Research
Nutrition
The Use of Nutritional 'Positive Deviants' to Identify Approached for Modification of Dietary Practices
Van Der Vynckt S, Wishik S. The Use of Nutritional 'Positive Deviants' to Identify Approaches for Modification of Dietary Practices. AJPH 66 (1): 38-42, January 1976.
This paper describes methodology for conducting nutrition surveys among deprived population groups of grossly homogeneous socioeconomic status so as to identify those families in which a child between age six months and five years falls in the upper 25 percent in height and weight measurements. In addition, the survey collected data on fertility because of findings concerning the close interrelatedness among a woman's nutritional state, her age when first giving birth, intervals between births, and the growth and development of her young children.
The Positive Deviance Approach Can Be Used to Create Culturally Appropriate Eating Guides Compatible with Reduced Cancer Risk
Anderson A, Campos R, Mayorga E, Medina-Monchez B, Solomons N, Soto-Me´ndez M, Vossenaar M. The Positive Deviance Approach Can Be Used to Create Culturally Appropriate Eating Guides Compatible with Reduced Cancer Risk. The Journal of Nutrition: 755-762. April 2009.
This paper examines whether the positive deviance approach could be appropriate for creating class-appropriate, healthy eating menu guides for consuming a diet to minimize cancer risk in Guatemala. The researchers transformed Food Frequency Questionnaires for 14 model individuals from each class into a diet guide for each group. They hypothesized that those individuals who manage to consume a healthful, risk-lowering diet in a situation of widespread unhealthful eating could provide insights into how appropriate consumption can be achieved.
NEW: Acceptability, feasibility, quality, effect, and sustainability of a “PD-Plus” approach for improving newborn, child, and maternal care in Quang Tri Province, Vietnam
Anh Vu N, Bich Ha P, Jones E, Khanh V, Marsh D, Thi Kiem T. December 2007“A positive deviance inquiry (PDI) is a formative research technique to study individuals who experience better outcomes than their neighbors with similar backgrounds. The insights from a PDI can inform behavior change strategies. Save the Children (SC) has extensive experience using PDIs to study poor Vietnamese families with well-nourished children.SC implemented a child survival project (2002-2007) in Huong Hoa and Dakrong Districts of Quang Tri Province. We supported the Ministry of Health to deliver maternal and newborn care and infant nutrition interventions, especially targeting Pakoh and Van Kieu minority populations. We strengthened facility-based and outreach services and delivered behavior change communication, primarily in a series of 12 monthly meetings, each promoting different messages. We modified the formative PDI: (1) to apply it throughout the project instead of only at baseline and (2) to inquire about behavioral outcomes instead of health status outcomes. SC trained community health workers (Guides) to facilitate the meetings, including conducting a “new topic PDI” to study if, why, and how attendees might already be practicing a good behaviors introduced at the current meeting and a “booster PDI” to study if, why and how they might have adopted behaviors discussed at previous meetings.We wanted to know about the effects, acceptability, feasibility, quality, and sustainability of Community Meetings with this modified PDI.”
Public Health
NEW: Positive deviance control-case life history: a method to develop grounded hypotheses about succesful long-term avoidance of infection
Des Jarlais D, Friedman S, Hagan H, Mateu-Gelabert P, Sandoval M. Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health 2008, 8:94This paper examines the use of a positive deviance control-case life history method to develop grounded hypotheses about successful long-term avoidance of infection among long-term injection drug users. The researchers’ methodology studies how some IDUs remain uninfected over many years of injection drug use. Thus, their emphasis is in terms of long-term trajectories in strategies, conditions, practices, and events that shape sustained, long-term safer behavior and/or long-term safer networks.
Identifying Positive Deviant Behaviors in Indian Mothers
This paper studies the maternal child-rearing behaviors, parental attributes, and socio-economic status of the family, and analyzes their association with positive deviance in the developmental status of preschool children between 1-5 years of age in Andhra Pradesh, India.
Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health Disparities
Dearden K, Hoke M, Sterling B, Walker L. Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health Disparities. Public Health Nursing 24 (6): 571–576. 2007.This paper presents a protocol for extending the concept of positive deviance (PD) to analysis of existing public health data. Using the PD perspective to analyze existing datasets is explored as a possible way to reduce health disparities.
Healthcare
Research in Action: Using Positive Deviance to Improve Quality of Health Care
Bradley E, Curry L, Krumholz H, Nembhard I, Ramanadhan S, Rowe L. Research in action: using positive deviance to improve quality of health care. Implementation Science 2009, 4:25.
This paper synthesizes existing literature on positive deviance, describes major alternative approaches, proposes benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describes an application of this approach in improving hospital care for patients with acute myocardial infarction.
NEW:Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance
Marra A., Reis Guastelli L., Manuela Pereira de Arau´ jo C., et.al. Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance. Infection Control and Hospital Epidimiology 31(1): 12-20, January 2010.This article focuses on the evaluation of the effectiveness of the positive deviance approach to improve hand hygiene and reduce hospital acquired infections (HAI’s) at the Hospital Israelita Albert Einstein in Sao Paulo, Brazil. The article details how a 9 month controlled trial using positive deviance yielded a significant improvement in hand hygiene which was linked to a decrease in the occurrence of HAI’s.
Other
Beyond Sweatshops: Positive Deviancy and Global Labor Practices
Arnold D, Hartman L. Beyond Sweatshops: Positive Deviancy and Global Labor Practices.In this paper, the authors apply the concept of Positive Deviance to global labor practices. They use empirical field studies of MNC factories in developing nations as a basis for arguing that multinational corporations (MNCs) are capable of voluntarily respecting the basic rights of workers while remaining economically competitive. The labor practices of “positive MNC deviants” can serve as models for other MNCs that wish to respect human rights while taking advantage of the economic benefits of a global workforce.
NEW: Learning from the positive to reduce rural poverty: Institutional innovations in agricultural and natural resources research and development
Biggs, Stephen. Learning from the positive to reduce rural poverty: institutional innovations in agricultural and natural resources research and development. February 2006.This paper argues that opportunities for reducing poverty, improving social inclusion, and influencing policy and institutional changes are being missed as a result of not learning sufficiently from development practitioners who have been effective in bringing about positive changes in the past. Cautionary tales, positive deviance, innovations systems and aid ethnographic literature are reviewed. Three agricultural and natural-resources case studies of positive experiences are described: (1) the spread of bamboo tubewells in eastern Bihar; (2) changes in rice research policy and institutions in Nepal; and (3) the spread of groups and group-based organisations and federations in Nepal. Implications for innovations theory and rural development are discussed. A key finding is that effective innovation in the policy and institutional arenas is generally location and time specific. This has significant implications for rural development policies and practices; especially those concerning the scaling up of technology and institutional models.NEW: Development through Positive Deviance and its Implications for Economic Policy Making and Public Administration in Africa: The Case of Kenyan Agricultural Development, 1930–2005
Cosmas Milton Obote Ochieng. World Development Vol. 35, No. 3, pp. 454–479, 2007.“Positive internal innovation has long been a central element of African agriculturaldevelopment, even if modern efforts to stimulate technical, institutional, and policy innovations in African agriculture have tended to look outwards. This paper examines the role of positive deviance in Kenyan agriculture over the last 75 years to cast doubt on the alleged authoritative sources of policy advice and mandates from the outside. Positive deviance and appreciative inquiry are suggested as organizing frameworks for identifying and amplifying the generation and uptake of internal African innovations.” 2006 Elsevier Ltd.
PD Approach
Understanding the Impact of Positive Deviance in Work Organizations: Positive deviance may help scholars understand and promote positive behaviors in the workplace
This paper presents a protocol for extending the concept of positive deviance (PD) to analysis of existing public health data. Using the PD perspective to analyze existing datasets is explored as a possible way to reduce health disparities.
NEW: The positive deviance approach: Challenges and opportunities for the future
Food and Nutrition Bulletin 23(4):128-135, 2002
In this Food and Nutrition Bulletin issue, the PD approach is summarized and examples are given of how the approach can be applied to issues such as malnutrition, HIV/AIDS, and food security. The abstract of the issue informs readers that, “Program-learners should consider identifying and explicitly attempting to modify the determinants of critical behavior(s), even if the desired outcome is a change in health status that depends on multiple behaviors; measure and maintain program quality, especially at scale; and creatively expand and test additional roles for PD within a given program.”
NEW: The Positive Deviance Approach – A Briefing
Devane, Tom. The Positive Deviance Approach – A Briefing. April 2009.
The primary intent of this briefing is to provide an overview of the Positive Deviance (PD) approach to those interested in initiating wide-reaching, important improvements in organizations and communities. Often leaders and change agents considering a major change are looking for a concise, single source for basic details of a particular approach so they can evaluate how it might help them achieve their objectives. This briefing is intended to be just such a document, and should be considered a starting resource for conversations about PD use in local situations.
Marsh DR, Pachon H, Schroeder DG, Ha TT, Dearden K, Lang TT, Hien ND, Tuan DA, Thach TD and Claussenius D. Supplement: The Postive Deviance Approach to Improve Health Outcomes: Experience and Evidence from the Field. Food and Nutrition Bulletin. 23(4): 2002.
Saco, Roberto. Good Companies: organizations discovering the good in themselves by using Positive Deviance as a chance management strategy. December 2005.
Walzer J. It takes a village. Tufts Nutrition Magazine, Fall 2002:19-21.
Vulnerable Populations
NEW: Gender Equitable Boys in a Gender Inequitable World
This article offers insights from a qualitative study with a group of more “gender equitable” heterosexual young men in low income setting in Rio de Janeiro, Brazil. It also considers the implications of this research for working with boys to promote gender equity, including increased attention to sexual and reproductive health.
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Research Spotlight
Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance
This paper, published in Infection Control and Hospital Epidimiology (January 2010) reviews a 9 month controlled trial comparing the effect of positive deviance on compliance with hand hygiene. The study found flaws in the study design but concluded that, "the positive deviance approach for improving hand hygiene compliance deserved further evaluation," and that, "positive deviance resulted in a significant improvement in hand hygiene, which was associated with a decrease in the incidence of hospital acquired infections."