Background
Social determinants of health (SDH), such as caregiver support, strongly influence chronic disease management. Within the biopsychosocial model, caregivers act as social enablers of preventive behaviors and treatment adherence. In Romania, where a complication like diabetic neuropathy is underdiagnosed and prevention culture is weak, the "Stand up for your feet" campaign aimed to raise awareness and improve outcomes. This study examined how caregiver awareness, preventive practices, and campaign recall contribute to patient adherence and health outcomes.


Methods
A cross-sectional analysis was conducted using data from the "Stand up for your feet" campaign evaluation (N=1,133; 760 sufferers, 373 caregivers). Key outcomes included awareness of diabetic neuropathy, preventive foot care (QU2 items), treatment adherence (QS9), and digital engagement (QM2). Comparisons used chi-square tests and independent t-tests.


Results
Awareness of diabetic neuropathy was higher in caregiver-supported households (33% vs. 25%). Patients with caregivers reported more preventive foot checks (62% vs. 50%), and self-examination was more common (64% vs. 47%). Treatment adherence was significantly greater in caregiver-supported sufferers (52% vs. 37%; χ²=7.8, p < .01).
Caregivers were more digitally active (M=1.52 vs. 2.98; p < .001), facilitating health information seeking and campaign recall. Preventive behavior scores were slightly higher in sufferers than caregivers (M=2.33 vs. 2.07; t=6.39, p < .001), but caregiver presence clearly improved sufferers' health outcomes.


Conclusions
Caregivers significantly improve patients' treatment adherence, preventive foot care, and disease awareness, acting as a protective social determinant of health. Their younger age, higher income, and stronger digital engagement position them as essential allies in chronic disease prevention. Public health campaigns and interventions should systematically engage caregivers to maximize health outcomes in patients.