Effectiveness of Transition Compass in optimising transition from paediatric to adult healthcare services: A randomised controlled trial

Transition Compass is a multi-component program that supports adolescents and young adults with chronic medical conditions as they move from paediatric to adult healthcare. The program integrates three key elements delivered over a two-year period following discharge from paediatric care: 1. Regular digital messaging: Participants receive SMS messages containing secure links to the Transition Compass digital platform. Each message leads to a brief, interactive session where participants receive tailored prompts (e.g. “Have you checked with your hospital or clinic about your specialist appointment date?”), complete short check-ins (e.g. “Do you have a regular GP?”), respond to reflection questions (e.g. “What’s important for your new specialist to know?”), and access transition resources such as their discharge letter or an appointment readiness checklist. The platform automatically adapts content based on participants’ responses, ensuring that reminders and guidance are personalised to their transition stage and needs. For example, participants who already have a specialist referral are prompted to book their appointment, while those without a referral are encouraged to see their GP to obtain one. Messages are sent approximately every two weeks until a specialist appointment is confirmed. Around the time of the appointment, participants receive about six messages providing reminders, practical tips, and a post-appointment check-in. As the primary outcome is engagement with adult services two years after discharge from paediatric care, the messaging cycle is reactivated in the second year to ensure ongoing follow-up and support. 2. Peer-delivered video modules: Participants receive monthly SMS messages containing secure links to short (<2-minute) videos on the Transition Compass digital platform. Each video focuses on a psychosocial or health-related theme—such as navigating adult services, self-advocacy, managing mental health, sexual health, or risk-taking behaviours. The videos were developed specifically for this study in collaboration with young people and clinicians to ensure relevance, authenticity, and diversity of perspectives. After viewing each video, participants are prompted to reflect on the topic and consider whether it raises any issues they would like to discuss with their specialist at their next appointment. Participants’ responses are stored within the platform and automatically surfaced as reminders three days before their scheduled appointment, encouraging preparation and follow-through. 3. Access to a trained Transition Compass Coach: Participants have access to a Transition Compass Coach who provides individualised support primarily through phone consultations. Coaches receive automated alerts if participants do not reach key transition milestones—for example, if they have not identified an adult specialist or have missed a scheduled appointment. Participants can also contact their coach at any time for additional support. Targeted support may include helping participants overcome barriers to finding a regular GP, attending specialist appointments, or navigating the adult healthcare system. Action plans are co-developed with participants to outline clear, achievable steps—for instance, identifying and booking an initial appointment with an adult specialist or developing strategies to manage anxiety about changing providers. Transition Compass Coaches have professional backgrounds in nursing or social work and complete structured training in motivational interviewing. Fidelity and role consistency are maintained through detailed consultation guides, which define the scope of the coach’s role, outline standardised approaches to key transition topics, and provide structured prompts to guide each interaction. These guides ensure that the advice and level of support delivered are consistent across sites, while still allowing flexibility for individual participant needs. Automated monitoring of digital activity further supports quality assurance and adherence to the intervention protocol. Although the intervention is designed for and targeted to adolescents and young adults, parents are also invited to take part and are automatically placed in the same group (control or intervention) as their participating child. Including parents allows the study to capture their perspectives and gain a more complete understanding of the transition process from both family and young person viewpoints. Parents in the intervention group have access to the digital platform and receive the videos only; they do not receive digital messages or have contact with the Transition Compass Coach. This approach is intended to encourage parent-child discussion about the healthcare transition process.