Objective
Identify the social determinants of therapeutic adherence among users of the primary health care system’s cardiovascular health program (PSCV).
Method
Cross-sectional observational-descriptive study in two family health centers (CESFAM) in Valparaíso, Chile from March to June 2024. A total of 364 users over 18 years of age from the PSCV, selected through proportional stratified sampling, were surveyed. To identify the factors that influence therapeutic adherence, an ad hoc scale was designed that integrates the Morisky-Green-Levine-MMAS-4 test, the dimensions of the Rosenstock, Janz, and Becker health belief model, and the Dahlgren and Whitehead social determinants model. Descriptive statistics and chi-square tests were used to identify significant associations between adherence and individual, social, and structural factors.
Results
It was found that 65.1% of the individuals surveyed exhibited low therapeutic adherence, and 58.2% low pharmacological adherence. Adherence was significantly associated with personal characteristics (age), lifestyle factors (knowledge about their disease, motivation, adherence to medical monitoring and diet, low stress), support networks (family support), and living conditions (access and quality of care in the CESFAM, user satisfaction, and physical and economic barriers).
Conclusions
The findings show the multidimensional influence of social and structural factors on adherence, emphasizing the centrality of the primary care level in managing cardiovascular diseases. Using a people-centered and territorial approach, implementation of strategies that include health education, psychosocial support, and the elimination of access barriers could improve therapeutic adherence.