Table 1 Procedures to thematic concern identification and prioritization

Step 1. Establishing the priority setting Partnership and defining scope

A cross-stakeholder groups(n = 20–25)including RPG and RAG will be selected with maximum variation comprising of relevant statutory and non-statutory organization representatives and individuals that can reach and advocate for, mobilizing resource, empower and support service users for involvement in mental health systems strengthening. The stakeholder groups will be invited to a half-day consultative meeting and discuss on the findings of foundational studies in Phases 1&2 about service user involvement so as to raise awareness, create the need for collaboration, and define the scope of the study for future action.

Step 2. Gathering and identifying questions

The cross-stakeholder groups will be invited in a 1-day thematic concern identification and prioritization exercise at Sodo district.

The participants will be divided into four homogeneous groups (service user, caregivers, and health professionals, community stakeholders) so that the participants are comfortable voicing their opinions.

Each group separately will be asked to list as many priority questions from their own perspectives perceived as the most important challenges to be addressed for service user and caregiver involvement in mental health system improvement.

Facilitators will gather the list of questions/thematic concerns in each group and record in a flip chart

In addition, each group will be provided with the pre-generated lists of potential priority areas (Additional file 2) to discuss on, augment their priorities, and identify additional priorities

Step 3. Reducing the questions and processing uncertainties

Each group will present their list of thematic concerns in a plenary session.

Facilitators will create a list of unique themes by merging duplicates and overlapping questions (issues) on a flip chart.

The identified themes will be grouped into key themes with list of specific concerns/issues.

Step 4. Interim Prioritization

The consolidated lists of priorities will be distributed to the homogenous groups to identify their top 10 research priorities in the order of perceived importance that they think need be the focus of research involving service users within Sodo district using pre-set criteria (e.g., relevance local primary health care and community, public health significance, magnitude of the problem, severity, feasibility/amenability to change with local context). Accordingly, each participant will select his/her top ten priorities and ranks them by giving each priority a score between 1(lowest) and 10(highest). The top list of each participant within the homogeneous groups will be combined by consensus and presented in a plenary session for listing the 10 priorities considered most important by all stakeholders group and reach consensus.

Step 5. Final Priority setting

The participants will be organized into nominal groups, and generate their top five priorities and rank them in orders of importance. This will follow the following five steps.

a. The participants will be divided into four groups with balance of service user, caregivers, health professionals and community stakeholders and each participant within each group will be asked to silently generate top five priorities from the top 10 lists generated.

b. A round robin approach of recording of priorities will be used to collate priorities, that is, each participant in turn will be asked to read one priority off the list within each group. This priority will be written on flip chart by a facilitator of each group.

c. Once all the priorities are written on the flip chart an open discussion will be conducted to allow all participants within each group to discuss, clarify, dispute and discarded or add or modify a priority within their groups.

d. The final lists of priorities from each group will be presented in a plenary session, bring similar priorities together on a flip chart, and will be discussed with the whole group in order to ensure that all participants understand and approve of the congregated priorities.

e. Finally, each participants will be provided with the combined consensus priorities and asked individually and anonymously, to rank all the five most important priorities in the order of importance by giving five to the highest valued priority, the next most important, a value of four and so on progressively down to the least important which will be assigned a value of 1. A mean priority score for each priority across all groups will be calculated by summarising ranking scores and dividing this by the maximum possible ranking score of that priority. The maximum possible ranking score for a given priority will be calculated by multiplying the number of participants who considered the priority by 5(the maximum rank)

Similar NGT will be conducted with RPG at a health facility level to identify and establish two top priorities for action trial.