Exploring The Impact of Genogram-Based Family Practice on Physicians’ Cultural Competence in Primary Care

Yıl 2025, Cilt: 9 Sayı: 3, 65 - 76, 30.12.2025

Sultan Zortul

Öz

Cultural competence is essential in primary care, especially in settings serving diverse populations. Although training programs often address theoretical aspects, practical tools to enhance cultural understanding are underused. The genogram is a visual representation of family and social structures and may offer a useful approach to improve cultural insight in clinical practice. This study explored the relationship between family physicians’ genogram knowledge and their levels of cultural competence. A cross-sectional survey was conducted among 84 family physicians in Erzurum, Türkiye. Data included demographics, clinical experience, cross-cultural exposure, genogram knowledge, and weekly patient volume. Cultural competence was measured using a validated 20-item scale comprising knowledge, skills, and sensitivity domains. Physicians who could draw a genogram scored significantly higher in overall cultural competence (p = 0.025) and cultural sensitivity (p = 0.028). Cross-cultural patient care experience was associated with higher scores across all subdomains (p < 0.01). Weekly patient volume was the only independent predictor of overall competence (β = 0.037, p = 0.015). Female physicians demonstrated lower cultural sensitivity than males (p = 0.01). Although 90.5% of participants were familiar with genograms, only 36.9% could construct one accurately. Practical exposure, through genogram use and cross-cultural interaction appears more effective than theoretical knowledge alone in developing cultural competence. Integrating genogram-based training and immersive experiences into medical education may enhance cultural responsiveness in primary care.

Anahtar Kelimeler

Cross-cultural healthcare , cultural competence , family medicine , genogram

Etik Beyan

This study was conducted in accordance with the ethical principles of the Helsinki Declaration, in-formed consent forms were signed by the participants, and it was approved by the Scientific Research Ethics Committee of Erzurum Health Sciences University Faculty of Medicine (decision no: BAEK 2024/11-202, date: 13.11.2024).

Birinci Basamakta Genograma Dayalı Aile Hekimliği Uygulamasının Hekimlerin Kültürel Yeterliliği Üzerindeki Etkisinin İncelenmesi

Öz

Kültürel yeterlilik, özellikle farklı hasta gruplarına hizmet veren birincil sağlık bakımında çok önemlidir. Eğitim programları genellikle teorik konulara odaklansa da, kültürel anlayışı artırmaya yönelik pratik araçlar yeterince kullanılmamaktadır. Genogram ailenin ve sosyal yapıların görsel bir temsilidir ve klinik uygulamalarda kültürel farkındalığı geliştirmek için faydalı bir yaklaşım sunabilir. Bu çalışma, aile hekimlerinin genogram bilgisi ile kültürel yeterlilik düzeyleri arasındaki ilişkiyi incelemiştir. Erzurum, Türkiye’de 84 aile hekimi ile kesitsel bir anket çalışması yapılmıştır. Toplanan veriler arasında demografik bilgiler, klinik deneyim, kültürlerarası etkileşim deneyimi, genogram bilgisi ve haftalık hasta sayısı yer almıştır. Kültürel yeterlilik, bilgi, beceri ve duyarlılık olmak üzere üç alt boyutu kapsayan doğrulanmış 20 maddelik bir ölçek ile ölçülmüştür. Genogram çizebilen hekimler, toplam kültürel yeterlilik (p = 0,025) ve kültürel duyarlılık (p = 0,028) puanlarında anlamlı olarak daha yüksek skor elde etmiştir. Kültürlerarası hasta bakım deneyimi, tüm alt boyutlarda daha yüksek puanlarla ilişkili bulunmuştur (p < 0,01). Haftalık hasta sayısı, toplam yeterliliğin tek bağımsız yordayıcısı olarak belirlenmiştir (β = 0,037, p = 0,015). Kadın hekimler, erkeklere kıyasla daha düşük kültürel duyarlılık puanına sahip olmuştur (p = 0,01). Katılımcıların %90,5’i genogramdan haberdar olmasına rağmen, yalnızca %36,9’u doğru şekilde genogram çizebilmiştir. Genogram kullanımı ve kültürlerarası etkileşim gibi pratik deneyimler, teorik bilgiye göre kültürel yeterliliği geliştirmede daha etkili görünmektedir. Genogram tabanlı eğitim ve gerçek yaşam kültürlerarası deneyimlerin tıp eğitimine entegrasyonu, birinci basamak sağlık hizmetlerinde kültürel duyarlılığı artırabilir.

Anahtar Kelimeler

Aile hekimliği , genogram , kültürel yeterlilik , kültürlerarası sağlık hizmeti

Etik Beyan

Bu çalışma, Helsinki Bildirgesi’nin etik ilkelerine uygun olarak yürütülmüş; katılımcılardan bilgilendirilmiş onam formları alınmış ve Erzurum Sağlık Bilimleri Üniversitesi Tıp Fakültesi Bilimsel Araştırmalar Etik Kurulu tarafından 13.11.2024 tarih ve BAEK 2024/11-202 sayılı karar ile onaylanmıştır.

Kaynakça

• 1. Erdoğan İ. Organizational Behavior in Businesses. İstanbul: Evrim Ofset Matbaacılık: İstanbul, 1983.
• 2. Lin, C.J., Lee, C.K., and Huang, M.C. (2017) Cultural competence of healthcare providers: a systematic review of assessment instruments. Journal of Nursing Research, 25(3), 174-86.
• 3. Taşkesen, MÖ (2017). Internal migration and working life in Turkey in the process of globalization. Bilge International Journal of Social Research , 1(1), 20-35.
• 4. Zorel, Fİ. (2014) Intercultural competence as a required qualification for international business employees. Journal of International Social Research, 7(30).
• 5. Çalışkan, H., and Yılmaz, S.H. (2017) Hemşirelerde kültürel yetkinlik algısının iş performansına etkisi. Sağlıkta Performans ve Kalite Dergisi, 13(1), 127-49.
• 6. The UN Refugee Agency, UNHCR. (2025) Annual Results Report 2024 Türkiye, Secondary Annual Results Report 2024. https://www.unhcr.org/sites/default/files/202506/Türkiye%20ARR%202024.pdf.
• 7. Betancourt, J.R., Green, A.R., Carrillo, J.E., and Ananeh-Firempong 2nd O (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4),293.
• 8. Erdoğan, M., Kırılmaz, H. (2020). Patient-centeredness and patient-centered care. İnsan ve İnsan, 7(24), 97-126.
• 9. Örs, OP., Öngel, K. (2012). Genogram for Family Medicine practice. Smyrna Medical Journal, 2 (1), 49-50.
• 10. Öngel, K., Örs, O P., (2019). Evaluation of patients based on family genogram. The Journal of Turkish Family Physician, 10(3),150-55. https://doi.org/10.15511/tjtfp.19.00350.
• 11. Penteado, PA.(2025) Genograma e atenção primária à saúde. Revista Brasileira de Medicina de Família e Comunidade, 20(47), 4621-21.
• 12. Kumar, R., Bhattacharya, S., Sharma, N., Thiyagarajan, A. (2019) Cultural competence in family practice and primary care setting. Medknow, 1-4.
• 13. Hardy, KV., Laszloffy, TA. (1995) The cultural genogram: Key to training culturally competent family therapists. Journal of Marital and Family Therapy, 21(3),227-37.
• 14. Turabian, JL. (2017) Family genogram in general medicine: A soft technology that can be strong. an update. RES. MED. ENG. SCI., 3(1), 186-91.
• 15. Piasecka, K., Slusarska, B., Drop, B. (2018) Genograms in nursing education and practice a sensitive but very effective technique: A systematic review. Journal of Community Medicine & Health Education, 8(6), 1-5.
• 16. Larasati, T., Lipoeto, NI., Sutomo, AH. (2020) “Genogram Physician Involvement Model” New Approach for Indonesian Physician Involvement with Family. Korean Journal of Family Medicine, 41(5), 325.
• 17. Gözüm, S., Tuzcu, A. (2020) Developing a cultural competency scale for primary health care professionals. Psikoloji Çalışmaları. https:// doi.org./ 10.26650/SP2019-0043.
• 18. Pettersson, S., Holstein, J., Jirwe, M., Jaarsma, T., Klompstra, L. (2022) Cultural competence in healthcare professionals, specialised in diabetes, working in primary healthcare—A descriptive study. Health & Social Care in the Community, 30(3), e717-e26.
• 19. Liu, J., Li, S. (2023) An ethnographic investigation of medical students’ cultural competence development in clinical placements. Advances in Health Sciences Education, 28(3), 705-39.
• 20. Alkhamees, M., Alasqah, I. (2023) Patient-physician communication in intercultural settings: an integrative review. Heliyon, 9(12).
• 21. Rich, EC., Burke, W., Heaton, CJ., et al. (2004) Reconsidering the family history in primary care. Journal of General Internal Medicine, 19(3), 273-80.
• 22. Cruz, J., Alquwez, N., Cruz, C., Felicilda‐Reynaldo R., Vitorino, L., Islam, S. (2017) Cultural competence among nursing students in Saudi Arabia: a cross‐sectional study. International Nursing Review, 64(2),215-23.
• 23. Červený, M., Kratochvilova, I., Hellerová, V., Tothova, V. (2022) Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011–2021. Frontiers in Psychology, 13, 936181.
• 24. Lai, DW., Lee, VW., Ruan, YX., (2023) Perspectives towards cultural competence and receptivity to cultural competence training: a qualitative study on healthcare professionals. Primary Health Care Research & Development, 24, e40.
• 25. Özkan, M., Adana, F., (2023) Intercultural and Ethical Sensitivity Levels of Healthcare Professionals and Related Factors. Florence Nightingale Journal of Nursing, 31(1),11.
• 26. Greer, JA., Park, ER., Green, AR., Betancourt, JR., Weissman, JS. (2007) Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences. Journal of General Internal Medicine, 22(8), 1107-13.