Advancing the concept of community positive health through participatory research in marginalized communities in Kenya

There have long been global calls to strengthen community-led and -engaged approaches in public health, but most community health interventions are still driven by governments and other external actors to reduce narrow measures of disease burden. Despite theoretical advancements in salutogenesis and positive health, these concepts remain underapplied in understanding and supporting collective health and wellbeing at the community level. This empirical qualitative study aimed to refine the concept of "community positive health" by grounding it in community perspectives and identifying the factors that shape local health and wellbeing. This participatory research engaged community health leaders and residents in marginalized communities in Kenya in expert interviews, community focus group discussions, and co-analysis in three iterative qualitative phases from 2021 to 2022. Thematic analysis guided the synthesis of community-derived insights into a definition of community positive health as a community-led salutogenic process supported by networked capabilities to provide mutual care and thrive as communities encounter changes and challenges for their health and wellbeing. Five interconnected dimensions at the intersection of resources and risk factors were identified: meeting basic needs, people-centered care, sustainable resource management, informed decision-making, and self-governance. Strengthening community positive health requires a dual focus on resources and risk factors, and, most importantly, how networked "communities of health" can be supported by formal community health structures. This approach offers a path toward reimagining health not just for communities but also with them.