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.

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 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.

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.