FACTORS ASSOCIATED WITH NON-ADHERENCE TO PHARMACOLOGICAL TREATMENT IN PATIENTS WITH CHRONIC NON-COMMUNICABLE DISEASES TREATED AT THE MARIANO ACOSTA HEALTH CENTER, IMBABURA PROVINCE, ECUADOR, 2025

Abstract

Introduction: Medication adherence is a critical determinant in the control of chronic diseases, particularly in rural Primary Health Care (PHC), where non-compliance represents a structural public health challenge. Objective: To analyze the factors associated with non-adherence to pharmacological treatment in patients with chronic diseases treated at the Mariano Acosta Health Center, Imbabura Province, Ecuador. Method: A cross-sectional analytical study was conducted with 110 patients diagnosed with arterial hypertension, diabetes mellitus, and hypothyroidism. The Morisky-Green-Levine questionnaire (Cronbach's alpha = 0.83) and the ACESS (Security Agency for the Quality of Health Services and Prepaid Medicine in Ecuador) satisfaction survey were applied. Statistical analysis was performed using STATA 17 through binary logistic regression. Results: It was identified that 66.36% of participants showed low medication adherence. The sociodemographic profile revealed an asymmetric sample with a predominance of older adults (75.45%), indigenous ethnicity (71.82%), and high economic vulnerability (96.36% with income < $100). In the logistic model, age was the only factor with a statistically significant association (OR = 1.09; 95% CI = 1.02–1.17; p = 0.014). An acquiescence bias was detected with 100% reported satisfaction in ACESS, contrasting with the actual low adherence. Conclusion: Non-adherence is critically influenced by aging and social determinants of health. We conclude there is a need to strengthen nursing care management through intercultural health strategies and home visits that transcend conventional education to improve the control of chronic non-communicable diseases.