van Holthe, Joana; Hirasing, Remy, A.Background: As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity. Objective: To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean. Methods: In a cross-sectional school-based study in 2004–2005, weight and height were measured by two research assistants in 1776 children aged 6–11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern. Results: 1451/1776 (81·7%) children were breastfed; 851/1766 (47·9%) children were breastfed for <4 months, 227/1776 (12·8%) for 4–6 months and 373/1776 (21·0%) for ≧6 months. Children who were breastfed for ≧4 months had lower odds (OR 0·32, 95%CI 0·25–0·40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≧4 months were more likely to have a structured food pattern of six eating moments a day (OR 7·43, 95% CI 5·87–9·39, P<0·001) and to have breakfast every day (OR 2·86, 95% CI 2·17–3·78, P<0·001) than those who were not or who were breastfed for <4 months. Conclusions: Breastfeeding for ≧4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight.Publication Implementing multiple intervention strategies in Dutch public health-related policy networks(2019) Harting, Janneke; Peters, Dorothee; Grêaux, Kimberly; van Assema, Patricia; Verweij, Stefan; Stronks, Karien; Klijn, Erik-HansImproving public health requires multiple intervention strategies. Implementing such an intervention mix is supposed to require a multisectoral policy network. As evidence to support this assumption is scarce, we examined under which conditions public health-related policy networks were able to implement an intervention mix. Data were collected (2009–14) from 29 Dutch public health policy networks. Surveys were used to identify the number of policy sectors, participation of actors, level of trust, networking by the project leader, and intervention strategies implemented. Conditions sufficient for an intervention mix (3 of 4 non-educational strategies present) were determined in a fuzzy-set qualitative comparative analysis. A multisectoral policy network (7 of 14 sectors present) was neither a necessary nor a sufficient condition. In multisectoral networks, additionally required was either the active participation of network actors (50% actively involved) or active networking by the project leader (monthly contacts with network actors). In policy networks that included few sectors, a high level of trust (positive perceptions of each other’s intentions) was needed—in the absence though of any of the other conditions. If the network actors were also actively involved, an extra requirement was active networking by the project leader. We conclude that the multisectoral composition of policy networks can contribute to the implementation of a variety of intervention strategies, but not without additional efforts. However, policy networks that include only few sectors are also able to implement an intervention mix. Here, trust seems to be the most important condition.Publication Conditions for addressing environmental determinants of health behavior in intersectoral policy networks: A fuzzy set Qualitative Comparative Analysis.(Elsevier, 2017) Peters, D.T.J.M.; Verweij, S.; Grêaux, Kimberly; Stronks, K.; Harting, JannekeImproving health requires changes in the social, physical, economic and political determinants of health behavior. For the realization of policies that address these environmental determinants, intersectoral policy networks are considered necessary for the pooling of resources to implement different policy instruments. However, such network diversity may increase network complexity and therefore hamper network performance. Network complexity may be reduced by network management and the provision of financial resources. This study examined whether network diversity - amidst the other conditions - is indeed needed to address environmental determinants of health behavior. We included 25 intersectoral policy networks in Dutch municipalities aimed at reducing overweight, smoking, and alcohol/drugs abuse. For our fuzzy set Qualitative Comparative Analysis we used data from three web-based surveys among (a) project leaders regarding network diversity and size (n = 38); (b) project leaders and project partners regarding management (n = 278); and (c) implementation professionals regarding types of environmental determinants addressed (n = 137). Data on budgets were retrieved from project application forms. Contrary to their intentions, most policy networks typically addressed personal determinants. If the environment was addressed too, it was mostly the social environment. To address environmental determinants of health behavior, network diversity (>50% of the actors are non-public health) was necessary in networks that were either small (<16 actors) or had small budgets (<€183,172), when both were intensively managed. Irrespective of network diversity, environmental determinants also were addressed by small networks with large budgets, and by large networks with small budgets, when both provided network management. We conclude that network diversity is important - although not necessary - for resource pooling to address environmental determinants of health behavior, but only effective in the presence of network management. Our findings may support intersectoral policy networks in improving health behaviors by addressing a variety of environmental determinants.Publication Structural integration and performance of inter-sectoral public health-related policy networks: An analysis across policy phases.(Elsevier, 2017) Peters, D.T.J.M.; Raab, J.; Grêaux, Kimberly; Stronks, K.; Harting, JannekeBackground: Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process. Methods: A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed. Results: In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks. Conclusion: The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor.Publication Women in hospitality leadership: barriers and best practices in Aruba(Taylor & Francis Online, 2021) Jadnanansing, Madhu; Nierop-Kappel, Thais; DiPietro, RobinThe current study uses qualitative semi-structured interviews to assess the perceived barriers and best practices of women at two different levels of leadership in the hospitality industry in Aruba. There were differences between levels related to acknowledgement and response to the glass ceiling, stereotyping, and work-life balance. Absence of formal higher education did not limit advancement to higher level positions. The majority of women used an inclusive, democratic leadership style unless it was deemed ineffective, and mentoring played a large role in the success of women in leadership. Implications for academics and practitioners in small island economies are discussed.Publication Publication Legal Systems and Economic Development: The Case of Aruba Post-Coronavirus(David Publishin, 2020) Taylor, DonThis paper intends to critically review some of the challenges rooted in Aruba’s civil law legal heritage in stimulating a post-corona economic recovery which should ideally be driven towards economic diversification. It also seeks to contextualize the effect of Aruba’s civil law system on economic growth compared to other Caribbean states with similar size, population, and tourism dependency but with legal systems rooted in the common law. This paper’s methodological approach is meta-analytical and includes a critique of the labor laws as well as the substantive role of the state in driving economic performance that is a normative feature in some civil law states. It posits that Aruba’s economic responsiveness, to the coronavirus should consider legal origins as a factor that limits its capacity and capability to execute an effective restructuring of tired economic paradigms and introduce new economic models that would challenge its mono-economic status.Publication Developing a Social Media Maturity Model for Full Service Restaurants in Aruba: A Multiple Case Study(University of Aruba, 2013) Oosterwaal, StefanPublication Tourism and Development in the Senian Context: Does It Help or Hurt SIDS? The Case of Aruba(Science Direct, 2018) Taylor, DonTourism is the lifeblood of many small island independent states and those that are categorized as small non-independent jurisdictions (SNIJs) such as Aruba. The question that this paper proposes to address is whether and how tourism helps or hinders island development. Research has been conducted on the economic effects of tourism in a global context; however, our approach is to look at its effect in one destination, Aruba, and to contextualize this research by situating it among other Caribbean islands. The rationale is that tourism is of more significance to the Caribbean in terms of economic dependence and tourism intensity. Because of the density of tourism in Aruba and its mono-economical development paradigm this makes for an ideal case study.1 Our methodology is based on an ontological review of the relationship between tourism and economic development utilizing a contextualized definition of development that fits within the philosophical position of Amartya Sen. In that context defined not just in terms of GDP growth but the enhanced social welfare of its citizens also in the Senian sense as distance from unfreedom. The concept of unfreedom for purposes of this paper is based on the extent to which there is an inertia to shift paradigms even if the existing paradigm enhances vulnerability, fragility and restricts opportunities to its citizenry. Therefore, despite its impact on the economy in terms of foreign exchange, investments, and employment, there are considerable and pervasive externalities which should be considered in conceptualizing the totality of tourism’s effect on economic and social development. In this essay, we consider Sen’s (2000) definition of development as freedom and situate it in that context and introduce the work of envelopment theory as conceptualized by Sankatsing (2016).Publication Perceptions and implications of implicit gender bias in the hotel sector in Aruba(Emerald Insight, 2024) Jadnanansing, Madhu; DiPietro, Robin; de Droog, MiekePurpose: This study aimed to collect data on the perception of top executive women in the Aruban hotel sector regarding implicit gender bias. Design/methodology/approach: A qualitative study on the metacognitive processes of awareness, evaluation and autocorrection was utilized. Through purposive sampling women in the top two leadership levels in Aruba Hotel and Tourism Association (AHATA) member-hotels were selected. Findings: Results showed that a third of the top female executives experienced implicit gender bias career barriers. Different types of bias were identified such as: judgments regarding pregnancy, unequal pay and obstructions by the male general manager. How the women dealt with this bias depended on the type of bias and their personality. The identification of bias and its effects on the career trajectory were also influenced by characteristics of the work setting such as the size of the hotel and functional area. Research limitations/implications: The research limitations include the chosen scope, the impediment of the generalizability of the findings due to the nature of the study, self-perceived data and possible researcher and respondent bias. Practical implications This study added to the existing body of leadership development literature with a focus on the effects of implicit bias on female leadership advancement. Some specific theoretical concepts that were combined in this study are organizational leadership, metacognition and the unconscious mind. The important role of personality was also confirmed in this study however one element that stood out in the current study was the effect of resilience in overcoming perceived barriers and attaining personal career goals. Suggestions and directions for future research are provided. Originality/value Despite the fact that gender bias was not observed in an explicit form, participants advised to be aware of the existence and effects of the implicit form and to seek education and guidance from female mentors and to remain goal oriented when confronted with this bias. Since female under-representation in senior leadership positions in other economic sectors is not observed this advice serves as a significant practical implication for the development of female leadership in this important sector in Aruba.