Community participation and health resilience against emergencies and disasters: a qualitative study

Abstract Introduction Community health resilience (CHR) is increasingly recognized as essential for reducing health risks during emergencies and disasters. Community participation (CP) is considered a central mechanism through which communities build this resilience, yet the factors and processes that enable effective CP remain poorly understood, particularly in vulnerable settings. This qualitative study explores how CP contributes to CHR in the context of emergencies and disasters in Iran, with a focus on the factors and mechanisms that enable effective participation. Methods A qualitative content analysis was conducted in Iran from June 2023 to July 2024. Participants included 24 individuals (16 males, 8 females) from diverse backgrounds, including healthcare providers, academics, and experienced laypeople, selected through purposive and maximum-variation sampling. Data were collected through 27 in-depth, semi-structured interviews and analyzed using Graneheim and Lundman’s approach. Audio-recorded interviews were transcribed verbatim, systematically coded, and iteratively organized into subcategories, categories, and overarching themes; initial coding was supported by MAXQDA 2020, while subsequent category refinement and theme development were conducted manually. Participants who withdrew after enrolment or were unable or unwilling to provide relevant information were excluded. Results Analysis yielded 523 open codes, organized into 23 subcategories, six categories, and two overarching themes. The first theme, “Enhancing Community Health Demands,” identified public risk perception, awareness of health rights, and community ownership as key factors. The second theme, “Establishing Effective CP Platforms,” highlighted local social networks, supportive policies and programs, and responsive local health systems as important components of CP platforms. Together, these findings highlight the multifaceted community- and system-level conditions through which CP can contribute to CHR. Conclusion This study demonstrates that CHR in the context of emergencies and disasters is closely linked to the capacity of communities to recognize and articulate their health needs and to participate through supportive and locally embedded structures. Effective CP requires not only greater risk perception, awareness of health rights, and a sense of community ownership, but also strong local social networks, supportive policies and programs, and responsive local health systems. Together, these findings suggest that strengthening CP requires simultaneous attention to community-level capacities and the institutional and structural conditions that enable sustained engagement.