Empowering refugee voices: Using Nominal Group Technique (NGT) with a diverse refugee Patient Advisory Committee (PAC) to identify health and research priorities in Calgary, Canada.

Abstract

Despite rising forced displacement globally, refugees' health and research priorities are largely unknown. We investigated whether a diverse refugee committee could utilize participatory methods to identify health priorities and a research agenda to address them. We conducted a qualitative study with focus groups of current and former refugees, asylum claimants and evacuees from a specialized refugee clinic over a year in Calgary, Alberta, Canada. We collected sociodemographic data using standardized instruments, then utilized a four-step nominal group technique process (idea generation, recording, discussion, and voting) to identify and rank participants' health and research priorities. Participants ranked their top five priorities across three time periods: Pre-migration/early arrival (0-3 months), post-migration (3 months-2 years), and long-term health (>2 years). Participants created overarching priorities and corroborated findings via a member checking step. Twenty-three participants (median age 35 years) attended one or more of five focus groups. Twenty-one completed sociodemographic surveys: 16/21 (76%) were women, representing 8 countries of origin. Participants identified "more family physicians" and "improving health system navigation" (11/60 votes each) as top health and research priorities respectively across all resettlement periods. Participants also prioritized pre-departure healthcare system orientation and improved post-arrival and long-term mental health services. Twelve participants completed the member checking process, affirming the results with minor clarifications. This proof-of-concept study illustrates how refugees can use a rigorous consensus process without external influence to prioritize their healthcare needs, direct a health research agenda to address those needs, and co-produce research. These low-cost participatory methods should be replicated elsewhere.