The CI plus model: a qualitative study of innovative community isolation and enhanced resilience in urban Thailand during the COVID-19 crisis

Abstract

Background: The COVID-19 pandemic exposed critical vulnerabilities in urban health systems, particularly in densely populated, low-resource communities. During the overwhelming third wave in Bangkok, Thailand, the Enhanced Community Isolation (CI Plus) Model emerged as an innovative response in the Yothi Medical Innovation District Community (YMIC). This qualitative study examined the mechanisms that enabled this vulnerable urban community to successfully implement a 170-bed isolation center and build resilience through community-based crisis response, providing insights for future pandemic preparedness strategies. Methods: This qualitative descriptive study employed focus group discussions guided by Donabedian’s Framework (Structure-Process-Outcome) and the Social-Ecological Model to examine multi-level factors influencing community resilience. Three focus groups were conducted with 18 key stakeholders (aged 25–80), including healthcare professionals, community leaders, and government officials who had direct operational experience with CI Plus. Data were analyzed using Thematic Content Analysis following systematic procedures for coding, theme development, and theoretical integration. Triangulation across multiple stakeholder perspectives enhanced credibility and trustworthiness. Results: Five interconnected mechanisms enabled CI Plus success and community resilience: (1) The Adaptive Leap - rapid, innovative deployment through visionary leadership willing to override bureaucratic constraints; (2) The Bedrock of Trust - activation of pre-existing social capital built through years of hospital-community partnerships; (3) Orchestrating Multi-Sectoral Synergy - effective coordination and resource integration across hospital, government, and community organizations; (4) Growing Stronger Through Continuous Learning - systematic adaptation to challenges while building lasting community capacity; and (5) Beyond the Immediate: Human-Centered Care - comprehensive attention to physical, emotional, and social well-being that preserved dignity during crisis. These mechanisms operated as an integrated framework, with each component enabling and reinforcing the others to create sustainable community resilience. Conclusions: The CI Plus Model demonstrates that effective urban crisis response requires simultaneous attention to innovative leadership, social capital activation, multi-sectoral coordination, adaptive learning, and humanistic care values. The model’s success in isolating 471 confirmed cases while building community capacity provides a transferable framework for community-based epidemic preparedness. However, implementation requires significant prerequisites, including pre-existing trust relationships, committed institutional partnerships, and the capacity for adaptive leadership. This framework offers valuable guidance for developing community-driven initiatives that enhance health systems and promote health equity and resilience among vulnerable urban populations worldwide. Clinical trial number: Not applicable.