Navigating Complexity: Lessons Learned from Co-Designing a Care Transition Intervention for People with Stroke.

Introduction: Participatory, emergent, and reflective approaches are needed in research on person-centred integrated care. This paper describes and explores the process of developing a complex care transition intervention for stroke survivors, along with the lessons learned. Description: This study concerns the Missing Link project, which aimed to develop and evaluate a care transition intervention from hospital to home. The care transition was developed according to the Medical Research Council (MRC) Framework and included studies on context, co-design workshops, and prototype development. Discussion: The development process faced challenges relating to understanding the emergence within the studied context and the complex adaptive systems. We failed to have a continuous and sustained involvement of healthcare professionals, patients, and significant others during the different phases of the project. Hence, a lack of shared understanding is conceivable as the emergence might have been interpreted and understood differently by the actors. Conclusion: Challenges in achieving shared understanding throughout the project underline the importance of investing in relationship building, meaningful interaction, and continuous feedback loops. While the MRC framework provides guidance for developing complex interventions, the phased approach may only partially capture the emergence and self-organisation within complex adaptive systems.