Creating a roadmap for refugee health research in North America

Refugees are individuals who have been forced to flee their home country due to persecution, war, or violence, often leaving behind family, possessions, and familiar surroundings in search of safety. Refugees face immense challenges both during and after their displacement. Their journeys are fraught with challenges, from enduring trauma, malnutrition, inadequate shelter, and exposure to violence, leaving lasting physical and emotional scars. Upon resettlement, they encounter additional barriers such as language differences, cultural adjustments, economic instability, and difficulty accessing healthcare in unfamiliar systems. Despite these intersecting obstacles, refugees bring with them resilience, diverse skills, and unique perspectives that enrich the communities they join.

Research efforts have historically been piecemeal, lacking a cohesive agenda that recognizes the diverse and intersecting needs of these populations. A recently published study in the Journal of Immigrant and Minority Health outlines a framework to address these gaps. Conducted by Drs. Elizabeth Dawson-Hahn, Sarah Brewer and collaborators from the Society of Refugee Healthcare Providers (SRHP), the study uses a stakeholder-informed process to identify research priorities that are essential to improving healthcare for refugees across North America. This study not only highlights critical areas of need but also underscores the importance of community engagement, cultural relevance, and practical implementation in this process.

The researchers employed the Delphi method, a systematic approach used to gather and synthesize expert opinions on a specific topic where evidence is limited, ambiguous, or evolving. As Dr. Brewer explained, “The Delphi model is the standard approach for getting expert opinion and setting both consensus and rankings. Initially, we intended to create a ‘top 10 list’ of priorities, but as we delved deeper into the qualitative data, we realized that ranking topics would oversimplify their interconnected nature. Instead, the team developed a nuanced agenda that integrates diverse research themes and methodologies. ”

The study began by analyzing abstracts from the North American Refugee Health Conference (NARHC) between 2016 and 2019 to identify existing research themes. These were refined through expert panel consultations, which included healthcare providers, researchers, public health professionals, and former refugees. Finally, a survey was distributed to 93 participants with expertise in areas such as community health, pediatrics, mental health, and ethics. Participants rated and ranked topic areas while also providing qualitative input on emerging questions in refugee health research.

Through this process, the researchers identified 12 core research domains critical to refugee health, including mental health, women's health, pediatric care, health education, and the social determinants of health. Overarching themes emerged across these domains, emphasizing the need for community-driven research partnerships and the development of evidence-based models for care. Dr. Brewer noted, “One of the surprises for me was the strong emphasis on community engagement and implementation science. While these methods are central to my work, it was eye-opening to realize how much the field lacks in terms of tailored strategies for refugee health contexts.”

Community engagement, as emphasized by study participants, must be intentional, sustainable, and non-exploitative. This involves creating spaces where refugees feel genuinely valued. Dr. Dawson-Hahn noted, “It’s about value. How does someone feel valued? That might mean providing transportation, childcare, food, or even salaries to compensate people for their expertise.” She critiqued systems that undervalue non-traditional expertise, such as individuals providing critical translation or health information within their communities, often without recognition or compensation. Dr. Dawson-Hahn added, “We must move beyond passive acknowledgment to actively addressing institutional barriers that prevent meaningful collaboration.”

A significant theme that emerged was the importance of refugee-centered community engagement. While only 2% of participants had lived experience as refugees, a limitation that shaped how they approached the study, the researchers actively acknowledge this as an area for growth and intentionally sought to balance traditional research expertise with the invaluable insights of those with firsthand knowledge. Dr. Brewer highlighted the thoughtful approach taken, stating, “We had to walk a line between capturing expert consensus from researchers and ensuring that voices of individuals with lived experiences were included,” she said. This agenda complements and strengthens community-driven initiatives by aligning with local priority lists and reflecting the diverse needs of refugee populations and contexts.

The agenda also emphasizes the importance of long-term partnerships. Effective community engagement requires more than one-off consultations; it demands sustainable collaborations that prioritize mutual benefit and shared goals. Dr. Brewer highlighted examples from SRHP members who have successfully built such partnerships by embedding their work in local contexts, fostering trust, and integrating refugee voices into every phase of research. “It’s about finding intersections and building relationships that last beyond individual projects,” she said.

This study calls for expanded research into mental health challenges faced by refugees, including stigma reduction and culturally tailored treatment strategies. It also emphasizes the importance of understanding barriers to healthcare access, such as language and transportation, and exploring ways to enhance healthcare navigation for refugees. These findings point to the need for a holistic approach that integrates social, medical, and structural factors into refugee health initiatives.

Ultimately, this study serves as a significant milestone in advancing refugee health research in North America. By fostering sustainable partnerships and prioritizing culturally relevant care, the agenda sets the stage for transformative changes in how refugee health is understood and addressed. As Dr. Brewer concluded, “What we need is not a simple list of priorities, but a menu of interconnected approaches and questions that guide the next phase of refugee health research.” This agenda provides a foundation for collaborative, impactful work that will evolve alongside the political, social, and medical landscapes affecting refugees.

Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium member Dr. Elizabeth Dawson-Hahn contributed to this study.

Researchers reported no funding sources for this study.

Brewer, S. E., Zeidan, A. J., Dawson-Hahn, E. E., Agrawal, P., Talavlikar, R., Barnett, E. D., DiVito, B. M., Hauck, F. R., Wieland, M. L., Gren, L. H., Karaki, F. M., & Payton, C. (2024). Development of a Refugee Health Research Agenda in North America. Journal of immigrant and minority health, 10.1007/s10903-024-01639-w. Advance online publication.