Designing trustworthy, low-threshold care coordination: co-creating a hybrid CareCompass with rural informal caregivers.

INTRODUCTION: As health systems across Europe face the dual pressures of environmental change and demographic aging, the need for a socio-ecological transformation that integrates health, equity, and sustainability has never been more pressing. Informal caregivers are central to long-term care systems, yet they often face time poverty, fragmented support, and unequal access to resources. These are conditions that can also constrain participation in health-promoting and climate-friendly everyday practices. This study reports a participatory co-design process that developed and iteratively refined CareCompass (PflegeKompass), a hybrid (digital-analogue) network-mapping and task-coordination concept for rural caregiving contexts in Austria. METHODS: Using a Design Thinking framework, we conducted three sequential in-person workshops in the region Waldviertler Kernland with n = 13 stakeholders (informal caregivers, community "third-space" actors, health professionals, and regional management). Workshop artefacts (posters, prioritisation outputs, and annotated prototype flows) and field notes were synthesised through an artefact-centred design synthesis informed by inductive coding and participant prioritisation outputs. RESULTS: Findings show that caregivers' primary challenge is coordination under uncertainty requiring timely access to information and resources, contingency management when support fails, financial strain, and cumulative planning effort. These insights translated into concrete equity-by-design needs: offline-first and low-threshold interaction using familiar calendar/list elements; role-based visibility and selective sharing to support privacy and prevent relational conflicts; and an onboarding model anchored in a locally trusted facilitator rather than a purely digital adoption. Prototype testing further revealed "trust and dignity" as design material, motivating a shift from a graphical network map to a list-based representation to avoid social comparison and shame. CONCLUSION: We contribute a transferable account of rural co-design for caregiving technologies, demonstrating how hybrid infrastructures, trust-sensitive representations, and explicit implementation conditions can be embedded early to support equitable, climate-resilient care coordination.