Giger
JOURNAL
& Davidhizar
OF TRANSCULTURAL
/ TRANSCULTURAL
NURSING
ASSESSMENT
/ JULY 2002
MODEL
The Giger and Davidhizar
Transcultural Assessment Model
JOYCE NEWMAN GIGER, EdD, RN, CS, FAAN
University of Alabama at Birmingham
RUTH DAVIDHIZAR, DNS, RN, CS, FAAN
Bethel College
The Giger and Davidhizar Transcultural Assessment Model
was developed in 1988 in response to the need for nursing stu-
dents in an undergraduate program to assess and provide
care for patients that were culturally diverse. The model
includes six cultural phenomena: communication, time,
space, social organization, environmental control, and bio-
logical variations. These provide a framework for patient
assessment and from which culturally sensitive care can be
designed.
T he Giger and Davidhizar Transcultural Assessment
Model was developed in 1988 in response to the need for
nursing students in an undergraduate program to assess and
provide care for patients that were culturally diverse. Today,
the fourth edition of Transcultural Nursing: Assessment and
Intervention (1999) is in process. In 1998, Mosby Yearbook
published a companion book that addresses Canadian ethnic
groups (Davidhizar & Giger, 1998). In addition, a pocket
guide was also published by Mosby that provides a quick
user-friendly format to understand various cultural groups
(Geissler, 1998). These books provide chapters on six cultural
phenomena and chapters that address cultural groups which
have been authored by nurses who are experts in the culture or
who are members of the cultural group.
The Giger and Davidhizar Transcultural Model postulates
that each individual is culturally unique and should be
assessed according to six cultural phenomena: (a) communi-
cation, (b) space, (c) social organization, (d) time, (e) envi-
ronmental control, and (f) biological variations.
Journal of Transcultural Nursing, Vol. 13 No. 3, July 2002 185-188
© 2002 Sage Publications
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Communication. Communication embraces the entire
world of human interaction and behavior. Communication is
the means by which culture is transmitted and preserved.
Both verbal and nonverbal communication are learned in
one’s culture. Communication often presents the most signif-
icant problem in working with clients from diverse cultural
backgrounds.
Space. Space refers to the distance between individuals
when they interact. All communication occurs in the context
of space. According to Hall (1966), there are four distinct
zones of interpersonal space: intimate, personal, social and
consultative, and public. Rules concerning personal distance
vary from culture to culture. Territoriality refers to feelings or
an attitude toward one’s personal area. Each person has their
own territorial behavior. Feelings of territoriality or violation
of the client’s personal and intimate space can cause discom-
fort and may result in a client’s refusing treatment or not
returning for further care.
Social organization. Social organization refers to the man-
ner in which a cultural group organizes itself around the fam-
ily group. Family structure and organization, religious values
and beliefs, and role assignments may all relate to ethnicity
and culture.
Time. Time is an important aspect of interpersonal com-
munication. Cultural groups can be past, present, or future
oriented. Preventive health care requires some future time ori-
entation because preventive actions are motivated by a future
reward.
Environmental control. Environmental control refers to
the ability of the person to control nature and to plan and
direct factors in the environment that affect them. Many
185
186 JOURNAL OF TRANSCULTURAL NURSING / JULY 2002

Assessment Nursing

Culturally
Unique
Individual Communication

Space

Biological Environmental Time Social

variations control organization

FIGURE 1. Giger and Davidhizar’s Transcultural Assessment Model.

SOURCE: Giger, J., & Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. St. Louis, MO: Mosby.

Americans believe they control nature to meet their needs and internal control and more in external control, there may be a
thus are more likely to seek health care when needed. If per- fatalistic view in which seeking health care is viewed as
sons come from a cultural group in which there is less belief in useless.

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 Giger & Davidhizar / TRANSCULTURAL ASSESSMENT MODEL
Biological variations. Biological differences, especially
genetic variations, exist between individuals in different
racial groups. It is a well-known fact that people differ cultur-
ally. Less recognized and understood are the biological differ-
ences that exist among people in various racial groups.
Although there is as much diversity within cultural and racial
groups as there is across and among cultural and racial
groups, knowledge of general baseline data relative to the
specific cultural group is an excellent starting point to provide
culturally appropriate care.
There is some evidence suggesting that different races
metabolize drugs in different ways and at different rates
(Echizen, Horari, & Ishizaki, 1989). For example, Chinese
people are more sensitive to the cardiovascular effects of
Propranolol than are White people. Primaquine is metabo-
lized by oxidation and is used in the treatment of malaria.
Although Primaquine is given to individuals who lack the
enzymes necessary for glucose metabolism or the red blood
cells, hemolysis of the red blood cells occurs. Approximately
100 million people in the world are affected by this particular
enzyme deficiency and thus are unable to ingest Primaquine.
Approximately 35% of African Americans have this particu-
lar enzyme deficiency. Antihypertensives are another cate-
gory of drugs that are metabolized differently depending on
race. For example, African Americans tend to need higher
doses of beta-adrenergic blocking agents such as Inderal.
Chinese men tend to need only about half as much Inderal as
compared to White American males.
One category of differences between racial groups is sus-
ceptibility to disease. The increased or decreased incidence
may be genetically, environmentally, or gene-environmen-
tally induced. American Indians have a tuberculosis inci-
dence that is 7 to 15 times that of non-Indians. African Ameri-
cans have a tuberculosis incidence three times that of White
Americans. Urban American Jews have been the most resis-
tant to tuberculosis. Ethnic minorities now account for more
than two thirds of all the reported cases of tuberculosis in the
United States, partly as a result of the increased incidence of
tuberculosis among ethnic minorities affected with HIV
(Centers for Disease Control, 1998). Diabetes is quite rare
among American Eskimos. Diabetes has a high incidence
within certain American Indian tribes, including the Semi-
nole, Pima, and Papago. NIDDM, or Type 2 diabetes, is a
major health problem for Native American Indians, occurring
as early as the teens or early twenties. Age-specific death
rates for diabetes appear to be 2.6 higher for Native Ameri-
cans between 25 and 54 years of age, compared with the rest
of the general population. The incidence of hypertension is
higher in African Americans than Whites. The onset by age is
earlier in African Americans, and the hypertension is more
severe and associated with the higher mortality in African
Americans. It is important to remember that susceptibility to
disease may also be environmental or a combination of both
genetic and environmental factors.
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187
METAPARADIGM FOR THE
GIGER AND DAVIDHIZAR MODEL
The metaparadigm for the Giger and Davidhizar model
includes:
1. Transcultural nursing: A culturally competent practice field
that is client centered and research focused.
2. Culturally competent care: A dynamic, fluid, continuous pro-
cess whereby an individual, system, or health care agency
finds meaningful and useful care delivery strategies based on
knowledge of the cultural heritage, beliefs, attitudes, and be-
haviors of those to whom they render care (Davidhizar &
Giger, 1998). Cultural competence connotes a higher, more
sophisticated level of refinement of cognitive skills and
psychomotor skills, attitudes, and personal beliefs. To de-
velop cultural competency, it is essential for the health care
professional to use knowledge gained from conceptual and
theoretical models of culturally appropriate care. Attainment
of cultural competence can assist the astute nurse in devising
meaningful interventions to promote optimal health among
individuals regardless of race, ethnicity, gender identity, sex-
ual identity, or cultural heritage.
3. Culturally unique individuals: An individual is culturally
unique and as such is a product of past experiences, cultural
beliefs, and cultural norms.
4. Culturally sensitive environments: Culturally diverse health
care can and should be rendered in a variety of clinical set-
tings. Regardless of the level of care, primary, secondary, or
tertiary knowledge of culturally relevant information will as-
sist in planning and implementing a culturally competent
treatment regime.
5. Health and health status: Health and health status is based on
culturally specific illness and wellness behaviors. An individ-
ual’s cultural beliefs, values, and attitudes all contribute to the
overarching meaning of health for each individual.
Internal Structure, Linkages, and Concepts
The Giger and Davidhizar Transcultural Assessment
Model is based on a number of premises. Culture is a pat-
terned behavioral response that develops over time as a result
of imprinting the mind through social and religious structures
and intellectual and artistic manifestations. Culture is also the
result of acquired mechanisms that may have innate influ-
ences but are primarily affected by internal and external stim-
uli. Culture is shaped by values, beliefs, norms, and practices
that are shared by members of the same cultural group. Cul-
ture guides our thinking, doing, and being and becomes pat-
terned expressions of who we are. These patterned expres-
sions are passed down from one generation to the next.
Culture implies a dynamic, ever-changing, active, or passive
process. Cultural values guide actions and decision-making
and facilitate self-worth and self-esteem.
Knowledge Antecedents
The Giger and Davidhizar Transcultural Assessment
Model builds on the seminal work of the founder of trans-
188 JOURNAL OF TRANSCULTURAL NURSING / JULY 2002
cultural nursing, Dr. Madeleine Leininger (1985); the work of
Dr. Rachel Spector (1996); the classic work of Orque, Bloch,
and Monrroy (1983); and the classic work of Hall (1966) and
others in space phenomena, communication, and
anthropology.
APPLICATION TO THEORY,
RESEARCH, AND PRACTICE
Giger and Strickland (1995) received $750,000 to test the
usefulness of the model to identify behavioral risk reduction
strategies and chronic genetic indicators for premenopausal,
African American women with high-risk indices of coronary
heart disease. In 1998, Linda Smith, DSN, completed a pilot
study using the model. The primary purpose of the study was
to describe the relationship among the scores and subscores
on scales measuring concepts of cultural competency. Three
scales were used: the cultural attitude scale originally devel-
oped by Bonaparte (1977, 1979) and modified by Rooda
(1990, 1992), the cultural self-efficacy scale developed by
Bernal and Froman (1987), and the knowledge-based ques-
tions on cultural competencies developed by Rooda (1990).
In this study, the model served as the theoretical foundation,
and the three scales served as the instruments. In 1998, Dr.
Sharon Mullen and Dr. Carla G. Phillips at Ohio University’s
School of Nursing also used the model as the overarching the-
oretical framework to explore the cultural beliefs of south-
eastern Ohio Appalachians. The primary purpose of the qual-
itative ethnographic study was to identify cultural beliefs of
southeastern Ohio Appalachians as a means of providing cul-
turally competent care. Giger and Davidhizar’s model was
used to identify cultural beliefs from the six cultural phenom-
ena previously described by Giger and Davidhizar (1990,
1995, 1998, 1999). Subjects were 14 adults who had resided
in the area their entire lives. The Giger and Davidhizar
Transcultural Assessment Model, which also included inter-
view questions and observational guidelines, was used for
structural interviews. Findings from this study suggested that
these individuals were more socially inclined, communicated
more openly, had more of an internal locus of control, had
fewer personal space needs, were more future oriented, used
no significant home remedies, tended to be conscientious
about getting to appointments on time, and were more likely
to follow medical protocols than Appalachians in general.
AREAS OF FUTURE DEVELOPMENT
Work relative to biological variation specifically regarding
genetic variations continues to undergo refinement with addi-
tional research by various researchers, including Giger and
Strickland.
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REFERENCES
Bernal, H., & Froman, R. (1987). The confidence of community health
nurses in caring for ethnically diverse populations. Image: Journal of
Nursing Scholarship, 19(4), 201-203.
Bonaparte, B. (1977). An investigation of the relation between ego defensive-
ness and open-closed mindedness of female registered public nurses and
their attitude toward culturally different patients. Unpublished doctoral
dissertation, New York University, New York, NY.
Bonaparte, B. (1979). Ego defensiveness, open-closed mindedness, and
nurses’ attitude toward culturally different patients. Nursing Research,
28(3), 166-172.
Centers for Disease Control and Prevention. (1998). HIV/AIDS surveillance
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intervention (1st ed.). St. Louis, MO: C. V. Mosby.
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intervention (2nd ed.). St. Louis, MO: C. V. Mosby.
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intervention (3rd ed.). St. Louis, MO: C. V. Mosby.
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chronic indicators and high-risk factors for premenopausal African
American women (25-45) with coronary heart disease. Grant No. N95-
019, Department of Defense, Uniformed Health Services, University of
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Joyce Newman Giger is a professor in the School of Nursing at
University of Alabama at Birmingham. She received her EdD in
nursing education from Ball State University. Areas of interest in-
clude cultural diversity, psychiatric nursing, genetic research, and
nursing administration. She is a fellow in the American Academy of
Nursing; has published more than 100 manuscripts, book chapters,
and books on topics related to cultural diversity; and has done exten-
sive research on topics related to cultural phenomena.
Ruth Davidhizar is dean of nursing in the Division of Nursing at
Bethel College. She received her DNS in nursing from Indiana Uni-
versity. Areas of interest include transcultural nursing, psychiatric
nursing, and nursing education. She is the author of more than 700
articles, book chapters, and books on cultural competency and other
health-related topics.