Abstract
Background: To understand and assess the level of vulnerability in user families to enable primary health care teams to make better decisions with a population-based approach and a territorial perspective.
Through the construction and application of a family health vulnerability scale conducted at the Family Health Center in the Panguipulli commune in southern Chile, a territory with high poverty rates and where the Chilean population coexists with the Indigenous Mapuche population.
Approach: It should be noted that Primary Health Care (PHC) in Chile is based on the Family Health Model. Therefore, characterizing users allows for targeted actions. It is crucial to have valid and territorially relevant instruments, especially considering that the concept of family vulnerability is key to understanding living conditions and health risks. Thus, an instrument was developed that considers variables related to family functioning, as well as socioeconomic, cultural, and environmental factors that impact well-being and access to health services.
This work was co-designed by the CESFAM Panguipulli team and the Universidad de La Frontera in Temuco, through two stages. The first involved the design and construction of the instrument, based on local preliminary work and theoretical review, allowing for the development of a list of items, which was reviewed by experts, local work teams, and users (families). This process allowed for the adaptation and incorporation of various elements that better reflect the sociocultural and territorial reality.
The second stage included the validation of the designed theoretical model, applying it to a random sample of 204 families, stratified by sector. This model allowed for the development of an instrument that provides scores for the families' vulnerability level, through a descriptive analysis based on frequencies, variables, and a factorial analysis of principal components that met the Kaiser criterion.
Results: The instrument was created, validated, and administered using a questionnaire. It provides a score classifying, with a comparative interpretation, the level of vulnerability of the families served at the Panguipulli CESFAM, guiding interventions tailored to their situation. This development was collaborative, responding to the needs of the team and local population.
It is evident that CESFAM families are more likely to be in a low- or medium-vulnerability situation, which allows for the design of preventive strategies with a population-based approach. The collaboration strengthened the cultural and social relevance of the instrument, as well as the ownership and identity of the team and community.
Implications: The learning experience for the Panguipulli CESFAM in the process of collaboratively developing a family vulnerability instrument can be replicated in similar contexts, demonstrating how a co-design approach and community participation can improve the relevance of health assessment instruments. The next steps include updating this score in accordance with current epidemiological and social changes.