Empowering Refugee Voices: Using Nominal Group Technique with a Diverse Refugee Patient Advisory Committee (PAC) to Identify Health and Research Priorities

Background: 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. Methods: 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. 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 to 3 months), post migration (3 months to 2 years), and long term health (beyond 2 years). Participants created overarching priorities and corroborated findings via a member checking step. Findings: 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. Interpretation: 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. Funding: Funded by the O Brien Institute for Public Health Catalyst Grant at the University of Calgary. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the O Brien Institute for Public Health Catalyst Grant at the University of Calgary. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Health Research Ethics Board (CHREB) of the University of Calgary gave ethical approval for this work (REB21-0954). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors