Background Engaging stakeholders in ACP is a challenging systemic problem that requires a social innovation approach and a clear conceptual framework guiding behavioural and social change efforts. This study aimed to generate, clarify, and structure stakeholders` perspectives on barriers to ACP engagement, options for overcoming these barriers, and end-user needs. Input from all relevant stakeholders was gathered to inform the design of a digital health behaviour change intervention for engaging older adults (50+) in ACP in Ireland. Methods: To advance co-production and intervention design goals, the current study used stakeholder-engaged collective intelligence and scenario-based design methods. A total of 22 participants were recruited to three collective intelligence sessions. Results: Identified barriers (n=109) were grouped into seven categories; including psychological, resources and supports, ACP process and methods, ACP literacy, interpersonal and inter-professional, cultural and societal and service-related. Stakeholders generated 222 options for overcoming these barriers, including (a) Changing Perceptions of ACP and Increasing Psychological Readiness, (b) Developing High Quality Resources, Support Systems, and Infrastructure, (c) Using Creative Methods and Strategies to Facilitate stakeholders’ Engagement in ACP, (d) Increasing ACP Literacy through Education and ACP Campaigns, (e) Facilitating Timely, Focused, and Meaningful Interaction between Stakeholders, (f) Promoting Cultural and Societal Transformation, and (g) Co-designing a Need and Value-based Service. Additionally, four domains of affordances (time, ACP training, conflict, and leadership) were highlighted. Participants identified a total of 230 end-user needs, grouped into five categories: Behavioural; Communication; Awareness, Information, and Knowledge; Decision; and Personal, Interpersonal, and Collaboration. Conclusion: Findings integration offered insight into the complexity of the design context and problem situation in Ireland and highlighted important directions for context-specific ACP intervention development. The use of design thinking methodologies is suggested in the next developmental phase. Implications for practice, policy, and future research are discussed.
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