Challenges, Barriers and Strategies to Improve the Community’s Participation in the Management of Quality and the Accreditation in Chile’s Primary Healthcare Centers

Objective: To analyze the level of community participation in quality management and accreditation processes in accredited Family Health Centers (FHCs) in Chile. Methodology: Analytical qualitative study based on the socio-critical paradigm and Participatory Action Research (PAR), reported under the Consolidated criteria for Reporting Qualitative research (COREQ) guidelines. Through purposive maximum variation sampling, 106 key stakeholders (70 healthcare professionals/managers and 36 community leaders) were recruited from eight accredited FHCs. Data collection included eight focus groups structured using the Logical Framework methodology. Data were processed using hybrid (deductive–inductive) qualitative content analysis supported by researcher triangulation. Results: Community participation was shown to be predominantly ritualized and symbolic, confined to passive or informative roles, and sustained mainly by older adult leaders. The main structural barriers include: the invisibility of the community dimension in technical accreditation guidelines, the hegemony of the biomedical–bureaucratic model, clinical workload, scarcity of resources, technical hermeticism, schedule incompatibility, the primacy of quantitative healthcare performance targets, marked knowledge and information asymmetries, and organizational barriers that exclude younger populations. This results in a missed opportunity to incorporate the community’s perspective into continuous process improvement, as well as a decline in the community’s sense of belonging and involvement, leading to purely formal accreditations and the weakening of social control. Proposed strategies prioritize critical health literacy, co-designed participatory monitoring, and the territorialization of local governance. Conclusions: There is a marked dissonance between Primary Healthcare (PHC) public policy and institutional practice; thus, community participation in quality management and health accreditation at this care level remains incipient and symbolic, relegated by systemic barriers to reactive responses. Ensuring legitimate accreditation requires leveraging local commitment and moving from consultative participation toward a model of substantive, deliberative, and oversight co-management with the community that guarantees genuinely binding social control.