Culture Specific Care Provisions – Giger and Davidhizar Model
Giger and Davidhizar’s model of transcultural assessment is a tool used worldwide to assist practitioners to provide culturally relevant healthcare to people of Afghanistan, Afghanistan America, and Islamic culture (Giger & Davidhizar, 2002).
Under this model, each individual is assessed according to 6 cultural phenomena: communication, space, social organization, time, environmental control and biological variations (Giger & Davidhizar, 2002).
Communication
Verbal
People of Afghani heritage may communicate in a number of different languages: Pashtu (35%), Afghan Persian (Dari) (50%), Turkin (Uzbek and Turkmen) (11%) and 30 other minor languages (4.0%) (Giger & Davidhizar, 2002).
Non-verbal
Touch is prohibited between members of the opposite sex if the individuals are not husband and wife (Giger & Davidhizar, 2002). Repetition and metaphors are used to increase emphasis and understanding, a common aspect of Afghan speech. There is a difference between speaking loudly for urgent messages and anger which is usually expressed in a high, intense voice (Giger & Davidhizar, 2002).
Interpreters
When using interpreters during health assessments, the focus should be on succinctly summarizing the main health issues (Arabic is a “flowery” language that can sound redundant in English) (Giger & Davidhizar, 2002). It is also necessary to use an interpreter of the same sex (Giger & Davidhizar, 2002). This also applies to family members who translate for the patient, especially regarding topics such as sex, reproduction, marital problems, and HIV/AIDS (Giger & Davidhizar, 2002).
Space
While rules concerning personal distance vary amongst cultures, Afghanis may prefer to maintain a close proximity with others of the same sex when interacting, to build trusting relationships (Giger & Davidhizar, 2002).
Social organization
In the Afghan population, family structure and organization, religious values and beliefs, and role assignments dictate how family members use health services. Usually, a male family member (father, eldest son, or an elderly uncle) is the family spokesperson (Giger & Davidhizar, 2002).
However, patient care in and out of the hospital is usually delegated to the women in the family (Giger & Davidhizar, 2002).
For instance, during childbirth, males are not usually present – females of relation to the birthing mother are usually there for support and care (Giger & Davidhizar, 2002). Within the Afghan culture, children are considered sacred. Child rearing is often based on negative reinforcement and permissiveness – as a result, Afghan children generally roam freely in public spheres, but are usually obedient to all adults including health professionals (Giger & Davidhizar, 2002).
Time
As noted by Giger & Davidhizar, understandings of time can differ between cultural groups. Groups that are “future-time” oriented are more inclined to follow preventative measures in dealing with their health, whereas individuals following past or present orientations do not plan for the future (Giger & Davidhizar, 1999). Traditionally Afghans are said to be inclined to focus on the past and/or the present versus the future when making decisions about healthcare (Giger & Davidhizar, 2002). They may idealize traditional values and/or practices when seeking health services and be less inclined to take or seek a preventative approaches (Giger & Davidhizar, 2002).
Environment
Some Afghans believe illness and disease are caused by external forces (Giger & Davidhizar, 2002). As a result, these individuals may view modern health care practices as irrelevant or useless.
Some Afghans believe that circumstances such as the evil eye, bad luck, loss of personal objects, germs, winds, draughts, or an imbalance of hot/dry and cold/moist are the causes of illness that need to be addressed (Giger & Davidhizar, 2002).
Biological variations
Major public health concerns for the Afghan population include trauma related to motor vehicle accidents, maternal-child health, and control of communicable diseases (tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, and parasitic infection) between urban and rural areas and from country to country (Giger & Davidhizar, 2002).
Medical studies have shown people of Afghani origin to be predisposed to the following: glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, sickle-cell anaemia, and thalassemia (Giger & Davidhizar, 2002). Coronary heart disease, diabetes, and hypertension have also emerged as major problems in Afghans, due to the multifactorial nature of these diseases (Giger & Davidhizar, 2002). Lastly, apolipoprotein A, apolipoprotein B, and nitrous oxidase synthase genes have all been genetically linked in Afghans as being contributory to the development of hypertension, diabetes, and coronary heart disease (Giger & Davidhizar, 2002).
Genetically determined diseases may also be due to high consanguinity rates in the Afghan population (Giger & Davidhizar, 2002). Approximately 30% of marriages are between first cousins. There is also a tendency to bear children right up until menopause. Similar activities are exhibited in other countries, such as Iraq, Kuwait, and Saudi Arabia (Giger, 1999).
References:
Giger, J. & Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. Mosby Year Book, St. Louis.
Giger, J. & Davidhizar, R. (2002). Culturally competent care: emphasis on understanding the people of Afghanistan, Afghanistan Americans, and Islamic culture and religion. International Nursing Review, 49, 79-86.
