Research prioritization in migrant health in Ireland: toward a participatory arts-based paradigm for academic primary care.

Context: People are experts in their own health and need to be involved in health-related decisions, including decisions about what issues should be researched. Underserved communities, such as refugees and migrants, are often excluded from having a voice in relation to their priorities for health research. To avoid tokenistic participation, it is important to develop and test innovative methodologies that are culturally attuned and that can offer 'whole person' (affective, creative and cognitive) engagement. The Participatory Irish World Music Café, first developed in the context of the Irish Refugee Protection Programme in 2015, uses music and singing to develop inclusive, social and creative spaces to support social integration. It has been adapted during COVID-19 as an on-line café. While the café has sustained a strong community presence for five years, its potential adaptation and use to support research health prioritisation processes is unknown. Objective: Explore the use of an on-line, participatory Irish World Music Café to generate research priorities about migrant health in Ireland. Study Design: Participatory health research study co-designed with community partners, using a qualitative ethnographic and arts-based framework. Data from six 1.5 hour on-line cafes includes interviews, focus groups and arts-based documentation generated during the cafes. Analysis follows principles of thematic analysis. Setting or Dataset: Community-based participatory study in Ireland Population studied: Refugees, migrants, primary care providers, national health service planners, artists and academics working in the field of migrant health (n=25) Intervention/Instrument (for interventional studies): n/a Outcome Measures: n/a. Results: Analysis is underway and will describe participants' shared and differential experiences of (i) the research prioritisation sessions with particular attention to their experience of using music and other artistic practices (ii) cultural attunement and whole person engagement and (iii) generating identified research priorities. Conclusions: Findings will inform the evidence base about music as an arts-based method to support a new, inclusive participatory arts-based paradigm for migrants' involvement in research prioritisation. The work will be disseminated in Ireland and in the 53 Member States of the WHO Euro region.

'If relevant, yes; if not, no': General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory.

CONTEXT: The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. OBJECTIVE: This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. METHODS: Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about 'sense' making and 'engagement'. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. RESULTS: The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as 'ethnicity' in the limited time available in consultations was also worrying. CONCLUSIONS: Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants' views and the EU GDPR.