Priorities to Commitments: A binational adapted-NGT for refugee health prioritization

Background: Priority-setting exercises shape research and policy agendas, yet their design is rarely reported, and the people most affected seldom participate. We present an adapted nominal group technique (NGT), embedded within an appreciative inquiry framework, where communities, professionals, and government set priorities together, voting separately on each priority's importance and actionability. Methods: The University of Calgary partnered with Immigration, Refugees and Citizenship Canada to host a two-day workshop (Calgary, July 2023) that convened clinicians, settlement providers, policymakers and academics from six Canadian provinces, seven US states and international organizations. It spanned three resettlement phases: pre-migration to early arrival, post-migration (up to two years), and long-term resettlement. A pre-workshop survey asked respondents to identify problems, what was working, and proposed solutions during each of these three phases. Solutions were grouped into preliminary solution lists. Participants expanded the lists, ranked solutions by weighted ballot, deliberated the leading priorities, and voted separately for the most important and most actionable priority in each phase. Survey responses and station notes were analysed qualitatively. Results: Fifty-three of 68 participants completed the preworkshop survey. Participants generated 141 candidate solutions (73 from the survey and 68 at the workshop), which weighted ranking reduced to five priorities per phase. In two phases, the priority voted most important differed from the one voted most actionable: in Phase 1, a stakeholder taskforce was most important (49.0%) and linking pre-departure medical examinations to refugee clinics most actionable (64.7%); in Phase 2, normalizing refugee health care in primary care was most important (69.2%) and health navigation most actionable (47.9%). In Phase 3, surge readiness was most important (40.0%) and tied for most actionable (39.6%). Mental health dominated Phase 2 survey responses and funding recurred across all phases, yet neither was voted most important or most actionable in any phase. Conclusion: An adapted NGT can build consensus across sectors that rarely deliberate together. Double-criterion voting separates importance from actionability, which a single ranking cannot. Pairing expert facilitation with research design offers a replicable model for whole-of-government, whole-of-society priority-setting; realizing its promise requires extending participation into process design and accountability for enacting jointly set priorities.